Treatment of Poikiloderma of Civatte with an Intense Pulsed Light Source

BACKGROUND: Effective treatment of poikiloderma of Civatte combines elimination of both the vascular and pigmented components simultaneously. A broad spectrum, noncoherent, intense pulsed light (IPL) source delivers multiple wavelengths with software controlled pulse durations and sequencing, which permits treatment of both vascular and pigmented lesions simultaneously. OBJECTIVE: To determine response and side effects of poikiloderma of Civatte of the neck and chest when treated by IPL. METHODS: One hundred and thirty-five patients randomly selected with typical changes of poikiloderma of Civatte on the neck and/or upper chest were treated with one to five treatments using IPL. RESULTS: Clearance of more than 75% of telangiectasias and hyperpigmentation comprising poikiloderma was observed. The incidence of side effects was 5%, including pigment changes. In many cases, improved skin texture was noted both by physician and patient. CONCLUSION: IPL is an effective mode of therapy for poikiloderma of Civatte. It offers a reduction of pigment and telangiectasias with a low risk profile. Additional benefits include subjective changes of improvement in skin texture.     

IPL technology: a review

BACKGROUND AND OBJECTIVES: Intense pulsed light (IPL) systems are high-intensity light sources, which emit polychromatic light. Unlike laser systems, these flashlamps work with noncoherent light in a broad wavelength spectrum of 515-1,200 nm. These properties allow for great variability in selecting individual treatment parameters and adapting to different types of skin types and indications. The purpose of this article was to critically review international medical publications of the many indication in which IPL technology can be used, including our own evaluations and experiences. STUDY DESIGN/MATERIALS AND METHODS: The range of therapeutic uses for high-intensity flashlamps was reviewed, ranging from benign cavernous hemangiomas, benign venous malformations, essential telangiectasias, leg telangiectasias, poikiloderma of Civatte, and port-wine stains to pigmented lesions, cosmetically undesired hypertrichosis, and facial rhydids. The relative benefits and risks were discussed in detail and compared with other laser systems. RESULTS: Because of the wide spectrum of potential combinations of wavelengths, pulse durations, pulse frequency, and fluences, a great deal of experience is required when using IPL technology. Proper patient selection and critical diagnostics serve to keep the adverse effects of the treatment to a minimum. CONCLUSIONS: The distinctive technical conditions involved combine to make IPL technology an alternative and auxiliary treatment option to existing laser systems and conventional therapies.     

Split treatment of photodamaged skin with KTP 532 nm laser with 10 mm handpiece versus IPL: a cheek-to-cheek comparison

BACKGROUND AND OBJECTIVES: The treatment of photodamaged skin with potassium-titanyl-phosphate (KTP) laser and intense pulsed light (IPL) has been reported in several studies. Each device has strengths and weaknesses; however, patient and device variability have made it difficult to ascertain the optimal device for photorejuvenation. The objective of this study was to obtain a head-to-head comparison of IPL and KTP laser for photorejuvenation. Each patient received one KTP laser treatment on one side of the face and one IPL treatment on the other side. STUDY DESIGN/MATERIALS AND METHODS: Seventeen patients with skin types I-IV were accepted into the study based on existence of dyschromias (pigmented and vascular) and/or discrete telangiectases. After performance of test spots on each patient to determine optimal settings for both devices, patients were treated with both devices in a split face manner. Evaluations and photographs were performed 1 week and 1 month after treatment. Patient and observer evaluations of results were recorded, as well as time to perform each treatment, and patient feedback with regard to pain and edema. No anesthesia was used in these treatments. Photographs were reviewed by a panel of blinded observers to assess changes in red and brown dyschromias. RESULTS: One month average improvement (evaluator) for IPL side was (mean) 38.16%/35.08% for vascular/pigment lesions versus 41.99%/30.21% for KTP side. Patient self-evaluated global improvement at 1 month was (mean) 65.59% for IPL side versus 60.88% for KTP side. A majority of patients found the KTP to be slightly more painful with a mean pain rating of 5.27 of 10 versus 4.4 of 10 for IPL. A majority of patients experienced subjectively greater post-procedure swelling on the KTP side. Time to conduct treatment was an average of 10.0 minutes for IPL, 8.7 minutes for KTP. CONCLUSIONS: Both large spot KTP and IPL achieved marked improvement in vascular and pigmented lesions in one session. The KTP laser caused slightly more discomfort and edema than the IPL. On the other hand, the KTP laser was faster, and more ergonomically flexible.     

