Rosacea Treatment with Laser and Intense Pulsed Light

What is a LASER and Intense Pulsed Light?  A laser is a medical device that uses a focused beam of light to target specific structures in the skin.  By definition a laser has a single wavelength of light.  The wavelength we use is a 1064nm NdYag laser – called the Cutera Xeo Cool Glide.  Why is this important?  The higher the number (up to about 1300nm), the longer the wavelength and the deeper the laser light penetrates in the skin.  Only a 1064nm laser effectively penetrates to the deeper layers of the skin where a number of the blood vessels lie.  In contrast, an Intense Pulsed Light device (which we also have in the office but we do not use for larger vein removal) contains many wavelengths of light between 560nm and 1200nm.  This type of device is generally less effective for larger veins, but can be effective for background redness.  Many things are marketed as a “laser”.  It is important to understand the above information to evaluate laser treatment options in an educated manner.

Laser Facial Vein Removal (Cutera Xeo 1064 NdYag laser)– For larger and more visible red and purple veins on the face. In laser vein removal, the laser light targets the pigment in the red blood cells that are in the blood that courses through the veins.  The interaction between the laser and the pigment in the blood generates energy, best described as heat.  This energy is transferred from the blood to the blood vessel wall.  By damaging the blood vessel wall, the blood vessel is no longer a good conduit for blood flow. Using this technology, laser vein treatments enable removal of unwanted facial veins, without needles or cautery, in a few treatments. (2-6 treatments spaced 6 weeks apart)

Laser Genesis (Cutera Xeo 1064 NdYag laser)– For background redness, acne and rosacea scarring and for those desiring improvement in fine lines, pore size and skin tone.  Laser Genesis is a no down time, painless procedure that can reduce visible facial vessels as well as diffuse redness, port-wine stains, acne scars, large pores, and fine lines and wrinkles around the mouth and eyes. It works by gently warming the upper dermis, stimulating the growth of new collagen and improving the appearance of your skin. The result is a healthy looking, vibrant appearance and decreased diffuse redness. (4-6 treatments spaced 2-6 weeks apart).

Intense Pulsed Light Fotofacial (Cutera Xeo Intense Pulsed Light)- .  For background redness and age spots or freckling.  Compared to the Laser Genesis procedure that we also offer, this procedure has more effect on brown discoloration of the skin – freckles and sunspots.  There are multiple wavelengths of light contained in the pulsed light. Some are more effectively absorbed by pigment-containing cells and others by small blood vessels.  By slowly eradicating cells that contain excess pigment, sealing shut small and unnecessary dilated blood vessels, and stimulation collagen growth, the skin achieves a smooth, even-toned, and healthier appearance.  (4-6 treatments spaced 4-6 weeks apart).

Photodynamic Therapy using Intense Pulsed Light (Cutera Xeo Intense Pulsed Light)- For those with active acneiform rosacea or phymatous change. This intensive therapy involves more downtime than any of the above procedures, but is much more effective than IPL alone.  Photodynamic therapy (PDT) is a light treatment that includes Levulan (Aminolevulinic acid), a photosensitizing compound. When applied, Levulan is preferentially absorbed by certain cells such as precancerous skin cells, oil glands, pores and other structures, making them more sensitive to light. Thus, when followed by intense pulsed light, we can treat conditions such as actinic keratoses, acne, rosacea, sebaceous gland hyperplasia and sun damaged skin.  (2-4 treatments spaced 2-4 weeks apart).

To ask your insurance if they will pay for these treatments, you will need the following diagnosis and treatment codes.  For the first three procedures …ICD9 - Rosacea 695.3, Telangectasia 448.1.  and CPT Destruction 17004 using a laser. The code for laser surgery is  CPT 54057.  For photodynamic therapy: 99213 modifier 25, 17004 or 96567, J7308 for Diagnosis of Rosacea 695.3.