Nd:YAG laser (1064 nm) irradiation for lower extremity telangiectases and small reticular veins: efficacy as measured by vessel color and size.

BACKGROUND: Laser treatment of lower extremity telangiectases and small reticular veins has remained difficult because of vessel color, diameter, depth, and associated high-pressure flow. Traditionally, larger-caliber blue leg veins do not respond well to laser treatment. Nd:YAG laser (1064 nm) irradiation is absorbed by oxyhemoglobin and reduced hemoglobin and is associated with greater depth of penetration than other previously studied vascular lasers. OBJECTIVE: To evaluate a millisecond contact-cooled 1064 nm Nd:YAG laser for the treatment of telangiectases and small reticular veins. METHODS: Twenty-one lower extremity sites, with Fitzpatrick skin types I-IV, received two laser treatments separated by a 4 to 6-week period. Blue and red vessels, ranging in size from 0.25 to 4.0 mm were treated. Pulse durations of 10-50 msec were utilized at fluences of 90-187 J/cm2. Three months after the last treatment, patients were evaluated for vessel improvement and complications. RESULTS: Seventy-one percent of lower extremity vessels had improvement graded as significant. All vessel colors and sizes were successfully treated. The only complication at 3 months was postinflammatory hyperpigmentation. CONCLUSION: 1064 nm Nd:YAG laser irradiation with associated contact cooling is a safe and effective treatment for telangiectases and small reticular veins of the lower extremities.     

Laser Treatment With a 1064-nm Laser for Lower Extremity Class I–III Veins Employing Variable Spots and Pulse Width Parameters

BACKGROUND: The long-pulsed 1064-nm Nd:YAG laser (employing varying spot sizes, pulse widths, and fluences) has gained popularity for treating lower extremity blue and red vessels that are less than 4 mm in diameter. OBJECTIVE: To evaluate the efficacy of high-power 50-ms 1064 Nd:YAG laser in the treatment of class I-III lower extremity vessels. METHODS: Ten female patients (mean age of 39 years) had a 5-cm2 area of veins measuring 0.2 to 3 mm in diameter treated with up to three treatment sessions using a new 1064 Nd:YAG laser, with the end point being 100% vessel clearing after three treatments. Red vessels were treated with a spot size of 1.5 mm, a fluence of 400 to 600 J/cm2, a pulse width of 30 to 50 ms; blue vessels of 1 to 3 mm were treated with a spot size of 3 mm, a fluence of 250 to 370 J/cm2, and a pulse width of 50 to 60 ms. Macrophotographic imaging evaluations by blinded observers using a quartile scale and a patient satisfaction scale were employed to evaluate results. RESULTS: At month 3 after the final treatment session, 20% of all vessel types had 50% to 75% improvement. Equal clearing was noted for blue and red vessels. At month 6, 80% of patients had a greater than 75% clearing. Ninety percent of patients were highly satisfied with the treatment results at 6 months. CONCLUSION: By varying spot size, fluence, and pulse duration, a long-wavelength 1064-nm Nd:YAG laser can achieve excellent results for treating both blue and red lower extremity vessels that are less than 3 mm in diameter.     

Treatment of face veins with a cryogen spray variable pulse width 1064 nm Nd:YAG Laser: a prospective study of 17 patients.

BACKGROUND: Through the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers with variable pulse width have shown promising results for both telangiectasia and reticular leg veins. Experience with these lasers for treatment of facial telangiectasia and periorbital reticular veins is scant. OBJECTIVE: To our knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of facial telangiectasia and larger periorbital reticular veins. METHODS: Seventeen volunteers, ages 32-67 years, skin types I-IV, with facial telangiectasia and reticular periorbital/temporal veins were treated once with the Nd:YAG laser at fluences of 125-150 J/cm2 with a 6 mm spot size and pulse widths of 25 msec for small vessels and 75-100 msec for reticular veins. Patients were examined 1 week and 1 month after the treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians, both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups: 0%, 0-25%, 25-50%, 50-75%, and 75-100%. RESULTS: All 17 patients completed the study. Thirty-two sites were treated (24 cheek, nose, and chin telangiectases, and 8 periorbital reticular veins). Greater than 75% improvement was observed in 97% of the treated sites. Greater than 50% improvement was observed in 100% of the treated sites. Notably, 100% of the facial reticular veins treated have essentially 100% resolution. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to express reservations about additional future treatment. Transient erythema and edema were common, but fine crusting was rare. Small areas of purpura were also quite rare. CONCLUSION: The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for skin type I-IV patients. It is an excellent tool for treatment of facial telangiectasia with minimal risk of purpura. For the first time we appear to have a simple, safe, and effective treatment for 1-2 mm periorbital reticular veins. The use of topical anesthesia may be needed for some patients.     