Intense Pulsed Light as a Nonablative Approach to Photoaging

Background and Objective. To describe the introduction and use of intense pulsed light (IPL) to treat vascular and pigmented lesions comprising photorejuvenation and its use in photodynamic therapy.
Methods. Review of the medical literature and the authors' experience with IPL.
Results and Conclusions. IPL is an excellent treatment modality for vascular and pigmented manifestations of photoaging and can be combined with photodynamic therapy for the treatment of early forms of skin cancer.     

Intense Pulsed Light and Laser Treatment of Facial Telangiectasias and Dyspigmentation: Some Theoretical and Practical Comparisons

Background and Objective. A comparative overview is presented, both theoretical and clinical, for intense pulsed light (IPL) and laser treatment of facial telangiectasias and pigmented lesions.
Materials and Methods. A narrative approach describes light penetration into the epidermis, dermis, dermal-epidermal junction, and facial ectasias. Based on mathematical models, we examine some temperature profiles for monochromatic and broadband light sources. Specifically, temperature elevations of representative vascular targets are discussed. Also, clinical scenarios are reviewed for both IPL and laser. Although multiple monochromatic devices are reviewed, only the 532 and 595 nm wavelengths are emphasized.
Results. In theory, an IPL can be filtered to simulate 532 and 595 nm laser light in the treatment of telangiectasias and dyschromias. In comparing our experiences with the different devices, all three (IPL, 532 nm laser, and 595 nm laser) are capable of achieving a reduction in ectasias and hyperpigmented macules.
Conclusions. With an optimal set of parameters, IPLs and lasers are comparable in the treatment of vascular and pigmented lesions with respect to treatment efficiency and safety.     

Split-Face Treatment of Facial Dyschromia: Pulsed Dye Laser with a Compression Handpiece versus Intense Pulsed Light

BACKGROUND Many visible light lasers and intense pulsed light (IPL) devices are available to treat photodamaged skin.
OBJECTIVES The objective was to perform a multiple-treatment split-face comparison evaluating a pulsed dye laser (PDL) with a compression handpiece versus IPL for photorejuvenation.
METHODS Ten subjects were treated three times at 3- to 4-week intervals. One side of the face was treated with the PDL with compression handpiece, and the other with IPL. One month after final treatment, blinded evaluation assessed for improvements in dyschromias and texture. Patients provided self-assessment of improvement in dyschromias and texture. Time to complete final treatments and pain during all treatments were recorded for each device.
RESULTS Improvement of the PDL was (mean) 86.5, 65, 85, 38, and 40% for dark lentigines, light lentigines, vessels <0.6 mm, vessels >0.6 mm, and texture, respectively, versus 82, 62.5, 78.5, 32.5, and 32%, respectively, for the IPL side. Patient-evaluated difference in improvement for vascular lesions significantly favored the PDL ( p =.011). Mean third treatment times were 7.7 minutes for PDL versus 4.6 minutes for the IPL ( p =.005). Mean pain ratings were 5.8 for the PDL and 3.1 for the IPL ( p =.007). Purpura-free procedures depended on proper technical use of the compression handpiece when treating lentigines with the PDL.
CONCLUSIONS The PDL with compression handpiece and IPL are highly effective for photorejuvenation.     

