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The revolution in treatments for venous incompetence includes combinations of lasers and sclerosing technologies for leg veins, along with the gold standard of pulsed dye lasers for facial telangiectasias, hemangiomas and port wine stains, according to Neil Sadick, M.D.
Successful treatment requires choosing the right wavelength to target blood vessels lying at different levels within the dermis, or those with thicker or thinner endothelial linings, says Dr. Sadick, clinical professor of dermatology at Weill Cornell Medical College, New York.
"For facial telangiectasias, several wavelengths can be utilized. For very discrete blood vessels, one can use a very short wavelength 532 nm KTP laser. The gold standard for smaller vessels is the pulsed dye laser, at 585 to 600 nm," along with intense pulsed light (IPL) with cutoff filters at 500 nm to 1,000 nm, he says.
"For deeper flushing syndromes, we like using the intermediate-pulsed 1,064 nm Nd:YAG laser, particularly for diffuse flushing syndromes, for deeper and larger blood vessels and for darker skin phenotypes and periorbital veins," he says.
In treating hemangiomas, Dr. Sadick says, "The pulsed dye laser is the gold standard for superficial lesions. But for deeper lesions, we sometimes use other wavelengths." For example, he says that for thicker, deeper lesions, "We might use a 1,064 nm Nd:YAG laser, or a 755 nm alexandrite laser. For more superficial vessels, we may also occasionally use a very short-wavelength 532 nm KTP laser."
For port wine stains, "We sometimes use combination approaches as well," he says. "We usually treat the superficial vessels first, then the deeper, more recalcitrant vessels. Multiple treatments may be necessary. But again, the pulsed dye laser is the gold standard. And we now treat these lesions earlier in life because this approach is associated with fewer treatments and better outcomes."
For leg veins, Dr. Sadick says he typically uses external lasers including the gold standard long-pulsed 1,064 nm Nd:YAG to target spider veins.