Long pulse Nd:YAG laser for treatment of leg veins in 40 patients with assessments at 6 and 12 months

The evaluation of long-pulsed Nd:YAG laser efficacy and side effects in the treatment of cutaneous vessels on the face and legs

BACKGROUND

Long-pulsed Nd:YAG lasers have been used for the treatment of cutaneous vascular lesions on face and leg veins.

OBJECTIVE

To report our experience with long-pulsed Nd:YAG lasers for the treatment cutaneous vessels on the face and legs.

MATERIALS AND METHODS

A total of 145 patients with cutaneous vessels on the face and the legs were included in this study. All patients received two treatment sessions, first at the beginning and second after four weeks. Patients were evaluated three times: first at the beginning of the therapy, and second and third after the four weekly follow-ups. The laser settings of each treatment session were recorded. The physician's assessment of treatment efficiency was taken by comparing gross photograph and clinical evaluation. The grade of improvement, as the percent of reduction in the severity of veins after laser treatment, was determined as follows: <25% improvement (mild); 25%-50% improvement (moderate); 51%-75% improvement (good); and >75% improvement (excellent). The side effects were also recorded.

RESULTS

Of the 145 patients who completed the study, 63.6% of patients had vessels on the face, and 36.4% had them on the legs. After the first session, 82.8% of patients have good improvement (51%-75%). After the second session, 78.6% of patients have excellent improvement (>75%). The clinical improvement after the second treatment session was significantly higher than the first treatment session (P ˂ .05). There were no statistical differences between the treatment areas (P ˃ .05). The most common side effect was erythema in 12.4% (P ˃ .05).

CONCLUSION

The Nd:YAG laser is an effective and safe treatment option for the treatment of cutaneous vessels on the face and the legs.

Evaluation of a new diode laser for the treatment of lower extremity leg veins

INTRODUCTION

Visible leg veins are a common cosmetic concern treated mostly by 1064 nm Nd:YAG laser that has become the chosen laser therapy for treating all leg veins up to 3 mm in size. The objective of the current prospective study was to evaluate the safety and efficacy of a new 1064 nm diode laser for leg veins and spider veins on the lower extremities.

METHODS

A total of 15 female subjects seeking leg veins and spider veins treatment were recruited to this study. The treatment protocol included two treatment sessions 6 weeks apart and two follow-up visits at three and 6 months after the last diode laser treatment. Results were evaluated by photographs and an investigator classification of the treated vascular lesions appearance on five scores scale from 0 (normal) to 4 (severe).

RESULTS

Treatment area photos demonstrated improvement in vascular lesions appearance. Average vascular lesions classification was reduced by approximately one score from baseline score of 2.9 (score 3 is moderate) to an average score 2 (mild) at the 3-month follow-up visit. This improved classification sustained also at 6-month follow-up visit, indicating the long-term effect of the treatment impact. No significant or unexpected adverse events were detected in any of the patients as a result of the treatments.

CONCLUSIONS

This study has demonstrated that the new 1064 nm diode laser is safe and effective for the treatment of leg vascular lesions on the lower extremities.

Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology

AIM

Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions.

METHODS

These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines.

RESULTS

Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.

Laser therapy of vascular lesions

Since the first construction of a laser by Maiman in 1960 and the first clinical application of a laser in the therapy of skin lesions by Leon Goldman, laser therapy has become an important therapeutic modality in dermatology. Various lasers can be used for the treatment of different vascular and non-vascular lesions. According to our results, vascular lesions constitute the most important indication for laser therapy in dermatology.

Split-face comparison of radiofrequency versus long-pulse Nd-YAG treatment of facial laxity

BACKGROUND AND OBJECTIVE

To improve photoaging skin with laser treatment, multiple sessions have been considered necessary to achieve results comparable with one radiofrequency (RF) treatment. We compared single-treatment improvements obtained by the long-pulse 1064 nm Nd:YAG laser and RF device.

STUDY DESIGN/MATERIALS AND METHODS

In a split-face study, patients with sagging skin were treated once with laser (left side) and once with RF (right side) energy.

RESULTS

Improvement judged by six blinded observers was greater for wrinkles and laxity (30% median) on the laser-treated side and essentially the same with both modalities (15% median) for texture, pores, and pigmentation. Improvement was maintained for at least 2-6 months on both facial sides without adverse effects.

CONCLUSION

With a single treatment, both the long-pulse 1064 nm Nd:YAG laser and ThermaCool RF device provide a modest degree of improvement in both wrinkles and laxity of facial skin and similar improvement in texture, pores, and pigmentation.

Quantitative Analysis of Sclerotherapy Results by Using Digital Photography and a Computer Program

BACKGROUND

Despite different telangiectasia treatments in the lower limbs, there is no method standardization for results assessment, making comparison between the existing treatments conflicting.

