Treatment of Leg Telangiectasias Using a 650-microsecond Pulsed Nd:YAG 1064nm Laser

James Newman, MD, Natalia Geraskova, MD, Center for Facial Plastic Surgery, San Mateo, CA; Laser Cosmetic Clinic “Loreksiniya”, Dubna, Russia

 Background and Objectives:
Nd Yag Lasers with 20-30 millisecond pulse widths are traditionally used to treat cosmetic leg veins, with well documented side effects of bruising and discomfort particularly with large areas treated. This study was conducted to evaluate the safety and clinical efficacy of a novel short pulsed, 650 microsecond pulsed 1064nm NdYag laser for the treatment of lower extremity telangiectasias.

Study Design and Methods: Adult female subjects with Fitzpatrick Skin types I-III with leg telangiectasias 0.2-3mm in diameter covering at least 20cm2 were selected for individual laser treatment sessions at 4 week intervals until satisfactory clinical clearance was observed. Laser treatment parameters varied depending on the size, quantity, and density of vessels as follows
Vessels with less than 1mm diameter- Spot size of 2mm, Fluence 127J/cm2, pulse width of 650microseconds
Vessels with diameter 1-3mm-Spot size 2-3mm, Fluence 159-223J/cm2, pulse width of 650 microseconds. Ice pack was used for precooling for 20-30 seconds prior to laser.
The vessels were treated for the full length and observed for clearance. Adverse events of discomfort, blistering, crusts, scars and duration of erythema were monitored for the first 4 weeks after treatment. Photos were taken before and immediately after treatment and at 4 weeks and 12 weeks after treatment. Follow up continued for 12 months to evaluate for recurrence.

Results: 22 female subjects were treated on the lower extremities. 72% of subjects showed substantial improvement at 4 weeks after the first treatment. 96% of patients showed substantial improvement 3 months after the third treatment. In all subjects mild erythema appeared immediately after treatment and lasted for 3-24 hours. Small vessels frequently disappeared during the treatment while larger vessels over 1 mm changed color by darkening. 5 patients exhibited light brown crusting along the coagulated vessel which did not leave any permanent marks by the 3 month follow up appointment. There were no burns, scarring or hyperpigmentation observed in any of the patients. Pain was rated as mild during the treatment sessions.

Conclusion: Lower extremity telangiectasias ranging from.1-3mm can be treated safely and effectively in skin types I-III with a novel 650 microsecond pulsed Nd Yag Laser with minimal discomfort.

As published at the 2016 Annual Meeting of the American Society for Laser Medicine & Surgery ASLMS

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