Transdermal laser reticular and telangiectasias

Transdermal laser reticular and
telangiectasias
Rodrigo Kikuchi
Vascular surgeon
Member of SBACV, SBLMC,ABFL,AVF,ACP, SVS,AFI,ASLMS
Commission Venous Disease SBACV 2012-13 e 2014-15
Institute ofVascular Excellence - Londrina/PR
Vascular Clinical Excellence Sao Paulo- São Paulo/SP
Monday, August 24, 15

Industra (Etherea)
LBT lasers (Harmony),
ORlight
Medsystems (Cutera)
Conﬂict of interest:Training and consulting

Aesthetic aspects of venous disease

pain
thrombosis
edema

pain
thrombosis
edema
It's ugly…

Aesthetics of market growth
128% in 2013
77% in 2014
Brazilian Association of Personal Hygiene, Perfumes & Cosmetics (ABHIPEC)

Aesthetics of market growth
128% in 2013
77% in 2014
Brazilian Association of Personal Hygiene, Perfumes & Cosmetics (ABHIPEC)
earning 136 billion reais

Living Beauty, Research of the French Institute Public Opinion, 2015
Where Brazilian are more willing to invest?

- belly = 58%
- hair = 40%
- buttocks = 32%

- belly = 58%
- hair = 40%
- buttocks = 32%
- legs = 29%

Journal of Cosmetic and Laser Therapy.
2007; 9: 113–124
The use of laser should be considered in patients before
sclerotherapy:
-with needle phobia
-who do not tolerate sclerotherapy
-that fail to respond to sclerotherapy
-who had some unintended effect of sclerotherapy
-that have tendency to form matting
Others
-lean patients with vessels <2mm in diameter or veins in the legs and
ankles
-pacients who do not want or can not tolerate the use of compression
indicated after sclerotherapy

J Vasc Surg 2011;53:2S-48S
Recommendation 12.1
We recommend using liquid sclerotherapy or foam to
telangiectasia, reticular veins and varicose veins of the lower limbs
Recommendation Grade 1 (strong)
Level of Evidence B (moderate)

Techniques involved in venous aesthetic treatment
liquid sclerotherapy
transdermal laser
foam sclerotherapy
endovenous laser
transdermal radiofrequency
endovenous radiofrequency
cryosclerotherapy
sclerotherapy cooling
augmented reality devices
Polarized lenses / transilluminators
photographic documentation
PPG venous
muscle pumping with electrical stimulation
mechanical and chemical ablation
ultrasound to practice aesthetic phlebology

What is the role of transdermal laser?
Others
techniques
transdermal laser

What is the role of transdermal laser?

JVasc Bras. 2013 Mar; 12(1):10-15

Dermatol
Surg
2011;37:1–13
- Literature review on the performance of light sources in the vessels
of the lower limbs
- Although sclerotherapy is widely used lasers exhibit comparable
results
- Nd:YAG 1064nm long pulse laser is the most popular because it acts
in larger and deeper vessels, while promoting more pain
- The variety of lasers and their settings allows to adapt
the treatment to a variety of vascular lesions

Rogachefsky AS, Silapunt S, Goldberg DJ. Nd:YAG Laser (1064 nm) Irradiation for Lower Extremity Telangiectases and
Small ReticularVeins: Efﬁcacy as Measured byVessel Color and Size. Dermatologic Surgery. 2002 Mar;28(3):220–3.
Transdermal laser Results
• single session with bleaching> 75% in 71% of lesions analyzed 3
months after the session

Trelles MA,Weiss R, Moreno-Moragas J, Romero C,Velez M,Alvarez X.Treatment of leg veins with combined pulsed
dye and Nd:YAG lasers: 60 patients assessed at 6 months. Lasers in Surgery and Medicine. 2010 Oct 25;42(9):769–
74.
• one or two sessions with good or very good improvement in 47/60
patients with an interval of 2 months analyzed in 6 months

Trelles MA,Weiss R, Moreno-Moragas J, Romero C,Velez M,Alvarez X.Treatment of leg veins with combined pulsed
dye and Nd:YAG lasers: 60 patients assessed at 6 months. Lasers in Surgery and Medicine. 2010 Oct 25;42(9):769–
74.
• up to 5 sessions at monthly intervals with significant improvement in
80% of vascular lesions of the lower limbs
• one or two sessions with good or very good improvement in 47/60
patients with an interval of 2 months analyzed in 6 months
Ozyurt K, Colgecen E, Baykan H, Ozturk P, Ozkose M.Treatment of Superficial CutaneousVascular Lesions:
Experience with the Long-Pulsed 1064 nm Nd:YAG Laser.The Scientific World Journal. 2012;2012(4):1–7.

Lupton JR,Alster TS, Romero P. Clinical Comparison of SclerotherapyVersus Long-Pulsed Nd:YAG Laser
Treatment for Lower Extremity Telangiectases. Dermatologic Surgery. 2002 Aug;28(8):694–7.
- STS 0.5% x Nd:YAG 1064nm both with two sessions
results not statistically signiﬁcant, but with a tendency to be greater with
sclerotherapy
Comparative results transdermal laser

- Polidocanol 0.5% x Nd:YAG 1064nm single session
results with no statistical difference
Levy JL, Elbahr C, Jouve E, Mordon S. Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser
and sclerotherapy in leg telangiectasias treatment. Lasers in Surgery and Medicine. 2004;34(3):273–6.
sclerotherapy