A side-by-side comparative study of 1064 nm Nd:YAG, 810 nm diode and 755 nm alexandrite lasers for treatment of 0.3-3 mm leg veins.

BACKGROUND: Laser and intense pulsed light device treatments of leg veins have generally yielded disappointing results. Use of longer wavelengths, longer pulse widths, and better cooling devices have recently sparked renewed interests in these methods. OBJECTIVE: To prospectively compare, side by side, a 3-msec cryogen spray-equipped 755 nm alexandrite, a sapphire window cooled super-long-pulse 810 nm diode, and a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of 0.3-3mm leg veins. METHODS: Thirty female volunteers, skin types I-V, age 32-67 years with comparable sets of leg veins were treated with the Nd:YAG laser and either the diode laser, alexandrite laser, or both. In most patients two to three sets of comparable sites were treated. Treatment parameters varied with each laser and according to the size of veins being treated. Patients were examined 1 week after each treatment and at 1, 2, and 3 months after the last treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups, 0%, 0-25%, 25-50%, 50-75%, and 75-100%. RESULTS: In the 22 patients completing the study, 36 leg vein sites were treated with the Nd:YAG laser, 18 leg vein sites were treated with the diode laser, and 12 leg vein sites were treated with the alexandrite laser. Greater than 75% improvement was observed at 88% of the Nd:YAG laser-treated sites, 29% of the diode laser-treated sites, and 33% of the alexandrite laser-treated sites. Greater than 50% improvement was observed at 94% of the Nd:YAG laser-treated sites, 33% of the diode laser-treated sites, and 58% of the alexandrite laser-treated sites. Less than 25% improvement was observed at 6% of the Nd:YAG laser-treated sites, 39% of the diode laser-treated sites, and 33% of the alexandrite laser-treated sites. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to decline further treatment. Posttreatment purpura and telangiectatic matting were a significant drawback for the alexandrite laser. Transient hemosiderin pigmentation, as seen with sclerotherapy, was common with larger vessels. CONCLUSION: The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for the treatment of 0.3-3 mm leg veins. The use of topical anesthesia may be needed for some patients. The super-long-pulse 810 nm diode laser gave unpredictable results. Additional refinements of fluence and pulse width could improve its performance. The 3-msec, 755 nm alexandrite laser at fluences of 60-70 J/cm2 and an 8 mm spot can be effective, but inflammatory response, purpura, and matting limit its usefulness. Longer pulse widths might decrease these problems. For leg vein treatment, the 1064 nm wavelength is very safe for type V skin, the 810 nm wavelength at super-long pulse widths of 400-1000 msec is very safe for type IV and marginal for type V skin, and the 755 nm wavelength is limited to nontanned type I-III skin.     

Early clinical results with a multiple synchronized pulse 1064 NM laser for leg telangiectasias and reticular veins.

BACKGROUND: The 1064 nm wavelength penetrates tissue and blood vessels with little absorption by melanin. OBJECTIVE: To perform a study examining the effects of 1064 nm laser used in pulses from 4 msec to 16 msec on leg telangiectasias ranging in size from 0.5 to 3 mm. METHOD: In this initial trial, 50 sites on 30 patients were enrolled and treated with a multiple synchronized pulse laser at 1064 nm. The primary parameter utilized was a single 10-16 msec pulse. Improvement was judged by comparison of digital images at 1 month, 2 months, and 3 months posttreatment. Improvement was judged, based on size and number of vessels remaining. Side effects were noted as present or absent at each visit. RESULTS: Immediate contraction or darkening followed by urtication and visible total vessel closure as indicated by absence of blanching and visual elimination of the vessel border occurred in most of the treated sites. Two 3 mm diameter vessels were confirmed to be closed without flow by Duplex ultrasound visualization, using a 10 MHz transducer. Bruising from vessel rupture was seen in approximately 50% of the cases. No epidermal injury was noted in any sites, even in Fitzpatrick skin Types IV. At 3 months follow-up, 75% improvement was noted at treatment sites. CONCLUSIONS: Initial clinical results with a new multiple synchronized pulsed 1064 nm laser indicate that this longer wavelength supplied at pulses of up to 16 msec appears to be a valuable modality for immediate closure and subsequent elimination of leg ectatic veins. Epidermal injury is unlikely, as the near infrared wavelength has minimal interaction with melanin.     

