Treatment of facial reticular veins with dynamically cooled, variable spot-sized 1064 nm Nd:YAG laser

Background Facial reticular veins are often seen on the temple and periorbital areas in patients with genetic predisposition or after facial cosmetic surgery. Aim The purpose of this study was to evaluate the efficacy and safety of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser in the treatment of facial reticular veins. Patients/methods This is a retrospective study. Twenty patients with facial reticular veins who underwent treatment with dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were evaluated. Patients were followed up 1 month to 2 years after the procedure. Results Objective and subjective improvement scores after one or two treatments of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were nearly 100% when appropriate parameters were used. Conclusion Dynamically cooled, variable spot sized 1064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins. Most patients responded to one treatment and experienced no significant side effects other than tolerable pain associated with the procedure.     

Intravascular lasers in the treatment of varicose veins

Historically, surgical treatments, such as high ligation or complete removal of an incompetent greater saphenous vein, were used to treat varicose veins resulting from saphenofemoral junction reflux. The relative lack of efficacy of these invasive methods, along with potential morbidity and significant patient downtime, has inspired the search for other treatments. Endovenous radiofrequency closure of the greater saphenous vein is effective and safe but its high cost, in terms of non-reusable catheters, and its slow withdrawal rate impair its practicality. A new technique for endovenous occlusion using endoluminal laser technology offers a less invasive alternative to ligation and stripping as well as a faster and less expensive method to treat varicose saphenous trunks and junctions. Initial clinical experience in several hundred patients shows a high degree of success with minimal side effects, most of which can be prevented or minimized by minor modifications of the technique. This paper reviews the use of an intravascular laser to destroy varicose veins. Various wavelengths including 810, 940, 980, 1064 and 1320 nm have been used to produce intravascular destruction of varicose veins. The 1320-nm intravascular laser with a motorized pull-back system appears to be the most efficient and reproducible system to effectively close and/or destroy an incompetent greater saphenous vein.     

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).     

Prospective study on combination diode laser and radiofrequency energies (ELOSTM) for the treatment of leg veins

OBJECTIVE: To evaluate the Polaris LV, electro‐optical synergy (ELOS) technology, which combines diode laser (915?nm) and radiofrequency (RF) (1?MHz) energies, for the treatment of leg veins.

METHODS: A total of 25 patients (Fitzpatrick I–IV) with a total of 35 sites (0.3–5.0?mm vessel diameters) were treated with up to three sessions at 4‐ to 10‐week intervals. Polaris LV settings included: 80–140?J/cm² of laser light, 80–100?J/cm³ of conducted RF, and pulses of 100–300?ms. Vessel clearance was graded by both the treating and an independent physician.

RESULTS: At 1 and 6 months after the final treatment, approximately 77% of treatment sites exhibited 75–100% vessel clearance, and 90% had 50–100% vessel clearance. No treatment sites had less than 25% vessel clearance. Transient dyschromic side effects were common.

CONCLUSIONS: The Polaris LV ELOS system is effective and safe in treating leg veins, including telangiectases, venulectases, and reticular veins.     

A prospective study of the impact of laser treatment on vascular lesions

BACKGROUND: Vascular lesions, especially on exposed sites, can be unsightly and may cause significant psychological distress. Lasers are effective in treating such lesions, but relatively few studies have been performed looking at psychological scoring before and after laser therapy. OBJECTIVES: To assess the change in psychological distress in patients with vascular lesions following laser treatment. PATIENTS AND METHODS: A prospective study was performed with patients recruited over a 3-month period. Psychological distress was measured using subjective scores on a standard questionnaire before treatment and at a 6-month follow-up. Each patient was treated every 4-8 weeks with an appropriate laser by the same dermatologist until discharge. Forty-two patients were recruited with one of four diagnoses: telangiectasia, port wine stain (PWS), vascular spider or cherry angioma, which occurred mainly on facial or exposed sites. RESULTS: Following laser treatment, there was a significant decrease in subjective scores of patients with telangiectasia and vascular spiders. Patients with PWS showed objective improvement but this was not reflected in their subjective scores. Psychological distress had reduced significantly in patients with less severe vascular lesions. CONCLUSIONS: Laser treatment of minor vascular lesions leads to objective improvement, which is paralleled by psychological benefit, but objective benefit in PWS may not be perceived as beneficial by patients.     

