TREATMENT GUIDE | treatment guide
Vascular and pigmented lesions
Joe Niamtu reviews the laser treatment options available for vascular and pigmented lesions
vascular lasers. Before the advent of predictable vascular
I 64 ❚
lasers, there were minimal options for vascular lesions, especially large ones. I remember growing up with a neighbour who had a large port wine stain on his cheek. I felt so sorry for him as other children teased him. He finally had it excised and was left with a large defect and scar that looked even worse. This young boy had a very unpleasant childhood. I often think of how easy it would have been today to treat that port wine stain with a number of available modalities.
F ONE WERE TO EXAMINE paradigm shifts in cosmetic surgery over the past 20 years, one of the technologies that would be high on the list would be lasers, and more specifically,
Early lasers that were used to treat
vascular lesions were not selective and often damaged normal tissues while treating vascular abnormalities. The advancement of laser physics, mechanics, and the understanding of the theory of selective thermolysis and thermal relaxation times, has allowed us to tune laser wavelengths to treat specific tissues without damaging the surrounding tissues.
Laser physics Although a boring conversation for most practitioners, basic laser physics must be understood by any surgeon using a laser. The 532 nm green light laser is created through a process known as frequence doubling. This is achieved by optically pumping a high-powered 808 nm laser
Figure 1 (A) Before and (B) after treatment with a 940 nm wavelength laser
through an Nd :YAG crystal, producing a 1064 nm light. The frequency is doubled by focusing this light onto a potassium titanyl phosphate crystal, which also halves the wavelength producing a 532 nm wavelength. A red diode beam is then used to target the 532 nm beam 1 The 532 nm wavelength is effective
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against red telangiectasia and other small vascular and pigmented lesions because of its high absorption by oxyhaemoglobin and melanin. The high absorption of the 532 nm wavelength by oxygenated haemoglobin makes it ideal for smaller (up to 1 mm) and more superficial vessels, but it also limits the depth of which the laser can penetrate the skin, making it less useful for large, deep, or blue vessels. When treating small superficial vessels
that contain significant amounts of oxygenated haemoglobin, it is beneficial to use the 532 nm wavelength as it is close to the primary absorption peak of haemoglobin. However, the 532 nm wavelength is also close to the absorption peak of melanin, making treatment for vascular lesions difficult on tanned or pigmented skin. Using the 532 nm laser with a 0.7 mm
Using the 532 nm laser with a 0.7 mm handpiece makes
tracing superficial to moderate ectatic vessels easy, efficient, and a ‘lunchtime’ procedure with no recovery
May/June 2013 |
prime-journal.com 18–20 J/cm2
handpiece makes tracing of superficial small to moderate ectatic vessels easy, efficient and a ‘lunchtime’ procedure with no recovery. I generally use this wavelength at for the average telangiectasia
(up to 1 mm) or pigmented lesion. Ectatic
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