Cutaneous Compression for the Laser Treatment of Epidermal Pigmented Lesions with the 595-nm Pulsed Dye Laser

BACKGROUND The 595-nm pulsed dye laser has been the standard of care for many vascular lesions and has rarely been used in the treatment of epidermal pigmented lesions.
OBJECTIVE The objective was to investigate the effectiveness and safety of a compression technique for the treatment of epidermal pigmented lesion using a modified 595-nm pulsed dye laser with no epidermal cooling.
METHODS Twelve subjects (mean age 58 years) underwent treatments using a modified 595-nm dye laser with a compression handpiece and no epidermal cooling. Treatments were performed with radiant exposures of 7 to 12 J/cm², 7-mm spot size, and 1.5-ms pulse duration. Each subject received one to four treatments, 4 to 6 weeks apart. Follow-up evaluations were held before each treatment and 4 months after last treatment.
RESULTS Clearance of 75% to 100% was obtained in 43, 59, 76, and 79% of the lesions treated after one, two, three, and four treatments respectively. The fourth treatment was evaluated 4 months posttreatment. Side effects included immediate erythema and edema and rare cases of transient hyperpigmentation and atrophy. No purpura and long-lasting side effects were observed.
CONCLUSION The compression technique with a modified 595-nm pulsed dye laser system is effective and safe for the treatment of epidermal pigmented lesions.     

The Effect of Botulinum Toxin Type A on Full-Face Intense Pulsed Light Treatment: A Randomized, Double-Blind, Split-Face Study

BACKGROUND Botulinum toxin type A (BTX) is commonly used in combination therapy, and it has been reported that periocular BTX treatment enhances the aesthetic improvements attained with intense pulsed light (IPL).
OBJECTIVE The objective was to evaluate if intradermal BTX treatment of the cheeks also enhances the efficacy of IPL.
METHODS AND MATERIALS Fifteen females enrolled in this prospective, randomized, double-blind, split-face study (14 completed, 1 lost to follow-up). All received standard IPL treatment and were randomly assigned to receive eight 0.1-mL intradermal injections of BTX (BOTOX Cosmetic, Allergan) in one cheek (8 U total dose) and eight injections of saline in the contralateral cheek. Small wrinkles and fine lines, erythema, hyperpigmentation, apparent pore size, skin texture, and overall appearance were evaluated for 8 weeks.
RESULTS A significantly higher proportion of patients showed improvement in small wrinkles and fine lines with IPL plus BTX than IPL plus saline—93% versus 29% at Week 4 ( p =.003). Adjunctive BTX also achieved a greater degree of improvement in erythema (although statistical significance was not achieved). Other efficacy measures showed comparable improvements with both regimens.
CONCLUSION The adjunctive use of BTX enhances the improvement in small wrinkles and fine lines, and possibly erythema, achieved with IPL alone.     

Gross and Microscopic Findings in Patients Submitted to Nonablative Full-Face Resurfacing Using Intense Pulsed Light: A Preliminary Study

BACKGROUND: Intense pulsed light (IPL) is a noncoherent, nonlaser, filtered flashlamp emitting a broadband visible light that has been shown to be effective in photoepilation, as well as in a number of vascular and pigmented lesions of the skin. Their efficacy has also been reported recently in the treatment of photodamaged facial skin. In the last condition, however, there are few studies showing the clinical and microscopic changes produced by IPL. OBJECTIVE: To assess the gross and microscopic changes that occur in photodamaged skin submitted to nonablative full-face resurfacing (NAFFR) using IPL. METHODS: Five women were submitted to five NAFFR sessions using IPL, one every 2 weeks. Skin biopsies and photographs were taken on all of the patients before the first procedure and after the last one, as well as weekly clinical assessment. Data concerning skin features (wrinkles, oiliness, thickness, dilated pores, and general appearance) were all assessed. Microscopic improvement of the aging features in the epidermis and dermis were all assessed. For the statistical analysis a t test for small samples was used. RESULTS: All the patients showed clinical and microscopic improvement in every one of the parameters assessed. The t test for small samples showed a statistically significant difference (P < 0.01) in epidermal thickness. CONCLUSION: Facial photodamage was clinically and microscopically improved using IPL. Use of IPL as a rejuvenating method seems to be promising, with minimal side effects, a wide safety margin, and minimal downtime.     

