Cosmetic, non-invasive treatments for the skin, especially the face and neck, are increasing exponentially throughout the world. Australia is no exception.
Aesthetic lasers have become ubiquitous since the recent downregulation of industry requirements in Western Australia to own or operate these devices. There is a plethora of devices, clinics, and operators of varying standards.
An understanding of this area should assist doctors when asked, to appropriately guide their patients.
Lasers are used for the treatment of a variety skin conditions, depending upon the device and experience of the operator. Tattoo removal and hair reduction are the most common treatments. Other skin treatments include wrinkle reduction, rejuvenation, resurfacing, pigmentation reduction and scar improvement.
The treatment of vascular lesions is less known. Laser treatment of many vascular lesions is a safe, effective, and cheaper alternative to surgery.
Laser emits coherent light of a single wavelength and controlled energy. This light is used as a treatment modality.
Light penetrates variably through the skin, and this is determined by the wavelength and the diameter of the beam.
In 1960, Theodore Maiman developed the first (ruby) laser for clinical application. Then, in 1963, Goldman demonstrated the effects of Maiman’s laser in selective photo destruction of pigmented skin elements such as black hair.
Rapidly, ruby and Q-switched lasers were developed for tattoo removal and pigmented lesions, the argon laser for vascular lesions and carbon dioxide lasers for skin lesion destruction. Ultimately the Nd: YAG laser (1064nm) and the Alexandrite (755nm) were developed.
Mechanism of action in vascular treatment
Both the 755nm and 1064nm wavelengths target haemoglobin. In turn, haemoglobin absorbs the laser light which is converted to heat that diffuses to vessel walls. These walls become damaged and collapse upon themselves and then reabsorbed over several weeks.
The 1064nm laser is usually used for the treatment of vascular lesions as it is not absorbed by the melanin as much as 755nm, therefore minimising risk of epidermal damage. The 1064nm can be used to treat all Fitzpatrick* skin types.
It penetrates more deeply than 755nm and is therefore used for deeper, larger vessels (up to 3mm in diameter). As haemoglobin absorption of 755nm is double that of 1064nm, it is more effective vessel heating.
The 755nm is appropriate for treatment by experienced operators for vascular lesions in patients with Fitzpatrick I-III only.
Commonly treated vascular lesions include:
- Facial telangiectasia, small, dilated vessels (diameters between 0. 1 and 1. 0mm)
- Leg or ‘spider’ veins. These affect approximately 80% of women with age hormones and genetics as contributing factors. Veins under 2mm will respond best
- Haemangioma – the most common benign tumours of childhood
- Port wine stain – are usually congenital and are composed of ectatic capillary malformation in the upper layer of the dermis
- The laser treatment of vascular lesions is best undertaken by experienced operators using high quality devices in a clinic with excellent quality control.
Alternatives to laser treatment of vascular lesions such as surgery or sclerotherapy should also be considered in the management of patients seeking advice on such lesions.
Any clinic operating a cosmetic laser and undertaking such work should refer the patient to their GP if the lesion the patient is concerned about is not suitable.
Key messages
- Demand for non-invasive cosmetic treatments is increasing
- Specific Laser treatment targets haemoglobin
- Laser therapy has a role in treating various skin concerns, including vascular lesions.
– References available on request
Author competing interests – the author owns a non-surgical cosmetic clinic.
* Fitzpatrick Skin Type is graded on a scale 1 to 6. It is an estimate of the melanin in the skin of an individual. As melanin also absorbs the laser energy and reacts to it, treatments must consider this.