PHOTODYNAMIC LED LIGHT THERAPY WITH OR WITHOUT ALA FOR ACNE

NATURE OF THE PROCEDURE

The laser emits a beam of light that seeks targeted tissues. The Smoothbeam laser alters the function and output of the sebaceous gland. Following treatment it will produce less oil and the need for Accutane or antibiotics may be reduced or eliminated. Without a food supply (the oil), the bacteria won’t want to populate the skin and there may be no need to take further and potentially dangerous oral medications. Instead, the Smoothbeam emits the longest wavelength for this purpose, and thus penetrates more deeply to the level of the sebaceous glands. This was the first FDA-approved laser specifically for acne. A reduction in lesion count may be seen immediately after the first treatment. During the initial studies, even six months after the completion of therapy, there was up to 100% decrease in lesion count in some patients. The Norseld Dual Yellow laser works differently - the wavelength at 578 nanometers specifically targets protoporphyrin IX. This is a chemical released by the bacteria that cause acne, and these bacteria are thus destroyed. In addition, this wavelength specifically reduces red skin color, and will make inflammatory lesions less obvious and less red.

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FEES

We recommend a series of four treatments one month apart.

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.

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SCHEDULING

Dr. Coverman or Allison must see all patients prior to the first treatment in order to discuss your eligibility, intended results, possible contraindications, and the concurrent use of other oral and topical medicines. There is a fee for this visit. Dr. Coverman or Allison will examine you and discuss your care, review prior and current medications, and outline a treatment program in addition to the laser if indicated.

If you are an existing patient and have seen Dr. Coverman, Allison or our aestheticians for acne, please let our receptionist know. In some cases, you may immediately schedule your first treatment with Tammy or Christi. Once laser sessions have been instituted, we suggest that you schedule your sessions in advance with either of our aestheticians such that follow-up appointments will be easy to get. You don’t necessarily need to see Dr. Coverman or Allison during your sessions. If you would like to discuss your regular ongoing acne care however, please schedule an appointment in addition to your laser sessions. There will be a fee for the visit with Dr. Coverman or Allison.

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.

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PRETREATMENT

None usually necessary - for three days prior to the procedure, do not use any topical acne medication. It is best to come in without make-up, but you can remove your make-up here if you need to and you can reapply it right after the procedure.

We prefer that you not suntan for a month prior to your treatment. There is virtually no downtime, and you may go right back to your work or your normal activities.

Do not take any oral antibiotics, antifungals, or NSAID’s (Naprosyn, Advil, Aleve) the day before and on your treatment day. If you need to be on these - tell us and we may reschedule.

Dr. Coverman recommends that you purchase a numbing cream. He recommends some specific brands that he feels works best. It is your responsibility to ask for and order these PRIOR to any scheduled appointment. Apply this liberally one hour before your treatment. This will blunt some of the discomfort. You will still feel some pain.

The numbing cream, although highly effective, and generally safe topically, can be absorbed by the body. If applied for too long in too broad of an area or on inflamed skin, too much of this could be absorbed with short term toxic results. It is not dangerous if used intermittently long term just prior to these treatments. Never occlude an area any larger than the total of two palm prints. Anything larger than this just put it on without any plastic or saran wrap occlusion. If we are treating broad areas such as the back or both legs, don’t use it at all. If it is from the hips to the knees, or the knees to the ankles, you may use it on these areas but not full legs at any one time. If there are any questions, ALWAYS ASK US FIRST!

SAVE the numbing cream! It can be used again for this treatment, other treatments like it, or for waxing, hair removal, even insect stings and sunburns. You will always find a use for this cream. Never put it on a fresh burn, infected skin, inflamed skin, or ANY weeping, open, or oozing skin. Never apply to any undiagnosed rash. For any questions, always ask our staff.

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.

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TREATMENT DAY

You will wear protective goggles, and then the procedure will immediately begin. You will feel a series of quick, pinprick or needle prick type of sensations that are uncomfortable but tolerable. Dr. Coverman has had this done himself without the numbing cream. Almost immediately after the procedure, this sensation should disappear quickly. No other pain medicine should be necessary. Women may apply make-up immediately and go right back to work or school.

Dr. Coverman’s licensed aestheticians, Tammy or Christi, will perform the procedure. They have the same training on this laser that Dr. Coverman has, and they have been additionally trained by Dr. Coverman on all lasers that they use in his practice.

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POST TREATMENT

Do not apply any topical acne, anti-aging, or other medicines for three days after your laser treatment. Use common sense! You may be a little red or inflamed, and some of these acne medicines can irritate you further. You may resume your oral medication (if any) immediately after the treatment. You may apply your make-up and go right back to work. Do not sunburn for the next week and avoid excess sun exposure for the next month.

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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.

SIDE EFFECTS

The laser procedure produces a brief burst of cooling spray both before and after each laser impulse. Because the cooling spray itself could be inflammatory, and likewise the laser, complications could include temporary reddening or small blistering of the treated areas. This is rare. This should fade by the end of the day, and should easily be covered by make-up. It is generally not bright red, nor objectionable. Very rarely, there could be increased pigment (hyperpigmentation) in the treated areas. This would be more likely in darkly pigmented people or heavily tanned people. In the initial studies, all patients that had this complication had complete fading over a reasonable period of time. Bleaches can be used. Sunscreen protection after the treatment is always recommended.

Other side effects could be darkening or lightening of the treated skin. Hair growth could be diminished. The above are usually completely reversible; RARELY they could be permanent.

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FOLLOW-UP

Dr. Coverman or Allison may recommend that you continue some type of traditional acne therapy in addition to the laser, although hopefully the frequency, intensity and duration can be decreased. This is not an end to your other acne therapies or treatments, just another method to help reduce its severity. On subsequent visits, Dr. Coverman or Allison will discuss how we may modify your acne treatments.

After three days, resume your prior acne treatments unless Dr. Coverman or Allison has specifically instructed not to or otherwise modified your regimen. Dr. Coverman or Allison would like to see you on a regular scheduled office visit one month after your first treatment (just before the beginning of your second treatment) to adjust your acne therapy if appropriate. There will be a normal fee for this visit.

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