Utilization of intense pulsed light in the treatment of face and neck erythrosis

Erythrosis is a clinical manifestation characterized by parossistic vasodilatations followed by fixed superficial venular dilatations localized at the face, neck, décolleté and pinnas. To date, a variety of lasers have been used for treating vascular skin lesions. This study will describe the response on these vascular lesions using the intense pulsed light (IPL) source. Twenty-two female patients and twelve men, aged between 19 and 65, had a phototype ranging from 2 to 4 on the Fitzpatrick scale. The technique is based on a pulsed light of high intensity obtained with a vascular filter of 560 nm. They underwent five treatments of twenty minutes each, at intervals of twenty-one days, with a variable fluency between 9-12 J/cm2 and impulse time of 10-20 ms. The sheaf used is a rectangular spot of 2 cm x 5 cm. In twenty-four patients we obtained a total regression of the cutaneous manifestation after 5 applications, whilst another two patients showed only an attenuation of the erythema. In five cases with erythrosis the erythema persisted after the end of the treatment, although the patients were satisfied with the evident benefits. In two patients affected by Civatte's poikiloderma of the neck we obtained differing results: In the first case an evident positive response of the clinical picture was perceived after only two application of the IPL; in the second case, the benefits were evident after 3-4 applications of IPL at a higher fluency of up to 14 J/ cm2. One patient in treatment with oral antibiotics showed good results from the first application with regression of the erythema up to its disappearance. Collateral effects are not reported, although there was a long-standing (more than 48 hours) post-treatment erythema in only one case. The IPL system, with its broad range of technical variables, is an effective tool in achieving meaningful and lasting clearance of erythrosis.     

A newly modified 595-nm pulsed dye laser with compression handpiece for the treatment of photodamaged skin

BACKGROUND AND OBJECTIVES: The pulsed dye laser set the standard of care for the treatment of vascular lesions, and recent modifications have enabled improved efficacy with fewer side effects. An investigational high energy, variable pulse duration pulsed dye laser has been modified to treat both vascular and pigmented lesions associated with photoaging. Each laser pulse is comprised of a sequence of eight uniform micropulses, which evenly distribute the pulse energy, effectively increasing the purpura threshold at any given fluence. Pigmented lesions are treated with a compression handpiece (CHP) that removes competing vascular target from the field, and helps to prevent purpura. This pilot study was undertaken to determine the optimum laser settings, and to investigate the ability of this device to improve vascular and pigmented lesions associated with photoaging. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four patients with photoaged skin and phototype I-III were enrolled in the study. Thirteen received treatment for vascular and pigmented lesions, and 11 subjects were treated for pigmented lesions alone. Subjects received one to three treatments at 3-4 weeks intervals, and underwent 3- and 12-week follow-up evaluation. The degree of improvement was assessed by subject evaluation as well as comparison of standardized digital photographs by three independent dermatologists. Background erythema was treated with a 12-mm spot size, at a fluence of 7 J/cm(2), and a pulse width of 10 ms. The cryogen cooling was set at 30 mseconds with a 30 ms delay. Individual telangiectasias were treated with a 5- or 7-mm spot size at fluences of 9-14 J/cm(2) and pulse widths of 6-20 mseconds. Pigmented lesions were treated using a 5- or 7-mm spot size, with energy of 9-15 J/cm(2) and a pulse width of 1.5-10 ms without cooling. The CHP had a 7-mm spot size, and fluences of 9-16 J/cm(2), and pulse widths of 1.5 or 3 ms were used in the treatment of pigmented lesions. RESULTS: The treatment was well tolerated without the use of topical anesthetic. All subjects noted improvement in the both vascular and pigmented lesions, and were satisfied with their outcomes. Objectively, there was moderate improvement in background erythema, telangiectasia, and pigmented lesions. Three subjects who were treated with sun tans developed transient hypopigmentation and two subjects developed a transient textural change following pulse stacking for the treatment of pigmented lesions with the conventional handpiece. Purpura was noted in all patients treated for pigment with the conventional handpiece at pulsewidths less than 6 mseconds, as compared to only one that was treated with the CHP. Three patients treated in rapid succession for vascular, and then pigmented lesions with the CHP exhibited purpura, which was prevented in future treatments with 1-2 minutes of topical ice cooling between passes. CONCLUSIONS: This novel 595-nm pulsed dye laser, with a modified pulse sequence and CHP, now has the versatility to safely treat both pigment and vascular changes associated with photoaging.     

