LASERS FOR VASCULAR LESIONS

NATURE OF THE PROCEDURE

All vascular lasers work by emitting a very specific wavelength of light that is absorbed by anything red. In this case it will be the oxyhemoglobin in red blood cells. The theory is that the overlying skin is spared since it is not red, but the target chromophore is this red pigment within blood vessels. By destroying this, the blood vessel as well will heat up and be destroyed, and then the body’s scavenger cells (macrophages) will come in and digest and remove these tissues. Of course, nothing is perfect and there can and will be variability in the nature of this "clearing" once the target damage has been accomplished. The theory is that we selectively destroy the blood vessels under the skin while sparing overlying skin and other structures such as the melanocytes that give pigment and skin color.

Anything red can be treated - facial veins, leg veins, port wine stains and even acne. In fact, because there is blood at deeper levels of the dermis, this same laser can even be used to treat wrinkles in a different mode.

If you are going elsewhere for "laser" - make sure it’s a laser! Epilight, Photofacial, IPL, and LED’s are NOT LASERS!

FEES PER TREATMENT

Dr. Coverman or Jennifer Jordan, PA-C will discuss fees with you prior to your session. Fees are based on several things including one or all of the following: size of the area to be treated, technical difficulty in treating that area (as an example treating near the eye where special eye cups will need to be inserted); thickness of the lesion; other underlying medical conditions; length of time needed to actually do the treatment; and the laser being used. Dr. Coverman uses three different lasers to treat vascular lesions - each of these lasers works differently, has a different size headpiece, and may have different expenses associated with its use.

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

SCHEDULING

For most cases, Dr. Coverman or Jennifer Jordan, PA-C prefer to see all patients first to assess the nature of the lesion and what might be the best treatment. Sometimes excision, electrocautery, or other methods of ablation might be appropriate. Also FotoFacial may be helpful. There is a fee for this visit.

For most uncomplicated small "spider veins," you may immediately see Tammy or Christi. They have attended the same laser courses that Dr. Coverman has for the lasers that they use. They have been additionally trained by Dr. Coverman in laser physics, laser safety, and the structure and function of the skin.

If you will be scheduling with Dr. Coverman or Jennifer, please ask our staff to set up your appointment. If you will be seeing Tammy or Christi, please call our main appointment desk and tell them that you have already had the consultation with Dr. Coverman and you are ready to schedule. If you are an existing patient of Tammy or Christi’s, and they have already discussed this treatment with you, you may likewise schedule directly with them at any time.

Because there will be visible inflammation, plan your work, school, social and travel around this. Do not plan vacation with excess sun exposure such as the beach or snow skiing for at least two weeks afterwards!

There is a $150 non-refundable fee for missed appointments without a 24 hour notice. If you need to cancel, please record the date, time, and name of the person you spoke with.

PRETREATMENT

Our usual numbing creams cannot be used with this laser because they may overly blanch the red color that the laser needs to "see." You may use LMX. Please ask for this before your procedure date.

If you have ever had herpes or think you may have (cold sores or fever blisters), inform Dr. Coverman or our staff prior to scheduling your appointment. We will give you a series of anti-herpes pills to take the day before the treatment, the day of, and the day after. This should help or suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

TREATMENT DAY

Please do not wear make-up prior to your treatment session - it will have to be removed anyway. You may bring it with you, and reapply it immediately (in most cases) after we are finished. You may go right back to work, school, or your normal daily activities. Do not get excess sun or sunburn!

POST TREATMENT

If we treat small spots there will be a pinpoint scab for about 7-10 days, just barely larger than the lesion we treated itself. If you have small blood vessels running across your skin you will have something similar to "cat scratch marks" where the laser treated you. Adjust your school, work, travel and social calendar accordingly. Please keep this area moist at all times with an antibiotic OINTMENT (not cream) for at least one week afterwards. Keep this moist at all times - do not let a dry scab form. Do not sunburn.

POST-TREATMENT PAIN

For normal post-operative pain following most of the procedures that we perform in our office, we do not recommend nor prescribe any of the stronger pain medicines including hydrocodone (Lortab; Darvocet N100; Mepergan Fortis; Ultram). We feel that a combination described below of over-the-counter medicines will be enough. This is what we recommend:

Take one Aleve or Advil pill every 4-6 hours with food. Wash it down well with liquid. Breakfast, lunch, dinner and bedtime snack.
Do not take Aleve or Advil if you are allergic to aspirin, ibuprofen, naproxin, these pills, or have any type of aspirin sensitivity or the syndrome of nasal polyps, allergies, atopic eczema, and aspirin-allergy. Likewise, do not take this if you have any bleeding problems, or have ever had any ulcer disease or similar stomach disease.
We also recommend that you take two Extra Strength (500 mg) Tylenol tablets every 4-6 hours as well at the same time.
Please remember that the side effects of Tylenol have nothing to do with the side effects of Aleve or Advil, thus these may be taken together.

If you have any liver disease or potential liver problems, do not take the Tylenol. Do not take Tylenol if you are allergic to it or acetaminophen. DO NOT DRINK ALCOHOL WITH THIS REGIMEN! Otherwise, follow the schedule below:

8:00 a.m. - Breakfast
One Aleve or Advil with breakfast and plenty of water.
Two 500 mg Tylenol for adults.
Noon to 2:00 p.m. - Lunch
One Aleve or Advil with lunch and plenty of water.
Two more 500 mg Tylenol.
6:00 p.m. - Dinner
One Aleve or Advil with dinner and plenty of water.
Two more Tylenol.
10:00 p.m. to midnight - Bedtime
One Aleve or Advil at bedtime and plenty of water.
Two more Tylenol.
Benadryl (diphenhydramine) 25-50 mg for sleep.

The Benadryl is a great idea. It is the main component of most over-the-counter sleeping pills. (Tylenol PM), and is not addicting. Never drink alcohol before or with this, and plan on going right to sleep and sleeping 8 hours. DO NOT take with any other sleeping pill, anti-depressant, MAO inhibitor, or anti-anxiety drug (Xanax, Valium, etc.). Do not drive or operate dangerous equipment.

Thus, in any given day you should never take more than the total of four Advil or Aleve or eight Tylenol total (two every four to six hours).

Normally you should be able to safely do this for one to three days - but never more. If the pain ever worsens or this fails to control it - call our office during normal office hours or the medical exchange (458-1121) after hours.

This combination of Aleve or Advil plus Tylenol is safe, covers you around the clock, and allows you to take two different pain medicines whose side effects don’t cross react with each other assuming you are not allergic to either.

COMPLICATIONS

There will be "cat scratch marks" or small scabs at the treated areas. With the yellow pulsed dye laser these will look like a series of purple dots the size of a pencil eraser or up to the size of a dime. Either of these should fade in 7-14 days. No guarantee can be made as to the complete erasure of any given area per lesion, per session or overall. Additional full fees will be charged for each additional treatment session. There can be scarring or unwanted pigment gain or loss in treated areas. Underlying herpes whether known or not could flare, even with oral anti-herpes drug treatment. This could leave to pigment or scarring.

There could be hair loss in the treated areas. There could be whitening or loss of pigment in and around the treated areas. This could be permanent. Some areas could get darker.

FOLLOW-UP

Usually none is necessary

You may go back to work after your treatment, but use common sense! Physical labor, gym workouts, gardening, etc. are prohibited! Use common sense! Avoid excess sun or sunburn!

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