Variable-Pulse Nd:YAG Laser in the Treatment of Facial Telangiectasias

BACKGROUND: Variable-pulse 1,064 nm wavelength lasers have been used with good effectiveness on leg telangiectasias and reticular veins and have shown promising results on facial telangiectasias as well. OBJECTIVE: To investigate the effectiveness of a variable-pulse neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using a small spot size in the treatment of facial telangiectasias. METHODS: Eight male patients (mean age 75 years) underwent a single treatment session using a variable-pulse 1.5 mm spot size Nd:YAG laser with epidermal cooling. Telangiectasia diameters were 0.3 to 2.0 mm. Test sites were performed using three pulse widths (3, 20, and 60 ms), with fluences varying depending on vessel size and response. Full treatments were performed using test parameters giving the best response. Thirteen weeks later, the patients returned for final evaluation and satisfaction rating. RESULTS: Fluences ranged from 226 to 425 J/cm2, with smaller vessels requiring larger energies. Pulse duration was equally divided between the 20 and 60 ms settings. The shortest pulse width (3 ms) was inferior in all patients. Longer pulse durations achieved superior vessel elimination with minimal immediate purpura and no postinflammatory hyperpigmentation. The average mean vessel clearance was 26 to 50% in half of the patients and 51 to 75% in the other half as evaluated by three unbiased dermatologists with extensive laser experience. CONCLUSION: A small-spot size Nd:YAG laser using a pulse width of 20 ms or higher appears to be effective in clearing a significant percentage of facial telangectasias with a single pass. The side effects were minimal.     

An In Vivo Trial Comparing the Clinical Efficacy and Complications of Q-Switched 755 nm Alexandrite and Q-Switched 1064 nm Nd:YAG Lasers in the Treatment of Nevus of Ota

BACKGROUND: Q-switched 755 nm alexandrite (QS alex) and Q-switched 1064 nm Nd:YAG lasers are effective in the treatment of nevus of Ota. Our previous in vivo study indicated that patients better tolerate QS alex than QS 1064 nm Nd:YAG laser. However, in terms of clinical efficacy and long-term complications, the study did not indicate which laser is superior. Although both machines may appear to be similar in effectiveness, the low number of treatment sessions may contribute to this apparent lack of difference. OBJECTIVE: The aim of this study was to compare the clinical efficacy and complications of QS 755 nm alex and QS 1064 nm Nd:YAG lasers in the treatment of nevus of Ota after three or more treatment sessions. METHOD: Forty patients were recruited for this study and all had received three or more laser treatment sessions with an interval of at least 2 months between each. Half of the lesion was treated with QS alex and the other half with QS 1064 nm Nd:YAG laser. The degree of lightening was assessed subjectively by the patient using a visual analog scale and objectively by two independent clinicians. Patients were called back to be examined for evidence of complications. RESULTS: In terms of subjective degree of lightening, QS 1064 nm Nd:YAG laser was found to be significantly more efficacious than QS alex (P = 0.018). Both clinicians also found QS 1064 nm Nd:YAG laser to be more effective, but statistical significance was only detected in one, not both of their scores (P = 0.005 and 0.414 for observers 1 and 2, respectively). More patients that received QS Alex developed complications (4 for QS alex and 2 for QS Nd:YAG), but the difference was not statistically significant. CONCLUSION: QS 1064 nm Nd:YAG laser appears to be more effective than QS alex in the lightening of nevus of Ota after three or more laser treatment sessions. However, the majority (55%) of the patients reported no differences in results between the two lasers, and only one of the two observers noted statistically significant improvement of QS 1064 nm Nd:YAG over QS alex.     

