Laser mix-and-match

"For violaceous vascular lesions, we use a 755 nm alexandrite laser, the GentleLase (Candela), which has previously been used for hair removal," says Suzanne Kilmer, M.D., director of the Laser and Skin Surgery Center of Northern California and associate clinical professor at the University of California, Davis, a presenter at the conference.

"The technique takes advantage of the deoxyhemoglobin absorption peak, as the longer wavelength allows for deeper penetration," she tells Dermatology Times.

"The 1064 nm is absorbed by both oxygenated or deoxygenated hemoglobin and penetrates even deeper than the 755 nm, but is a little riskier for port wine stains and some other vascular lesions because the response is more unpredictable," she says. "It can cause ulceration, which can lead to scarring. Still, the newer models offer distinct advantages over the older models. With traditional pulsed dye lasers, you often had leftover blood vessels, because the laser couldn't penetrate deeply enough."

Combination Dr. Kilmer says newer models may often be used in non-ablative laser rejuvenation, often in conjunction with more traditional models, to treat acne, acne scars and sebaceous hyperplasia.

"If they have more brown spots, you might want to start out with the more standard intense pulsed light devices, whereas if they have vessels or erythema, start with the pulsed dye laser, which will not only treat the vascular component, but will also help with collagen remodeling," she suggests. "For those patients who are more acne-prone, you can then use a SmoothBeam (Candela) on the next visit."

Dr. Kilmer offered one more pearl for conference-goers: The use of the topical anesthetic EMLA not only helps reduce pain in ablative resurfacing patients, but drastically reduces side effects and shortens recovery time.

"The use of EMLA hydrates the skin and allows the laser to work more evenly," says Dr. Kilmer, who has used this method effectively for about nine years. "With our technique, we've found a less than 1 percent chance of hyper- or hypopigmentation, whereas the standard risk is about 10 percent. Also, we experience a re-epithelialization period of only about seven days, whereas the standard is about 20 days."

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