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Vascular Lasers
We have multiple types of lasers to choose for treating vascular lesions, each with varying strong points. Treatment success depends on wavelength, fluence and pulse duration. Each device has its own method of optimizing thermocoagulation of vascular lesions while minimizing patient discomfort and epidermal damage. The lower wavelengths offer maximum absorption but have decreased depth of penetration and increased epidermal absorption, which can lead to more surface burns. The longer wavelengths have less epidermal absorption and an increase in depth penetration but require an increase in fluence.
Each of the devices has unique properties for increased efficacy and fewer adverse effects. Future studies will show which have the best benefits. Here’s a look at some of the newer lasers.
Vbeam. A pulsed dye laser manufactured by Candela, the VBeam has a wavelength of 595 nm. Compact and easy to use, it has been studied for treating conditions such as facial telangiectasias, rosacea, poikiloderma of Civatte, leg veins and port wine stains.1,2
Equipped with the dynamic cooling device, this feature provides epidermal cooling with a cryogen spray spurt prior to laser impact. This allows you to increase penetration while decreasing patients’ pain. In addition, you can use higher fluences to increase efficacy.
With a pulse duration of 1.5 to 40 msec, the device delivers laser energy over a longer time, uniformly heating vascular lesions and decreasing purpura. The cooling device has the dual purpose of increasing efficacy and decreasing purpura, which had been common in the past.
CoolGlide excel Nd:YAG. Manufactured by Altus, the CoolGlide Excel is a long-pulse Nd:YAG laser with a wavelength of 1064 nm. This device is also equipped with a contact-cooling device located in the handpiece. The handpiece has an adjustable spot size feature for 3, 5, 7, or 10 mm.
The longer wavelength of the CoolGlide Excel allows for greater photon penetration, allowing you to treat deeply located vascular lesions; however, you need an increase in fluence to thermocoagulate vessels. The longer wavelength offers the benefit of reducing epidermal damage because the delay in pulses is greater than the thermal relaxation time for the epidermis. Also the epidermis is directly cooled so that the photons can pass through without generating damaging heat. This allows you to treat vessels 3 mm to 4 mm in diameter and skin types I to VI since melanin absorption is decreased at this wavelength.3 The device is beneficial for treating telangiectasia, spider veins, leg veins and removing hair as well.
SLP 1000. A super long-pulse diode laser made by Palomar, the SLP 1000 has a pulse (up to 1000 ms) with a wavelength of 810 nm. This enables you to deliver energy over a longer time, resulting in less epidermal damage, less patient discomfort, and more success treating darker skin types.
The larger diameter and deeper vessels have a long thermal relaxation time, requiring high fluences and longer pulses. The longer pulse duration of the SLP 1000 allows you to treat these vessels while protecting epidermal damage with the handpiece cooling device. The SLP 1000 also utilizes photon recycling — capturing light that has been reflected away from the skin and reflecting it back toward the skin surface. The device is also equipped with spot sizes of 4 mm, 8 mm, and 12 mm, allowing treatment of various vessel sizes.
You can employ this laser to treat spider veins, leg veins, telangiectasia and to remove hair.4 The system is also compact, which is ideal for easy transport — plus, it takes less space in treatment suites.