Facial teleangectasias: our experience in treatment with IPL

BACKGROUND AND OBJECTIVES: Facial teleangectasias can be a relevant cosmetic problem, which the patient usually hides with a thick layer of makeup. This study will describe the response on these vascular lesions using the intense pulsed light (IPL) source. METHODS: Five hundred eighteen consecutive patients were treated with Photoderm VL (Lumenis Ltd.). The average age of patients of various skin types (Fitzpatrick I to IV) was 48.5 years. They were subjected to a mean of 1.69 treatments (range 1-9) followed up 48 hours, 72 hours, 1 week, 3 weeks, and 1 month after each treatment. All patients were followed up after 2 months from the last treatment and the percentage of clearance was assessed by comparing pre- and post-treatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The physicians evaluation was also recorded on the same form. RESULTS: Patients (87.64%) presented a clearance of 75%-100%. The results appear not correlated with lesions size, age, skin type but with operator experience. Minimal side adverse effects occurred in 20% of the patients. CONCLUSION: The IPL source, Photoderm VL, can be considered an alternative or a supplement to the existing laser devices for facial teleangectasias treatment.     

Focal Trichloroacetic Acid Peel Method for Benign Pigmented Lesions in Dark-Skinned Patients

Background. Benign pigmented lesions, including seborrheic keratosis, solar lentigines, melasma, and freckles, are common disorders, and various treatment modalities have been tried. We suggest a technique consisting of focal trichloroacetic acid (TCA) peel applied by pressing firmly onto the focal lesions.
Objective. To evaluate the clinical effects of focal TCA peel on pigmented lesions in dark-skinned patients.
Methods. An analysis was conducted of 106 patients with benign pigmented lesions who were treated using focal TCA peel. Seborrheic keratosis was treated with 65% focal TCA peel, solar lentigines, and freckles with 50% to 65% focal TCA peel, and melasmas with 10% to 50% focal TCA peel. Patients had Fitzpatrick skin types IV–V.
Results. Patient treatment data indicated that 19 of 23 (83%) patients with seborrheic keratosis, 42 of 49 (86%) patients with solar lentigines, 8 of 14 (58%) patients with freckles, and 11 of 20 (55%) patients with melasma experienced a good clinical response. Good satisfaction rates in the seborrheic keratosis, solar lentigines, freckles, and melasma groups were recorded. No significant complications were observed.
Conclusion. The focal TCA peel method presented in this study is a safe and effective modality for the treatment of benign pigmented lesions with no significant complications.     

Stretch Marks: Treatment Using the 1,064-nm Nd:YAG Laser

BACKGROUND Striae are frequent skin lesions that cause considerable aesthetic concern. The 1,064-nm long-pulsed Nd:YAG laser has been used to promote an increase in dermal collagen and is known to be a laser that has a high affinity for vascular chromophores.
OBJECTIVE This study aims to verify the efficacy of the long-pulsed Nd:YAG laser in the treatment of immature striae.
MATERIALS AND METHODS Twenty patients who had immature striae, i.e., red striae, were treated using the 1,064-nm long-pulsed Nd:YAG laser. The analysis of treatment efficacy was performed by the comparison between the images taken before and after each treatment session as well as through a subjective assessment carried out by the patients themselves.
RESULTS Results were considered satisfactory to both patients and doctors. A higher number of patients (55%) considered the results excellent when compared to the same assessment made by the doctor (40%).
CONCLUSION The clinical improvement of immature striae can be obtained with the use of the 1,064-nm long-pulsed Nd:YAG laser. The low incidence of side effects makes this laser a good alternative in the treatment of these common skin lesions.     

