Laser or Ohmic devices for telangectasia: when and why Selective

11/19/2015
Laser or Ohmic devices for
telangectasia: when and why
Conflict of interest : none
Disclosures: none
Ian J Franklin
Consultant Vascular Surgeon
London, UK
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www.londonvascularclinic.com
Thread veins
Selective Photothermolysis
The ideal wavelength should be:
• 100% absorbed by the target tissue
• 0% absorbed by everything else
Before and after
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Selective thermolysis
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Selective thermolysis
Exploits differences in absorption spectra
Exploits differences in absorption spectra
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11/19/2015
Selective thermolysis
Exploits differences in absorption spectra
Therapeutic lasers
• Different wavelengths
– Selective thermolysis
– Longer wavelengths penetrate better through darker
skin
• Variable spot sizes
• Variable pulse duration and frequency
– Thermal relaxation time
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Therapeutic lasers
Norseld laser
Copper based laser
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Therapeutic uses of yellow laser
5 weeks after one treatment
Telangiectasia
Thread veins
Rosacea
Port Wine Stains
Hemangiomas
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Mccoy et al, Derm Surg, 1996
Owen et al, Aus J Derm 2012
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5 weeks after one treatment
1 session
Norseld
laser
Ulm et al
195 patients
75% improvement after 2 treatments
Most patients “satisfied”
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Upper body: facial telangectasia
Upper body: angiomas
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Lower limb
Beware larger veins
• Higher power is
needed: thermolysis
no longer selective
• Consider longer
wavelength laser (with
cooling)
• Sclerotherapy for the
feeding vein
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Cooling devices
•
•
•
•
Continuous contact
Contact pre-cooling
Cold spray
Continuous air cooling
-Helps
the selective thermolysis
-Reduces pain
IPL (Intense Pulsed Light)
• High intensity light
sources
• Polychromatic noncoherent
• Filters allow adjustable
wavelengths
• Variable pulse durations
• Multiple uses
–
–
–
–
Hair removal
Skin rejuvenation
Pigmented
Vascular lesions
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VeinGogh
EVRF
• Developed from Veinwave
• Veinwave progressed to multi-versatile
generator
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EVRF
EVRF
• CR30i fiber is used to treat
reticular veins from 2 to 5mm.
• The catheter is manipulated with a
sterilized handset.
• Scrolling the handset’s wheel will
move the catheter into or out of
the vein.
CR12i fibers are usedwww.londonvascularclinic.com
for the veins from 1 to 2 mm.
Demerkilic et al
7560 patients treated over 10 years
Effective for fine veins, not for larger
1-3 treatments needed
Two thirds had adjunctive sclerotherapy
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Conclusion
• Consider wavelength,
power, depth, cooling
• Laser and RF very
effective on face
• For legs, the results are
very dependent on the
quality of adjunctive
sclerotherapy
• “The best device
is the one you
are best at using
which is usually
the one you
already own”
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