OBJECTIVE

To compare the assessment carried out by a group of specialists with the assessment carried out by a computer program, according to clearance degree of telangiectasias during treatment by sclerotherapy.

MATERIALS AND METHODS

Nineteen patients (21 studied areas) with telangiectasias of thighs and popliteal fossa were assessed, with a mean age of 37.5 (21-59) years old, all female. The pre- and posttreatment photos were standardized as per distance, light exposure, and aperture time. The sclerotherapy sessions were performed with 75% glucose. The clearance degree of telangiectasias was judged by a group of six doctors and by a computer program that analyzed the initial and final photos. The results of such assessment were compared according to concordance and correlation.

RESULTS

There was no statistical difference between the assessments carried out by the specialists and the assessments carried out by the computer program according to the sclerotherapy results.

CONCLUSION

The assessment carried out by the computer program was equivalent to the assessment carried out by the specialists in the judgment of clearance degree of telangiectasias of the lower limbs.

Optimal parameters for the treatment of leg veins using Nd:YAG lasers at 1064 nm

BACKGROUND

The treatment of large vessels such as leg veins is successfully performed in clinical practice using pulsed Nd:YAG lasers. However, it is still unclear how laser parameters such as wavelength, fluence and pulse duration influence vessel destruction in leg veins.

OBJECTIVES

To elucidate the governing parameters in selective photothermolysis of large vessels.

METHODS

A recently developed mathematical model for photothermolysis has been adapted for the treatment of leg veins. The model was used to analyse the effectiveness of the selective photothermolysis process in laser treatment of leg veins by Nd:YAG at 1064 nm. The efficiency of laser-induced vessel heating was defined as a ratio between the absorbed and delivered energy.

RESULTS

The efficiency improved with increasing vessel diameter, in agreement with clinical findings in various studies. The pulse duration made a minor contribution for laser fluences of 100-400 J cm(-2), whereas the efficiency was better for a small spot. The use of moderate fluences of 100-200 J cm(-2) reduced excess dermis heating and pain.

CONCLUSIONS

We provide reference parameters for optimal treatment of leg veins using Nd:YAG lasers at 1064 nm. Our model predicts a maximal efficiency of a range of fluences (100-200 J cm(-2)) and pulse durations (10-100 ms).

Laser treatment of leg veins

The development of lasers using deeper-penetrating, near-infrared wavelengths with millisecond pulse durations and skin-cooling methods has produced safer and more predictable results for the treatment of leg veins less than 1 mm in diameter and depth. Recent prospective studies of the near-infrared lasers show comparable efficacy and side effect profiles to those observed with sclerotherapy. Treatment of reticular and varicose veins is effective with these wavelengths but is limited by patient discomfort when compared with sclerotherapy. Visible light lasers (such as the pulsed dye and KTP) and intense pulsed-light sources are reproducibly effective only for superficial, nonarborizing pink-to-red telangiectasia, in the absence of points of proximal reflux. Because most lower-extremity vascular ectasias comprise a heterogeneous group of vessel sizes and depths, many patients achieve the best results using a combination of techniques. This article reviews the fundamentals of laser tissue interactions for the treatment of leg veins and details the recent clinical experience with the newer near-infrared devices.

A Side-by-Side Prospective Study of Intense Pulsed Light and Nd:YAG Laser Treatment for Vascular Lesions

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins <1 mm were more satisfied after IPL, while those with leg veins >1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.

Treatment effects of combined radio-frequency current and a 900 nm diode laser on leg blood vessels

BACKGROUND AND OBJECTIVES

Effective laser treatment of leg veins remains a major challenge. The present study examined the safety and efficacy of a new technology for leg vein treatment combining 900 nm diode laser with radiofrequency (RF) current.

STUDY DESIGN/MATERIALS AND METHODS

Forty patients, skin types II-IV, received a maximum of three treatments on 1-4 mm leg veins at 2-week intervals with a 900 nm diode laser (250 millisecond exposure time, average fluence 60 J/cm2) and RF (energy 100 J/cm3). Results were assessed after each treatment and at 2 and 6 months after the final session. Patients rated their satisfaction with the clinical outcome on a five-item scale. Clinician and computer analysis of the clinical photography was also performed, in addition to histological assessment.

RESULTS

One or two sessions were required in the majority of patients. Shortly after treatment, histology revealed contracted vessels with perivascular edema. Side effects were extremely rare. The clinician 2- and 6-month assessments showed that 70% and 82.5% of subjects, respectively, achieved over 50% clearance, with patient and computer assessments lower and slightly higher, respectively. Treatments showed greater efficacy on thicker vessels and in the darker skin types.

CONCLUSIONS

The success of the treatment, minimal side effects, and patient comfort suggest that this combination is an effective, safe technique for leg vein treatment. When compared to previous studies using diode laser alone, the very low fluence needed to achieve vessel clearance emphasizes the role of RF energy.