优化强脉冲光联合长脉宽Nd∶YAG1064nm激光治疗痤疮瘢痕疗效研究

目的 观察优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗痤疮瘢痕及其伴发色素沉着、红斑、毛孔粗大临床疗效. 方法 痤疮瘢痕患者共162例,采用随机分组其中78例运用优化强脉冲光联合长脉宽Nd：YAG 1064nm激光治疗,48例运用优化强脉冲光治疗,36例运用长脉宽Nd：YAG 1064nm激光治疗.治疗参数：强脉冲光滤光片640nm,能量密度20～24J/cm2,脉宽4ms,脉冲3个,延迟时间30ms.Nd：YAG1064nm激光,9mm光斑治疗头,能量密度单脉冲58～64J/cm2,脉宽20ms.一疗程5次,每次间隔1个月. 结果 162例患者3种治疗方式ECCA评分差异有统计学意义（P＜0.05）;治疗方式中优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗组与优化强脉冲治疗组ECCA评分差异有统计学意义（P＜0.05）,优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗组与长脉宽Nd：YAG1064nm激光治疗组ECCA评分差异有统计学意义（P＜0.05）.痤疮瘢痕及其伴发色素沉着有效率71.19％（95％CI：59.40％～82.98％）,红斑有效率88.14％ （95％CI：79.91％～96.37％）,毛孔粗大有效率71％（95％CI：60.45％～81.97％）.所有患者治疗中未发现任何严重的副作用. 结论 优化强脉冲光联合长脉宽Nd：YAG1064nm激光治疗对痤疮瘢痕及伴有局部色素沉着,红斑,毛孔粗大等都有较好的疗效.     

Clinical Comparison of Sclerotherapy Versus Long-Pulsed Nd:YAG Laser Treatment for Lower Extremity Telangiectases

BACKGROUND: Sclerotherapy has traditionally been considered the gold standard of treatment for leg veins, but patient fear of multiple needle injections and side effects of treatment have fueled investigation into other treatment alternatives. As a result, vascular-specific laser and light sources have been developed in an effort to treat these vessels with minimal morbidity and improved efficacy. OBJECTIVE: To compare the clinical efficacy of leg telangiectasia treatment with sodium tetradecyl sulfate sclerotherapy to long-pulsed 1064 nm Nd:YAG laser irradiation. METHODS: A series of 20 patients with size-matched superficial telangiectases of the lower extremities were randomly assigned to receive two consecutive monthly treatments with injectable sodium tetradecyl sulfate on one leg and long-pulsed 1064 nm Nd:YAG laser irradiation on the other. Patients were evaluated by two masked assessors at each treatment visit and at 1 and 3 months after treatment to assess clinical improvement within matched sites. RESULTS: Leg telangiectases responded best to sclerotherapy in fewer treatment sessions than to long-pulsed 1064 nm Nd:YAG laser irradiation. The incidence of adverse sequelae was minimal and equivocal in both treatment groups. CONCLUSION: Despite recent advances in laser technology for treatment of lower extremity telangiectases, sclerotherapy continues to offer superior clinical effect in the majority of cases. Laser leg vein treatment appears to be most beneficial in patients with telangiectatic matting, needle phobia, or sclerosant allergy.     

Using a "non uniform pulse sequence" can improve selective coagulation with a Nd:YAG laser (1.06 microm) thanks to Met-hemoglobin absorption: a clinical study on blue leg veins

