Treatment of blood vessels on the face and body can be performed safely and effectively using lasers and light devices. Blood vessels are located beneath the epidermis (superficial skin) in the dermis of the skin. Procedures to remove unwanted vessels need to be able to reach these deeper structures without damaging the epidermis. Lasers and light devices can accomplish this using a method termed ‘selective photothermolysis’. Basically, this means that the light gets selectively absorbed by the target (blood vessels for example) without damaging the surrounding tissues. Hemoglobin, the oxygen carrying component of blood, is able to absorb light of different wavelengths. Various lasers can be used targeting hemoglobin and sparing the other tissues.
Vascular lasers and light devices come in a variety of wavelengths. Hemoglobin can absorb light at many different wavelengths, which means that many devices exist for possible use. Short wavelength devices such as the potassium titanyl phosphate laser (KTP, 532nm), and the pulsed dye laser (PDL 585, 595nm) are popular choices since hemoglobin easily absorbs light at these wavelengths. However, short wavelengths sometimes don’t penetrate to a deep enough level, making treatment of areas with thicker skin, typically off the face, more difficult. Longer wavelengths, with deeper penetration, can also be used. The Neodynium Yag laser (Nd:Yag, 1064nm) and several diode lasers (800-940nm) are employed on thicker skin areas, and on deeper vessels, such as those of the legs. These wavelengths are less well absorbed by hemoglobin, but penetrate deeper. The Alexandrite laser has also recently been used for vascular lesions. With a wavelength of 755nm, its properties lie somewhere between the two groups described above. Though, at the current time, the primary use of the Alexandrite laser is still for laser hair removal and pigmented lesions. Intense pulsed light devices (IPLs) are also used to treat vascular lesions and have recently been gaining in popularity for this indication. Several vascular lasers of the past (argon, copper vapor, krypton) are no longer in use due to their increased risk for complications.
Vascular lasers can be used to treat various conditions besides telangiectasias (blood vessels). Red lesions of the skin also respond well to these treatments. Acne, acne scarring, hypertrophic (raised and thick) scars, hemangiomas, port wine stains, striae (stretch marks), photodamage, rosacea, and verrucae (warts) are other common uses for vascular lasers. All of these conditions have one thing in common, and that is the color red. Most red lesions will absorb the light emitted by vascular lasers and are possibilities for treatment with these devices.
The shorter wavelengths vascular lasers are also absorbed by melanin in the skin. Melanin gives skin dark color. For this reason, these devices come equipped with a cooling attachment. The cooling protects the epidermis from the laser, while the laser penetrates deeper into the dermis where the vessels are located. Without cooling, treatment with the short wavelength vascular lasers (PDL, KTP) can burn the epidermis. The longer wavelength lasers (diodes and Nd: Yag) are not well absorbed by melanin and pose less of a risk for epidermal damage, though it can occur. That being said, the short wavelength lasers with proper cooling can be used safely and effective in dark skin types.
The procedure is slightly different depending on which laser is used. Most of the vascular lasers do not require numbing cream. Treatment of vascular birthmarks (hemangiomas or port wine stains), or treatment of pediatric patients warrants topical anesthesia. Several sessions for optimal results are generally required. However, one session will show improvement. Treatment sessions last from 5 minutes to 30 minutes depending on the area being treated. Prior to treatment the face should be clean and free of any topicals, including sunscreen or makeup. After treatment, the skin can stay red for up to 48 hours. Some treatments with the pulsed dye laser can leave the skin with bruising for 5-7 days. Bruising is as result of the vessels being broken by the laser. This is not considered a complication, but can be difficult to conceal with makeup. Treatment of vascular birthmarks is typically performed at doses that cause bruising, but treatment of other conditions use lower energies and have little to none.
The pulsed dye laser (PDL) has been the workhorse of the vascular lasers for a long time. It has always been considered to be the most effective of its group. In recent studies, however, several new IPLs have been shown to be at least as effective in some cases. PDL is still the most popular of the vascular lasers, but expect others to gain recognition as these devices become more sophisticated.
Laser treatment for any indication should be tailored to the each specific case. For vascular lasers, this includes the size of the vessel, the depth of the vessel, the patient’s skin type and location of the area to be treated. The laser’s parameters (wavelength, cooling, treatment time etc.) should be adjusted for optimal efficacy and safety with each treatment.
Possible complications of vascular lasers include pigment changes, erythema (redness), crusting and blistering. Blistering can lead to scarring. In addition, dark hair will be temporarily removed in the area of treatment, but will re-grow after treatment. Protective eyewear should be worn by everyone in the room at all times when the laser is in operating mode.