Efficacy and Safety of Intense Pulsed Light in Treatment of Melasma in Chinese Patients

BACKGROUND Melasma is commonly seen in the Asian population. Traditional therapies are less effective and may cause adverse effects.
OBJECTIVE The objective was to study the efficacy and safety of a new intense pulsed light (IPL) device in the treatment of melasma in Chinese patients.
METHODS Eighty-nine women with melasma were enrolled in this open-labeled study. Subjects received a total of four IPL treatments at 3-week intervals. Changes in facial hyperpigmentation and telangiectasis were evaluated using an objective, skin colorimeter (Mexameter, Courage & Khazaka), the melasma area and severity index (MASI), and a global evaluation by the patients and blind investigators.
RESULTS Sixty-nine of 89 patients (77.5%) obtained 51% to 100% improvement, according to the overall evaluation by dermatologists. Self-assessment by the patients indicated that 63 of 89 patients (70.8) considered more than 50% or more improvement. Mean MASI scores decreased substantially from 15.2 to 4.5. Mexameter results demonstrated a significant decrease in the degree of pigmentation and erythema beneath the melasma lesions. Patients with the epidermal-type melasma responded better to treatment than the mixed type. Adverse actions were minimal.
CONCLUSION IPL treatment is a good option for patients with melasma. Adverse actions of IPL were minimal and acceptable.     

Effective Treatment of Rosacea Using Intense Pulsed Light Systems

BACKGROUND: To date, a variety of lasers have been used for treating vascular skin lesions. Intense pulsed light (IPL) is a proven technology for vascular lesion management, such as rosacea. OBJECTIVES: The aim of this study was to test the effectiveness of IPL in treating vascular facial lesions in rosacea patients. METHODS: Sixty patients presenting with telangiectasia owing to facial rosacea were selected randomly from the patient population in the Department of Laser Therapy at the Medical Centre Maastricht, the Netherlands. Patients of various skin types (Fitzpatrick I-IV) were selected with an average age of 44.2 years. Five hundred eight sites were treated, with a mean of 4.1 treatments per site and an IPL spectrum ranging from 515 to 1,200 nm with different pulse durations between 4.3 and 6.5 milliseconds. The energy density varied from 25 to 35 J/cm2. RESULTS: Patients were assessed clinically and photographically. A mean clearance of 77.8% was achieved and was maintained for a follow-up period averaging 51.6 months (range 12-99 months). No correlation was found between the clearance of rosacea and patient-related or technical data. For approximately 3 years post-treatment, lesion recurrence was noted in 4 of the 508 treated facial sites. DISCUSSION: This study demonstrated that IPL treatment of facial rosacea is effective in obtaining clearance of 77.8%, with minimal side effects, and that treatment effects are maintained. CONCLUSION: The IPL system, with its broad range of technical variables, is an effective tool in achieving meaningful and lasting rosacea clearance.     

Development of terminal hair following skin lesion treatments with an intense pulsed light source

Laser and other light sources have been used to treat vascular and pigmented skin lesions and to remove tattoos and unwanted hair, with varying degrees of success and various side effects. It has not yet been reported that hair growth can occur as a side effect of such treatments. In this paper two cases are presented, one port wine stain and one tattoo, that were each treated several times with an intense pulsed light source (IPLS) for removal. Terminal hair, not present before treatment, partially developed in treated areas of both lesions. Local inflammatory reactions are believed to trigger such outcomes.     