BACKGROUND AND OBJECTIVES: Evaluation of the efficacy, on 1-2 mm blue leg telangiectasia, of a 1,064 nm Nd:YAG laser emitting in a non uniform pulse sequence calculated to consider Met-Hb formation during laser irradiation of a blood vessel. MATERIALS AND METHODS: A 1,064 nm Nd:YAG laser (Quantel Medical, Athos, France) was used in a non uniform pulse sequence mode, fluences: 300-360 J/cm(2) spot: 2 mm, + 5 degrees C contact cooling. The clinical evaluation was performed on 11 female patients, average age: 43 (25-57) years, phototype I-VI. All subjects were previously examined with Doppler ultrasound. A treatment site (6 x 4 cm) was selected on each patient. The topography of the vessels network was reported on a tracing plastic frame before each session and 6 weeks after the last one. These frames were digitized and the number of vessels was determined using the Digitized Tracing Frames Technique. Side effects were noted before and after every treatment, and 6 weeks after the last one. This study lasted for 10 months. RESULTS AND DISCUSSIONS: Patients tolerated the procedure without anesthesia. Moderate pain, transient erythema and edema, one hyperpigmentation and one matting were noted. There was no hypopigmentation. 55% (P < 0.002) vessels clearance after one session, 86% after two sessions (P < 0.001), and 98% (P < 0.001) after three sessions were obtained. On two patients, the treatment was completed after two sessions with a full clearance. Data reported in this study were obtained thanks to a computerized calculation of vessels clearance. They are similar or superior to those reported in the literature about 1,064 nm Nd:YAG lasers and leg telangiectasia. CONCLUSIONS: Since, it was developed to consider the modification of blood absorption and the methemoglobin formation which leads to an increase of the 1.06 microm wavelength absorption, the non uniform pulse mode emphasizes the efficacy of this 1,064 nm Nd:YAG laser concerning the treatment of blue leg veins telangiectasia between 1 and 2 mm. This mode gives the possibility to deliver high energy while preserving the surrounding tissue and leads to a rapid vessel clearance with reduced pain and few side effects when compared to previously published clinical studies using a 1.06 microm laser.     

长脉宽1064nm Nd：YAG激光治疗黄褐斑疗效观察

目的：探讨长脉宽1064nm Nd：YAG激光治疗黄褐斑的临床疗效和安全性。方法：选取12例面部黄褐斑患者,采用长脉宽1064nm Nd：YAG激光,光斑直径5mm,脉宽0.3～0.4ms,能量13～15J/cm2,频率7～10Hz,全面部每次扫描约6000～12000个脉冲,共治疗10次,每2周1次,术后严格防晒。每次治疗前采用MASI评分和前后照片比较改善效果。结果：12例经过10次治疗,黄褐斑患者均获得不同程度改善,其中3例的改善率达到了60%,5例达到50%以上的改善。无1例出现严重副反应,同时还有改善皮肤质地的作用,80%以上的患者表示满意。结论：长脉宽1064nm Nd：YAG激光治疗黄褐斑疗效确切,安全性高,无明显副作用,是一种治疗黄褐斑安全、有效的新方法。     

Successful Treatment of Spider Leg Veins with a High-Energy, Long-Pulse, Frequency-Doubled Neodymium:YAG Laser (HELP-G)

BACKGROUND: While sclerotherapy has been the standard treatment for spider leg veins for many years, recent advances have allowed lasers to be considered as a treatment option. OBJECTIVE: To study the efficacy of a frequency-doubled Nd:YAG laser at 532 nm with a 50 ms pulse width and chill tip device in the treatment of spider leg veins. METHODS: Forty-six patients with spider leg veins with a diameter of less than 1 mm or 1-2 mm were treated with a frequency-doubled Nd:YAG laser at 532 nm with a pulse width of 50 ms (VersaPulse HELP-G laser) while using a water-cooled chill tip device. RESULTS: Of patients with veins less than 1 mm in diameter, 60% had greater than 50% clearing after one treatment and 80% had greater than 50% clearing after two treatments. Of patients with veins 1-2 mm in diameter, 39% achieved greater than 50% clearing after one treatment and 67% had greater than 50% clearing after two sessions. CONCLUSION: Our results suggest that the frequency-doubled Nd:YAG laser with a pulse width of 50 ms and chill tip device offers an excellent alternative to sclerotherapy in the treatment of small spider leg veins.     

单用强脉冲光、长脉宽Nd:YAG激光以及低能量下两者联合使用治疗微静脉畸形的临床疗效比较

目的:观察单用强脉冲光、长脉宽1064nm Nd:YAG激光以及低能量下两者联合使用治疗微静脉畸形的临床疗效和不良反应。方法:联合应用590～1200nm强脉冲光(能量密度12～16J/cm2,脉宽3.0～5.0ms)以及长脉宽1064nm Nd:YAG激光(能量密度80～90J/cm2,脉宽10～20ms)治疗51例微静脉畸形患者;并与单独应用强脉冲光(能量密度13～20J/cm2)及长脉宽Nd:YAG激光(能量密度120～145J/cm2)治疗结果比较。结果:强脉冲光、长脉宽1064nmNd:YAG激光及低能量下联合使用治疗微静脉畸形的有效率分别为33.1%、40.3%和56.9%,瘢痕发生率分别为0%、10.7%和5.9%。结论:低能量下联合使用强脉冲光及长脉宽1064nm Nd:YAG激光提高了微静脉畸形的有效率,且不良反应小。     

Multiple Color Changes Following Laser Therapy of Cosmetic Tattoos

OBJECTIVE: To emphasize the wisdom of small test areas when treating cosmetic tattoos and the need for multiple laser systems. METHODS: A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2 J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3 J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size, 16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively. RESULTS: Significant but incomplete resolution of the tattoo ink was achieved. CONCLUSION: Multiple laser systems are needed to remove cosmetic tattoos. Test areas must be done before treatment.     

