This combination is used to treat different skin conditions, including acne, actinic keratosis or pre-cancerous lesions, Basal Cell Carcinoma and to augment the uses of IPL for sun-damaged and rosacea complexions and acne scars. The combination of Levulan allows the light sources to penetrate more deeply and hastens the results seen with IPL alone. Treatments are scheduled one month apart. What is Intense Pulsed Light? Intense Pulsed Light (IPL) also known as photo-facial is a state-of-the art system which delivers high intensity, smooth and powerful pulses of light. It targets pigment cells, capillaries and oil glands. New evidence proves that it stimulates new collagen, creating smoother, firmer skin and smaller pore size. Long-term studies support its safety and effectiveness. IPL is delivered by a highly sophisticated computer which regulates the light pulse in specific wavelengths, in turn heating portions of the skin. The light is pulsed or flashed on to the skin by a crystal that is held close to the skin. The light is absorbed by hemoglobin (red blood cells), or melanin (pigment cells) heating, damaging them and causing them to be eliminated or absorbed. New pro-collagen protein is produced eventual resulting in the laying down of new, healthy collagen. Who is a good candidate for PDT? Levulan together with IPL or blue light (PDT) is an excellent choice for men and women of all ages considering treatment for various skin problems including: Brown or age sports Facial Spider Veins, Rosacea Acne and Acne Scars Actinic Keratosis Basal Cell Carcinoma If you are prone to keloid scars, increased skin pigmentation, or are darkly tanned, it is best not to proceed with PDT. Types 1-4 (fair Caucasian to Mediterranean) skin types can be successfully and safely treated with PDT. Lower settings are used for skin of Mediterranean origin. Black skin may be treated with IPL alone, but the combination PDT is not suggested. What can I expect during treatment? You will arrive at the office at the allotted time and one of our nurses, Diane or Nan or our technician Lucie will cleanse the skin and apply a thin layer of Levulan. You will wait in office for 1-1.5 hours as the Levulan is absorbed into the skin. If the IPL light source is used, metal shield goggles are applied over the eyes, and a thick layer of cold gel applied to the skin. The IPL crystal (glass prism) will be held above the skin over small area and the intense light will be flashed onto the skin. A popping sound, light flashing and a quick sensation of discomfort lasting milliseconds will be experienced. This discomfort quickly abates. The procedure continues until the entire area is treated. You leave the office with a slight increased redness and after heading home, stay indoors for 24 hours. If Blu-Light is used, after the incubation of Levulan, goggles are worn and you are placed under the light source for a variable length of time depending on skin type. A typical session would last 15 minutes. During this time, you will experience a very warm sensation. Again, you must stay out of day light exposure for 24 hours. What can I expect after treatment? The immediate results are variable depending on skin type and energies of light used. The average patient develops a slightly pink, sunburned like reaction which lasts 2-3 days. Some will develop swelling, and crusting, and rarely blisters. It is best to plan 2-3 days out of important activities. For patients being treated with Blue-Light for Actinic Keratosis, it is generally best to plan 1 week off. If small areas of crusting develop, it may require a week of healing. If swelling occurs after treatment cold compresses or ice packs in first 24 hours may be applied. Gentle cleansers are used after treatment (Cetaphil, Toleriane, dove for sensitive skin followed by careful sun-protection (Roche-Posay SPF-45, Ombrelle 45). Should blisters develop these can be treated with Polysporin, Fucidin or Bactroban. Do not pick or scratch. Gentle moisturizers such as Cetaphil, Toleraine will be applied to keep adequate hydration. Within one treatment, there is noticeable improvement in redness, browns and actinic keratosis. In the acne and acne scarred patients, one treatment alone will produce only mild improvement. How experienced is the staff? We have used this technology since its inception in Canada over the past 3 years. Our nurses Nan and Diane are fully trained and experienced over this time. Lucie, our technician has 7 years experience with IPL, having practiced in the US before returning to Canada. She uses IPL, Nd Yag and Laser Hair Removal 5 days per week and has treated thousands of patients. Our staff members are intelligent, cautious, meticulous individuals. Thanks to the team involved and our careful professional approach, we continue to deliver safe and efficacious treatment. How many treatments will I need? This again depends on the presenting problem. Those patients with rosacea and brown spots or multiple actinic keratoses will generally be completed in 3 treatments. Sometimes additional IPL treatments without the Levulan may be added. Patients with acne or acne scarring will receive 3 treatments of PDT (photodynamic therapy) followed by monthly IPL sessions. Will I require long-term or follow-up treatment? Rosacea is a chronic problem, and it is expected that new broken capillaries will develop in time. The overall presenting problem tends to recur to a minor extent over time and that some (not all) patients find they need 1-2 IPL sessions in the next year. Brown age spots: If the patient is carefully compliant with sun protection, the pigmentation tends not to recur. If however, the patient is active outdoors with no sunscreens or clothing coverage, it is quite likely that new pigmentation will develop Actinic Keratosis: PDT does an excellent job at clearing the majority of pre-cancerous lesions. New AKs can and do develop, but they are much easier to control with periodic follow-ups and treatment with Liquid Nitrogen or Imiquimod. Acne Scars: Once scars are corrected, it is very unlikely that they will recur. What are the costs involved? The costs of Levulan are straight costs from the manufacturer at $150.00. This medicine has D.I.N. #02243933 and many have successfully submitted this claim to their insurance companies. The cost of Blue-Light is $150 per session. The cost of IPL is $350 per session. $200 for acne or acne scarring Questions? If you have further questions, do not hesitate to call our office 905-304-1013 and direct these to our receptionist Lataunya, or nurse Diane, or book to speak with Dr. Wismer in follow-up or consultation. We believe that the most satisfied patients are those that have clearly understood this technology. Above: Levulan and Blue light for Actinic Keratosis (precancerous lesion)