Evaluation of the 1,540-nm Erbium:Glass Laser in the Treatment of Inflammatory Facial Acne

BACKGROUND The erbium:glass laser is approved to treat inflammatory acne on the back.
OBJECTIVE This aim of this study was to evaluate the use of the 1,540-nm erbium:glass laser in the treatment of moderate to severe inflammatory acne on the face.
METHODS AND MATERIALS An erbium:glass laser (Aramis, Quantel Medical, Clermont-Ferrand, France) was used to treat 15 patients with moderate to severe acne four times at 2-week intervals. Active lesions were first treated with six pulses at 10 J/cm². The entire face was then treated with a single pass using bursts of four pulses at 10 J/cm². Sebum measurements were performed. Six patients continued in a double-arm study to determine whether an additional treatment at 6 months would prolong the lesion-free period. Final evaluation was at 9 months.
RESULTS At 6-month follow-up, patients rated improvement as 68%, and the mean investigator improvement assessment was 78%. Sebum measurements did not change. No patients required anesthesia, and no side effects were observed. A single retreatment session 6 months after the initial course held clearance at 80% at 9-month follow-up, whereas patients without retreatment had 72% clearance.
CONCLUSION Treatment of inflammatory facial acne with the 1,540-nm erbium:glass laser is effective and relatively painless. Papules, pustules, and nodules all respond well to therapy. Additional treatment sessions may prolong the lesion-free period, and maintenance therapy should be included as a part of the treatment course.     

Intense pulsed light and Nd:YAG laser non-ablative treatment of facial rhytids

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the intense pulsed light source (IPL) and the Nd:YAG laser in the treatment of facial rhytids. Both systems can be used in a non-ablative manner and cause a dermal wound. This is thought to stimulate the production of new collagen without epidermal disruption. Non-ablative techniques eliminate the downtime that must be endured by patients treated with ablative methods such as the carbon dioxide and erbium lasers. STUDY DESIGN/MATERIALS AND METHODS: Fifteen subjects with perioral rhytids and Fitzpatrick skin types II and III received three-to-five treatments with the IPL using 590 and 755 nm cut-off filters, and the 1,064-nm Nd:YAG laser. The subjects were evaluated at 2, 4, 8, 12, and 24 weeks after the final treatment for improvement in rhytids and presence of any side effects. RESULTS: At 6 months, the patient satisfaction score (1-10) was comparable in all three groups. Evaluator assessment of improved skin quality was also similar in all three treatment groups. Side effects such as blistering and erythema were most commonly seen in the subjects treated with the IPL. The least discomfort was seen with the Nd:YAG laser. CONCLUSIONS: Although both non-ablative treatment systems improved facial rhytids presumably by causing a non-specific dermal wound, the Nd:YAG laser was better tolerated and produced fewer side effects.     

Treatment of Facial Telangiectasia Using a Dual-Wavelength Laser System (595 and 1,064 nm): A Randomized Controlled Trial with Blinded Response Evaluation

BACKGROUND AND OBJECTIVE Pulsed dye (PDL) 595- and 1,064-nm Nd:YAG lasers are used for the treatment of vascular lesions. PDL-heated blood exhibits increased absorption of radiation at 1,064 nm, suggesting that the use of combined sequential dual wavelengths may offer benefits over single-wavelength treatments. This study compares the treatment efficacy of combined sequential dual-wavelength versus single delivery of 595-nm PDL or 1,064-nm Nd:YAG wavelengths in facial telangiectasia in a split face study design using subpurpuric parameters.
MATERIALS AND METHODS Twenty patients were studied using the sequential delivery of PDL and Nd:YAG wavelengths on one side of the nose. The other side received either PDL or Nd:YAG treatment. Vessels (<0.6 mm in diameter) were treated with a 7-mm spot size at 10 J/cm², 10 ms with the PDL, followed by the Nd:YAG at 70 J/cm², 15 ms with a multiplex interpulse delay of 100 ms. Subjects received a single treatment, and results were evaluated after 4-week follow-up. Improvement was determined by blinded assessment of photographs taken before and after final evaluation.
RESULTS The efficacy of the dual-wavelength laser treatment when compared to Nd:YAG or PDL laser alone was significantly more evident than either single-wavelength treatment ( p <.05). There was no statistically significant difference in efficacy between the single-wavelength treatment groups.
CONCLUSION The sequential delivery of 595- and 1,064-nm-wavelength radiation with an interpulse delay suggests that the synergistic approach to laser therapy for facial telangiectasia is a superior method compared to standard single wavelength therapy.