Vbeam Laser 101

Formulate user Shelly wrote in with several questions about the Vbeam pulsed dye laser. Here's what she had to say:

I'm a lurker on several different skin care Subreddits, and I've read a lot of really interesting things about Vbeam. Obviously you can't trust everything you read on Reddit, so I wanted to fact check some things with someone who might know more!

How is it possible that Vbeam is effective for diverse conditions such as birthmarks, bruises, scars, warts, sun damage, and wrinkles? They are all so different, so this is surprising to me.
I'm most interested in using it for scars on my face. Is that something that most dermatologists recommend using it for?
How much does it cost, and how do you go about finding a qualified provider?
Is bruising as common as some people say it is online? I feel like I've read a lot of horror stories, and I have a people-facing job so that could get rather awkward. Even if there are no bruises involved, how much downtime do most people end up needing? And is there any risk of it burning my face?
I read that you can't have undergo Vbeam if you are currently taking Accutane or have any cold sores. Why is this? I was considering going back on Accutane and would like to know how this would affect my ability to potentially get this treatment.
Does it hurt?

Thanks so much for your thoughtful questions, Shelly!

Before we get started, here's some background information on what Vbeam is: Vbeam, also known as Vbeam Perfecta, is a medical laser device that targets specific blood vessels and vascular structures in the skin. It works by emitting a burst of light that is absorbed only by certain blood vessels areas in the skin. The blood vessels are heated, which causes them to be reabsorbed by the body over time. Vbeam is an in-office treatment, and can only be administered by trained medical professionals.

To answer Shelly's questions, we consulted with Dr. Michele Green, a board-certified dermatologist in New York City. A graduate of Yale University with an MD from Mount Sinai Medical School in NYC, Dr. Green is an expert in minimally invasive cosmetic procedures. We hope you enjoy our conversation below!

How does Vbeam work? What is the method of action?

Dr. Green: Vbeam is a pulsed dye laser (PDL). In general, lasers work by emitting high-intensity bursts of light. Depending on the wavelength of the light, pulse width, and energy used, lasers can treat various skin conditions. A dye laser is a laser that uses a dye mixed in a solvent as the lasing medium.

Vbeam works via selective photothermolysis. The chromophores in the skin absorb the laser's energy. In a pulsed dye laser like Vbeam, the main target is the hemoglobin in blood or blood vessels. Therefore, the laser uses a frequency that the blood vessels can absorb, but the skin cannot.

How is it possible that Vbeam is effective for diverse conditions such as birthmarks, bruises, warts, sun damage, and wrinkles? They all seem like very different concerns.

Dr. Green: Vbeam is the gold standard laser for treating vascular lesions and anything red in color. Therefore, Vbeam can treat vascular birthmarks and dark red birthmarks like hemangiomas and port wine stains. In fact, Vbeam is safe enough to treat port wine stains on infants.

Bruising occurs when there is damage to the small blood vessels near the skin's surface, and the blood leaks out of the vessels. Vbeam is very effective at eliminating early bruising and is a common treatment done after cosmetic injections like Botox and dermal fillers.

Vbeam can target melanin, which allows it to treat pigmentation issues like freckles, sunspots, and solar lentigos. However, the wavelength it uses for pigmentation does not penetrate deeply, so it is best for superficial skin pigmentation. Other lasers like Fraxel and AlexTrivantage, along with chemical peels, may be more appropriate for effectively removing certain dark spots.

Vbeam is also an option to treat warts because it targets the blood vessels that provide the wart with oxygen and nutrients, depriving the wart of essential survival resources.

Vbeam can improve wrinkles and fine lines because it stimulates collagen synthesis.

However, dynamic wrinkles and deeper lines may require neuromodulators or dermal fillers for the best cosmetic results.

How much does it generally cost to get a Vbeam laser treatment?

Dr. Green: The cost of Vbeam laser treatment starts at around $800 per treatment, increasing in price based on the size of the area.

Why is it priced this way?

Dr. Green: The cost of any cosmetic treatments also depends on other factors, such as the expertise and licensure of the provider (nurse vs. board-certified dermatologist) and geographical location (e.g. New York vs. Florida). It is best to call the individual office to ask for specific pricing on Vbeam laser treatments.

Is Vbeam ever covered by insurance?