低能量Q开关Nd:YAG激光对黄褐斑体表温度与黑素指数的影响

目的:观察Q开关Nd:YAG激光治疗黄褐斑时皮肤体表的温度变化,探讨体表温度的改变与黑素指数的关系。方法:对22例黄褐斑患者使用Q开关Nd:YAG1064nm激光治疗,光斑直径6mm或8mm,能量密度2.0～3.3J/cm2,每周1次,12次为1个疗程。单次激光治疗前、治疗中、治疗后即刻用红外测温仪测量黄褐斑部位皮肤体表温度,并在治疗前、治疗6次、12次后使用皮肤多功能测试仪检测相应固定部位黑素指数。结果:黄褐斑皮损区单次治疗后双面颊体表温度高于治疗前,但与正常皮肤相比无差异;激光治疗6次、12次后黑素指数均显著性减少。结论:低能量Q开关Nd:YAG激光治疗黄褐斑后皮肤温度有一定程度升高,但并不引起明显光斑反应,治疗后黑素指数降低,表明温度并非导致激光光斑反应的唯一及主要因素,可能与Q开关激光激活黑素细胞内部的反应原件相关。     

Nd：YAG 1064nm激光治疗面部毛细血管扩张的临床体会

目的：观察Nd：YAG 1064nm激光治疗面部毛细血管扩张的临床疗效和安全性。方法：应用Nd：YAG 1064nm激光治疗面部毛细血管扩张患者35例,毛细血管直径0.3～1.5mm,光斑直径1.5mm,能量密度280～420J/cm^2,脉宽20～50ms,重复频率1Hz,共治疗1～4次,治疗间隔6～8周。治疗后随访1～6个月,评价治疗效果。结果：35例患者,痊愈18例（51.4%）,显效11例（31.4%）,有效6例（17.1%）,无效0例,有效率82.9%。所有病例均无水疱,紫癜,色素沉着或减退、脱失及瘢痕形成等。结论：在调整好治疗参数的情况下,Nd：YAG1064nm激光治疗面部毛细血管扩张安全、疗效显著,可进一步临床观察应用。     

A clinical, histological, and computer-based assessment of the Polaris LV, combination diode, and radiofrequency system, for leg vein treatment

BACKGROUND AND OBJECTIVES: Electro-optical synergy (ELOS) is a novel technology that combines radiofrequency (RF) with optical energy. This study investigated the safety and effectiveness of the Polaris LV system, which is based on combined RF and diode laser (915 nm), for the treatment of leg veins. STUDY DESIGN/MATERIALS AND METHODS: Fifty women (Fitzpatrick II-IV) with red or blue leg veins (1-4 mm in diameter) were treated with the Polaris LV, using a fluence of 60-80 J/cm(2) and conducted RF energy of 100 J/cm(3). Patients received up to three treatment sessions at 2- to 4-week intervals. Both patients and an independent physician graded the level of vessel clearance at 2 months following the last treatment, using pre- and post-treatment photographs. Also, a computer-generated assessment of vessel clearance was done in 40 patients. Twenty patients provided biopsy specimens for histologic assessment. RESULTS: Approximately three-quarters of patients demonstrated >/= 50% vessel clearance, and about 30% had 75%-100% vessel clearance. Computer-generated scores correlated closely with physician scores. Histologic assessment showed signs of coagulation and prominent endothelial degeneration in all treated vessels, but the epidermis remained normal. There were minimal complications. CONCLUSIONS: The Polaris LV is effective and safe in treating red and blue leg veins up to 4 mm in diameter.     