白鲜皮对急性微循环障碍大鼠血管内皮分泌的细胞因子和黏附分子表达的影响

目的观测实验性急性微循环障碍大鼠血管内皮分泌的细胞因子和黏附分子表达情况及白鲜皮对其的作用.方法以腹腔注射肾上腺素,冰水浸泡的方法制备SD大鼠急性微循环障碍模型,通过酶联免疫方法和硝酸还原酶法分别检测血清中的内皮素-1(ET-1)、P-选择素(P-selection)、血管内皮生长因子(VEGF)和一氧化氮(NO).结果造模后模型组血清ET-1表达显著增加(P＜0.05),NO表达减低(P＜0.05);P-selection表达显著增加(P＜0.01),且与ET-1的表达呈正相关性;VEGF表达增加(P＜0.01);白鲜皮治疗高剂量组ET-1减低(P＜0.01),NO增加(P＜0.05);白鲜皮低、中、高剂量组P-selection、VEGF都显著减低(P＜0.01).结论该实验性急性微循环障碍模型存在血管内皮功能障碍,存在血管舒缩功能的紊乱、通透性的增加和黏附分子的异常表达.而白鲜皮治疗组有显著的改善作用,表明白鲜皮可保护血管内皮功能.     

窄谱中波紫外线对银屑病皮损VEGF、bFGF表达及微血管密度水平的影响

目的探讨窄谱中波紫外线(NB-UVB)对银屑病患者皮损中血管内皮生长因(VEGF)、碱性成纤维细胞生长因子(bFGF)及微血管密度(MVD)水平的影响。方法采用免疫组化法检测NB-UVB治疗前后的寻常性银屑病患者皮损处VEGF、bFGF及微血管密度(MVD)的表达情况。结果银屑病患者NB-UVB治疗前皮损处VEGF、bFGF的表达水平及MVD值明显高于治疗后(P均<0.01)。结论 NB-UVB可能通过抗血管新生作用来治疗银屑病。     

Induction of melasma by 1064‐nm Q‐switched neodymium:yttrium–aluminum–garnet laser therapy for acquired bilateral nevus of Ota‐like macules (Hori nevus): A study on related factors in the Chinese population

Laser treatment has emerged as a common treatment modality for acquired bilateral nevus of Ota‐like macules (ABNOM). To identify the ratio of melasma induction and exacerbation before and after laser therapy for ABNOM and to observe the risk factors related to the induction and exacerbation of melasma by laser therapy, we analyzed related factors of 1268 adult Chinese patients who underwent 1064‐nm Q‐switched neodymium:yttrium–aluminum–garnet (Nd:YAG) laser (QNYL) treatment using case series and case–control studies. Overall, 24.0% of the ABNOM patients had mixed melasma. Among the ABNOM patients without melasma, after laser therapy the development of melasma was more frequently noted in patients older than 35 years (P < 0.0001), as well in patients whose ABNOM was less than 10 cm² (P = 0.027), ABNOM were light (similar to yellow‐brown) in color (P = 0.021) and skin types were closer to type IV (P < 0.0001). New melasma lesions also appeared most frequently in the zygomatic region (P < 0.0001). Among the ABNOM patients with melasma, 89.5% experienced worsening of their melasma, irrespective of their related factors above. We concluded that the risk of inducing melasma is great after 1064‐nm QNYL treatment in ABNOM patients, and particularly in the patients with both ABNOM and melasma. ABNOM patients should be treated as early as possible and before the age of 35 years.