Sponsored by Wontech
Cutaneous vascular disorders have been treated with a variety of medical methods, from sclerotherapy to energy-based devices like lasers and intense pulsed light (IPL), and even surgery. According to the extended theory of selective photothermolysis, long-pulsed lasers are preferred, with various wavelengths having been used to treat vascular lesions effectively and safely, including 577 nm, 585 nm, 595 nm, 532 nm, 755 nm, 1064 nm and others.
Owing to its feature of a higher absorption coefficient in hemoglobin, pulsed dye laser (PDL) is one of the most commonly used devices to treat vascular lesions, such as telangiectasia, rosacea and so forth. However, PDL has a train pulse associated with microseconds, which can cause blood to leak from the vessel wall and result in purpura. Also, since the medium is a consumable dye, high maintenance costs are required.
Studies have shown that KTP provides a similar effect to PDL, but with the added benefit of improved comfort and reduced purpura, making it a suitable alternative wavelength. With a higher absorption coefficient in hemoglobin, it delivers a smooth pulse profile, rather than a spiky profile duration, which results in a reduction in the incidence of purpura when treating vascular lesions.
I personally use the long-pulsed KTP and Nd:YAG laser, V-laser, developed by Wontech, Ltd., Co. (Daejeon, South Korea), and am very satisfied with its performance and clinical outcomes.
V-laser has a square-shaped pulse and is called a true long pulse. The pulse duration can be adjusted over a wide range, allowing physicians to modify the pulse width based on the size of the lesion. For smaller vascular lesions sized less than 1 mm, 10-12 ms are typically used, and for larger vascular lesions from 2-4 mm, 20-40 ms are used.
The V-laser system has a dual wave-length of 532 nm and 1064 nm. I use the 532 nm KTP to treat red and superficial lesions, such as telangiectasia, cherry angioma, rosacea, hemangioma and diffuse redness, while the 1064 nm Nd:YAG is used for the treatment of blue and deep veins like venulectasia, reticular veins and others.
For leg veins larger than 2-3 mm, surgery is normally required. However, I have achieved very satisfactory clinical results using the V-laser. Patients are also satisfied with the V-laser treatment due to improved comfort and minimal post-treatment complications compared to surgery.
A 3 mm spot size is commonly used for vascular lesions, but occasionally a 5 mm spot size is used. However, it is important to remember that for safe and effective procedures with larger spot sizes, you must fine-tune the parameters and cooling temperatures.
The V-laser is equipped with a contact cooling system that is extremely efficient in increasing procedural comfort and skin cooling with no consumables. And the sapphire window is large enough to provide a perfect view of the treatment area. Cooling temperatures can be adjusted in five steps (off, 5° C, 10° C, 15° C, 20° C) so that treatment can be performed at the proper temperature for each lesion.
Clear gel is used when treating vascular lesions because colored gels can react to the laser energy. The gel improves cooling capability, which increases comfort and helps prevent thermal damage.
With a long-pulsed KTP and Nd:YAG, benign pigmented lesions can also be treated (i.e. lentigines, dyschromia, freckles, pigment, post-inflammatory hyperpigmentation, poikiloderma, etc.). While benign pigmented lesions are frequently treated with Q-switched lasers, by delivering a photothermal effect instead of a photomechanical effect, a long-pulsed laser delivers a gentler treatment in terms of adverse side effects and downtime.
Even melasma can be treated with KTP and Nd:YAG. KTP works as a pigment remover and Nd:YAG is used to cut down the feeding vessels and/or improve the dermal environment.
The dual wavelength can also be used in other indications, including inflammatory lesions and skin rejuvenation. V-laser effectively treats inflammatory lesions such as acne vulgaris, providing photo-dynamic effects on P. acnes and sebaceous glands.
For skin rejuvenation, the 532 nm KTP removes pigmentation and diffuse redness, and improves dull skin tone. The 1064 nm delivers bulk heating to the dermis, thus stimulating fibroblasts for neocollagenesis. In addition, the combination of V-laser treatment with hyaluronic acid and/or neurotoxin can provide dramatic skin rejuvenation and skin revitalization outcomes.
The V-laser has a variety of spot sizes in the form of cartridges so you can choose a spot size that is appropriate for the treatment area and/or lesion. Another advantage is that even if one cartridge is broken, you don’t need to replace all of the cartridges.
Another thing to emphasize with the V-laser system is that it is designed to delay the first laser irradiation about 0.5 seconds. This reduces KTP damage, thus decreasing the need for maintenance and increasing the lifetime of the device.
Most patients who come to my clinic desire solutions for vascular and/or pigmented lesions and skin rejuvenation. The V-laser’s versatility and ease of use allow me to treat all of these indications and more, safely and effectively.
About the Author
Zbigniew Matuszewski, MD
Dr. Matuszewski founded the Laser Studio in Poland in 1998. He has been fascinated with the possibilities of lasers in medicine since he first started practicing medicine. He has developed a number of original laser techniques and practices, and each treatment plan is individually designed for each patient. After more than 20 years of professional experience, Dr. Matuszewski has invented a number of successful and innovative aesthetic and surgical procedures, many of which are only performed at Laser Studio.