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Varicose vein laser removal

Laser therapy of leg vein malformations such as varicose veins is one of the most sought after cosmetic corrections nowadays. Its popularity has been on the rise since the development of safer and surer techniques and results. This has been possible with the recent developments in deep-reaching, near-infrared wavelengths with millisecond pulse periods and protective skin-cooling procedures. However, laser therapy is mainly effective for small sized (less than 1 mm) and superficial leg veins. Leg veins with are larger, thicker, deeper, with high hydrostatic pressures or consisting of assorted blood vessels types cannot be easily corrected with lasers. Here is an overview of the technique, types and advancements in laser therapy of leg veins.

Ther laser procedure involved in leg vein therapy

Selective photothermolysis is the process involved in laser therapy. This can be defined as the targeted thermal damage of pigmented tissues by selectively assimilated radiation. The effectiveness of selective photothermolysis is dependent on the following underlying factors:

Wavelength

In selective photothermolysis, the laser wavelength should be such so as to enable the target tissues to selectively absorb the rays up to a sufficient depth to reach the target site. The 532-nm KTP lasers, 585-to 595-nm pulsed dye lasers and IPL devices (500-1100 nm) are suitable for tissue depths less than 1.0 mm.

Near infrared wavelengths such as the alexandrite (755 nm), diode (800 nm, 940 nm) and neody-nium:yittrium-aluminum-garnet (Nd:YAG, 1064 nm) lasers have also proved beneficial for leg veins.

Pulse duration

This means the period of exposure to the laser radiation should ideally not be greater than the time required for the target tissue to cool down and relax. This time is called the ‘thermal damage time’ and is a non-uniform process, since the absorption of radiation is also non-uniform.

Fluence or energy density

This must be sufficient to achieve a temperature suitable to damage the target tissues. If the correct fluence is used its absorption generates the suitable heat that enables the target tissue to retain it and speedily dissipate it, which is the process which triggers off the selective damage. The selective damage by heating is made possible when fluence or energy accumulates at a greater speed than the cooling rate of the target tissue.

Laser beam diameter

There are two aspects of beam diameter:

  1. Larger beam diameters ensure greater penetration of heat in larger, deeper blood vessels. However, it could increase the side effects, especially in case of 1064-nm lasers. Hence, it is best to match beam diameter to the vessel diameter.
    It ensures optimum absorption of radiation and minimum damage to the surrounding structures.
  2. Longer spot size minimizes the diffusion of the ray and hence improves the degree of target tissue access.

Skin cooling

Cooling of the epidermis is essential in laser therapy for leg veins, since it involves very strong radiation, which may cause epidermal injury. Epidermal cooling ensures its protection and also improves its effectiveness by allowing the use of higher fleunces. The various cooling options are:

  • Contact cooling with a sapphire window or copper plate
  • Cryogen spray cooling
  • Convection air cooling
  • Cooling with aluminum rollers or cold gels

Number of laser sessions

After laser therapy, there are certain effects on the optical properties of blood, caused by the heating of the blood vessel. As a result, there is also a change in blood absorption capacity after a laser application. Hence, it is best to use a second laser pulse at lower fluences to reduce side effects. The other way to minimize side effects and discomfort is to first use a pulse with a strongly assimilated wavelength and then another pulse with a more incisive wavelength administered at sub threshold fluences.

Keeping in mind the above factors, these are the laser options applicable in varicose leg vein treatment:

Long pulsed alexandrite lasers

The properties of this laser associated with leg vein treatment are:

  • Wavelength of 755 nm
  • Penetration capacity of 2 to 3 mm
  • Best pulse extent for leg veins is 3 to 20 ms
  • Side effects include, purpura, hyperpigmentation and rarely hypopigmentation
  • Cryogen spray cooling helps lessen treatment discomfort and allows epidermally safe use of fluences up to 80 J/cm2
  • Safe for leg veins in skin phototypes I-III and without any suntan
  • Most effective in vessels with 0.4 mm to 2.0 mm diameter
  • Leg telangiectasia requires higher fluences and proper skin cooling

Diode lasers

The features of a diode laser in leg vein correction are:

  • Wavelengths of 800 nm, 810 nm, and 940 nm with 5-to 250-millisecond pulse durations is best for leg telangiectasia and reticular veins
  • Larger veins require longer wavelengths and pulse durations
  • Discomfort is reasonable to acute
  • Ice packs are a good way to ensure epidermal cooling
  • Side effects include temporary hyperpigmentation and hypopigmentation
  • Follow-ups improve effects
  • Takes 6 months to a year for complete clearance
  • Best for patients with phototypes I-IV and no suntan
  • No safety clearance for treatment of darker pigmented skin as of now
  • The sapphire chilled tip on the 800-nm diode lasers should be well compressed during a laser pulse session to guarantee proper epidermal cooling.

Pulsed neodynium: yittrium-aluminium-garnet (ND:YAG) lasers

Here are the features of this kind of laser applicable for leg vein treatment:

  • Millisecond-domain 1064-nm lasers is effective in the treatment of reticular blue veins and bigger telangiectasia
  • Skin cooling mandatory to avoid epidermal injury. It also works as an analgesic
  • Application of similar wavelengths to bigger vessels may cause considerable pain
  • Cryogen spray-assisted 1064 nm Nd:YAG laser are ideally safe for the correction of 0.3 to 3 mm leg veins
  • The superlong-pulse 810-nm diode laser shows inconsistent effects
  • The 3-millisecond 755-nm alexandrite laser at fluences of 60 to 70 J/cm2 and an 8-mm spot is also effective but shows more side effects
  • The 1064-nm wavelength is safe for type V skin
  • The 810-nm wavelength at very long pulse widths of 400 to 1000 milliseconds is safe for type IV and moderately for type V skin
  • 755 nm wavelengths are good for the type I-III skin with no sun tan
 

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