长脉冲1064nm Nd：YAG激光治疗面部激素依赖性皮炎伴发的毛细血管扩张

目的：观察长脉冲1 064nm Nd：YAG激光治疗面部激素依赖性皮炎伴发毛细血管扩张的临床治疗效果。方法：治疗参数选用：光斑直径3mm,平均脉宽（13.5±3.4）ms,平均能量密度（267.2±3.1）J/cm2。结果：37例女性患者,平均治疗2.3次,面部毛细血管扩张平均密度由（2.76±1.03）根/cm2下降至（0.42±0.27）根/cm2,临床疗效显著。治疗后,皮肤恢复至基本正常状态,无瘢痕、色素改变,皮炎反复发作的现象消失。结论：长脉冲1 064nm Nd：YAG激光治疗面部激素依赖性皮炎伴有的毛细血管扩张具有较好临床治疗效果,方法值得进行更广泛的临床实践与深入研究。     

Treatment of Spider Veins Using a 10 Millisecond Pulse-Duration Frequency-Doubled Neodymium YAG Laser

BACKGROUND: The pulsed dye laser has been the standard for treating vascular lesions. Although quite effective for treating facial vessels and port-wine stains, spider veins of the lower extremities are more difficult to treat. Recent studies have shown that lasers with longer pulse durations are more effective at treating spider veins. A new long-pulse frequency-doubled Neodymium:YAG laser has been developed with a 10-ms pulse duration and sufficient energy to enable treatment with a 3- or 4-mm diameter treatment beam. OBJECTIVE: To determine the effectiveness of the long pulse Neodymium:YAG laser for treating spider veins of the lower extremities. METHODS: Spider veins less than 0.75 mm in diameter on the legs of 15 female volunteers were treated in 1 or 2 areas. Treatments were administered through a water-cooled chill tip using the frequency-doubled Neodymium:YAG laser with a 10-ms pulse duration. A dose of 16 J/cm2 was administered, completing 3 passes over each visible vein during each session, for a total of 2 sessions administered 6 weeks apart. Photographs of treatment areas were digitally analyzed for degree of vessel clearance. RESULTS: Computer-based image analysis revealed clearing of over 75% of veins following 2 treatments with 16 J/cm2. Side effects were minimal, and the treatments were well tolerated. CONCLUSIONS: The 532 nm, 10 ms pulse duration, frequency-doubled Neodymium:YAG laser is safe and effective for treating spider veins of the lower extremities less than 0.75 mm in diameter, in patients with Fitzpatrick skin Types I-III.     

Comparison of the 595 nm Long-Pulse (1.5 msec) and Ultralong-Pulse (4 msec) Lasers in the Treatment of Leg Veins

BACKGROUND: Although several lasers and light sources are now available for vascular lesions, treatment of leg veins has not been very satisfactory. Lengthening the pulse width should theoretically result in improved response rates. OBJECTIVE: This study compared the efficacy and safety of 595 nm pulsed lasers at 1.5 msec and 4 msec in treating leg veins. METHODS: For group A, 27 healthy adult volunteers with leg veins measuring less than 1 mm in diameter were treated with a 2 mm x 7 mm elliptical handpiece. Each patient had three areas treated. The first two areas were treated with the 4 msec pulsed dye laser with fluences of 16 and 20 J/cm2, while the last area was treated with a 1.5 msec pulsed dye laser at fluences ranging from 14 to 16 J/cm2. For group B, 13 subjects were treated. Areas 1 and 2 were treated with the 4 msec pulsed dye laser using a 3 mm x 5 mm and 5 mm handpiece, respectively, while the third site was treated with a 1.5 msec laser using a 3 mm x 5 mm handpiece. Fluences ranging from 14 to 16 J/cm2 were used. Clinical evaluations were performed and photographs taken at 4-8 week intervals. RESULTS: Neither laser regularly induced satisfactory diminution or disappearance of these vessels after one treatment. In group A, more than 50% of patients had little to no improvement, while in group B little to no improvement was observed in 33% of patients following a single treatment. Although there was no significant difference in outcomes between the test sites, the 4 msec PDL with a 3 mm x 5 mm spot size appeared to be most effective. Transient hyperpigmentation was common following either treatment, while hypopigmentation was seen in group B subjects. No scarring was noted. CONCLUSION: Both the 4 and 1.5 msec flashlamp-pumped pulsed dye lasers were ineffective in treating leg telangiectasia following a single treatment.