Dr. Green: Vbeam treatments are not covered by insurance, as it is considered cosmetic and not medically necessary.

How can you locate an experienced provider who can provide Vbeam?

Dr. Green: A quick Google search will provide a list of physicians in your local area who provide Vbeam laser treatments. Candela Medical, the company that makes Vbeam laser, has a section on the website where you can find a Vbeam treatment provider near your location.

The best way to find an experienced Vbeam provider is to call the individual office and inquire who will administer the laser treatment, the licensure, and expertise of the provider, and how long the Vbeam laser has been used in the office for the skin condition you are looking to improve.

Is Vbeam something you would recommend for facial scars?

Dr. Green: Vbeam is commonly used for early post-surgical scars anywhere on the body, including the face. Vbeam is also commonly used to treat red acne scars and new stretch marks. The Vbeam laser energy targets the blood vessels within the scar tissue to reveal smoother-looking skin that is less noticeable. Vbeam will not improve old facial scars, acne scars that are not red in color, or white stretch marks.

How much downtime should you anticipate after getting this treatment?

Dr. Green: Vbeam has minimal downtime, making it a perfect "lunchtime" laser treatment for busy people. The treated area may be swollen and red for about two days after the procedure. Patients with sensitive skin are more prone to a histamine reaction after Vbeam, causing inflammation. We recommend that these patients take an antihistamine like Zyrtec or Claritin before the Vbeam treatment.

What does aftercare look like?

Dr. Green: Avoiding direct sun exposure for at least three months after the last Vbeam treatment is extremely important because the laser treatment makes the skin more sensitive to sun damage. Apply sunscreen with SPF 30 or higher and wear sun-protective clothing like a wide-brimmed hat. The sunscreen should be labeled as "broad-spectrum," which protects against both UVA and UVB rays. SPF should also be reapplied every two hours and after sweating/getting out of the water.

For one week after Vbeam laser treatment, use gentle, non-irritating, and non-comedogenic skincare products. Avoid exfoliants, retinoids, acids, toners, and hydroquinone for one week after Vbeam. Lastly, avoid excessive heat for two days after the Vbeam treatment, like a hot tub, sauna, and heavy exercise.

How frequently does bruising happen after Vbeam?

Dr. Green: Bruising after Vbeam is not common, but it is possible. Some vascular lesions need a lot of energy to treat, like scars and keloids. Using higher energy means there is a higher chance of bruising. However, most Vbeam treatments have no downtime and no bruising. Furthermore, bruising does not mean that the treatment will be more effective.

Since it's a laser, could it burn or otherwise damage your skin?

Dr. Green: There is a risk of a burn with Vbeam, although it is very rare as Vbeam is a non-ablative laser. A burn can occur if the settings are not correctly selected or if an inexperienced provider administers the Vbeam laser treatment. This is why it is important to do the appropriate research and carefully select a board-certified dermatologist for Vbeam treatments.

The risk of burns increases if you are tan or have self-tanner. Therefore, avoiding sun exposure for one month before Vbeam treatments is important. You should not apply self-tanner before the Vbeam treatment as well.

Why can you not have Vbeam if you've been on Accutane or have cold sores?

Dr. Green: Lasers should not be performed while taking Accutane or oral isotretinoin because the medication makes the skin more sensitive and affects the skin's ability to heal. This is especially the case for ablative lasers like CO2. It is recommended to wait about six months after finishing Accutane to start laser treatments for acne scars.

Vbeam treatments can trigger cold sores in those with a history of herpes simplex virus previously. A history of cold sores is not a contraindication for Vbeam. Those with a history of cold sores are pretreated with Valtrex or valacyclovir as a preventative measure before Vbeam.

Does Vbeam hurt?

Dr. Green: VBeam treatments are commonly described as similar to rubber bands snapping on the skin. The VBeam device has a built-in cooling system released with each pulse, making the laser procedure tolerable. Patients with sensitive skin can apply a topical anesthetic one hour before the laser treatment to minimize discomfort. It is recommended for those undergoing Vbeam for scars and vascular lesions like spider veins to apply the numbing cream before the laser treatment. However, most patients do not need any local anesthetic for Vbeam.

Many thanks to Dr. Green for her time and thoughtful answers. As always, we appreciate her expertise!