- Polidocanol 0.5% x Nd:YAG 1064nm single session
results with no statistical difference
Levy JL, Elbahr C, Jouve E, Mordon S. Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser
and sclerotherapy in leg telangiectasias treatment. Lasers in Surgery and Medicine. 2004;34(3):273–6.
- 75% glucose x Nd:YAG 1064nm both with 3 sessions
- Photographic analysis for the laser superior (p = 0.002)
Munia MA,Wolosker N, Munia CG, Chao WS, Puech-Leão P. Comparison of LaserVersus Sclerotherapy in the
Treatment of Lower Extremity Telangiectases:A Prospective Study. Dermatologic Surgery. 2011 Dec 30;38(4):635–
9.
sclerotherapy

At the time becomes an option ...
... we have to know how to use

wavelength: selective absorption of the chromophore targeted for treatment and the
desired depth allowing treatment
spot size: concentration of power under the air-skin interface due to refraction.
pulse duration: Heat conﬁnement (must be less than the TRT so there is the correct
photothermal process in the target chromophore)
ﬂuency or energy: refers to the desired degree of injury (should be kept the balance so
that the thermal damage occurs only at the target treatment and not in adjacent regions)
Fundamental combination
Meesters AA, Pitassi LHU, CamposV,Wolkerstorfer A, Dierickx CC.Transcutaneous laser
treatment of leg veins. Lasers Med Sci (2014) 29:481–492

Journal of the Laser and Health Academy, May 2013, s19
-- ﬁrst pass
4 mm spot, 90 J/cm2, 25 ms
- - second pass
4mm spot, 120-130 J/cm2, 14 ms

- is it possible only
with liquid sclero?
3 days after session
Nd:YAG 1064nm 6mm, 20ms, 80J/cm2 + Glucose 75%

 
Two sessions Nd:YAG
1064nm + Gl 75%
6mm spot size, 15ms, 90J/cm2
3mm spot size, 15ms, 175/cm2

Rua Itapeva, 202 12.andar
Sao Paulo-SP , 01322-000
Patient: Eloiza Rodrigues
Date of Birth: June 8, 1960
Date: 09/09/2014
R Posterior Thigh
July 29, 2014
R Posterior Thigh
Sept. 9, 2014
single session Nd:YAG
1064nm

Single session Nd:YAG
1064nm

3760 South Lindbergh Blvd Suite 101
St. Louis , Missouri 63127
(314) 849-0923
Patient: Tositto Valquiria
Date of Birth: Jan. 1, 1995
Date: 11/29/2014
R Posterior Thigh
Nov. 29, 2014
R Posterior Thigh
Nov. 29, 2014
Single session Nd:YAG
1064nm

Nd:YAG 1064nm 7mm spot size, 20ms, 110J/cm2

Nd:YAG 1064nm 3mm spot size, 15ms, 150J/cm2

What changes with the diode devices?
First 3 videos of treating leg vessels on Google

Diodo 980nm
LIP
Diodo 940nm
First 3 videos of treating leg vessels on Google

- Wavelength: 1064nm diode? 980nm?

- Spot size: 1-5 mm?

- Pulse duration: 10-30 ms?

- Fluency: 60-200 J/cm2?

- Fluency: 60-200 J/cm2?
Can not offer everything at once!

Calculation of Energy and Power of the device
Energy (J)
Pulse duration (s)
Peak power (W) =
Energy (J) = Fluency (J/cm2) x Spot Size (cm2)
Fluency (J/cm2) x Spot Size (cm2)
Pulse duration (s)
Peak power (W) =

30 ou 60W

30 ou 60W
26,333 watts

Pulse duration (s)
Peak power (W) =
Fluency (J/cm2)
Peak power (W) x pulse duration (s)
=
Spot Size (cm2)

Pulse duration (s)
Peak power (W) =
Fluency (J/cm2)
=
Spot Size (cm2)
- Increase the duration
- Reduce the spot size

Pulse duration (s)
Peak power (W) =
Fluency (J/cm2)
=
Spot Size (cm2)
- Increase the duration
- Reduce the spot size
Will be restricted to small vessels, surface and in patients
Fitzpatrick 1 and 2

Int. J. Med. Sci. 2009; 6(6):358-364
Diodo 980nm
Fluency between 80-100J cm/2
spot 2mm
pulse duration 60ms

Diodo 980nm 2mm spot size, 70ms, 60W, 105J/cm2 Dr. Fadul J, Quito-Equador

Journal of Cosmetic and Laser Therapy, 2014; Early Online: 1–8

J Am Acad Dermatol 2003;48:76-81
- 7mm spot size, 50ms, 100J/cm2

Programmed settings for Diode 980nm or 1064nm
spot size
potencia do
aparelho
duração de pulso
0,5mm 1mm 40W 70ms
0,5mm 1mm 60W 46ms
0,5-1mm 2mm 40W 100ms
0,5-1mm 2mm 60W 66ms
1mm-2mm 2mm 40W 130ms
1mm-2mm 2mm 60W 86ms
Fonte: consultoria técnica ORlight Laser

Final considerations:

- the laser is a useful and efﬁcient tool, but requires a proper management

- It is possible and is a choice laser treatment of reticular veins and
telangiectasias

telangiectasias
- Although there are various protocols the most appropriate setting
depends, besides knowing the parameters, to know what the device in use
offers

telangiectasias
- Although there are various protocols the most appropriate setting
depends, besides knowing the parameters, to know what the device in use
offers
Be aware to provide a technique to his patient, even one that only
seeks to aesthetics.You will be charged!

Cursos de Aperfeiçoamento Teórico-Prático em:
Espuma Ecoguiada

Cursos de Aperfeiçoamento Teórico-Prático em:
Espuma Ecoguiada
Individual ou
em
dupla

Recomendado!

kikuchi@excelenciavascular.com.br
www.excelenciavascular.com.br
área destinada para médicos
+55 (11) 98111-9901

Transdermal laser reticular and telangiectasias

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