Thermal relaxation of port-wine stain vessels probed in vivo: the need for 1-10-millisecond laser pulse treatment

Lasers and Nonsurgical Modalities

Head and neck vascular pathology is routinely encountered by the maxillofacial surgeon. Although these anomalies have been traditionally managed by surgical means, adjunctive therapies have been popularized in recent years. The use of laser therapy has gained attention for its ability to better access and to provide more predictable outcomes in the highly intricate and vascular areas of the head and neck. Laser therapy allows for the selective targeting of diseased tissue while maintaining the integrity of surrounding healthy tissue.

Assessment of the efficacy of 595 nm pulsed dye laser in the management of facial flat angiomas. Results of a case series

BACKGROUND

Studies on pulsed dye laser (PDL) have shown the best efficacy and safety data for treating vascular anomalies among the various lasers used and the 595-nm PDL has been used to treat cutaneous vascular anomalies for about 30 years. The purpose of this study was to assess the efficacy of 595 nm Pulsed Dye Laser in the management of facial flat angiomas present in the form of Port-Wine Stain.

MATERIALS AND METHODS

Seven cases of PWS in Fitzpatrick skin type ranged from I to III and colour ranging from pink to purple, were treated with 595 nm pulse Dye Laser. Patients underwent to 6-8 laser sessions at 20-30 days intervals. Results obtained were judged by dermatologist, by comparing pre-treatment and post-treatment photographs, 6 months after the last session and a quartile scale of lesion clearance (4-point Investigator Global Assessment scale): 1 = no or low results (0%-25% of the lesion area improved), 2 = slight improvement (25%-50% of the lesion area cleared), 3 = moderate-good improvement (50%-75%), and 4 = excellent improvement (75%-100%) was used. Possible side effects such as blisters, hyper/hypopigmentation, and scarring were monitored.

RESULTS

All patients observed global improvements. 71% of patients achieved excellent clearance and 29% patients achieved good-moderate clearance of their angioma. Patients were asked for a subjective evaluation of the results: 57% of patients were very satisfied, 29% were satisfied, and 14% patients were not very satisfied with the results. No patients were dissatisfied. No significant side effects were noted.

CONCLUSION

This research confirms the efficacy of the 595 nm PDL for flat angioma management, without considerable side effects.

Lasers for cutaneous lesions: An update

There are several types of medical settings which use lasers. Dermatologists use lasers as it is non-invasive with preferential cosmetic outcomes and finer wound healing. The types of lasers are relying on their wavelengths and delivery systems. Over time, by using several distinct devices and strategies, new lasers have been generated; as a consequence, they are manipulated in a wide range of dermatological settings. In this review, laser applications in various vascular, infectious, and hyperpigmented cutaneous lesions were framed. We aimed to represent the fitness of phototherapy for each condition as well as the overall challenges that face laser. In addition, low-level laser therapy, and laser resurfacing were noted as the marketable line of lasers in the current time for cosmetic purposes.

Laser and Light-Based Device Education in a Plastic Surgery Residency Program: A Continuing Medical Education Overview

The increasing prevalence of laser use, particularly in plastic surgery, demands education of both practitioners and trainees to ensure efficacy and patient safety. The purpose of this continuing medical education module is to provide the learner with a detailed outline for laser training education for plastic surgery trainees. In this overview, a discussion of the characteristics of light, an introduction to fundamental laser principles, a comparison of lasers and pulsed light systems, and examples of several therapeutic applications for light-based devices in the clinical setting will be presented. Additionally, the 5 parameters necessary for operation of light-based devices, as well as the importance of laser safety education, will be reviewed. We hope this continuing medical education will provide both practicing plastic surgeons and trainees with the proper education on the lasers and pulsed light devices they will use in their clinical practices.

Blue Laser (450 nm) in the Treatment of Port Wine Stains and Telangiectasia

This study aimed to test a blue light source for the treatment of port wine stains (PWS) and telangiectasia and to compare this with the application of green and yellow lasers based on data in the literature. A total of 22 patients with PWS were treated with radiation from a novel, high-power 450 nm blue laser that was created for this project. The group contained 15 patients with red PWS and 7 with pink PWS. The best results were achieved for red PWS, using 15–20 ms light pulses and 47 W power. For patients with pink malformations, the results were unsatisfactory. The group with telangiectasia consisted of six patients with facial lesions and three with leg lesions. The recovery was completed for all patients with facial telangiectasia, while the blue laser therapy was ineffective for patients with leg telangiectasia. This study shows that, in some cases, the use of a blue laser may be an alternative to the use of green and yellow lasers.

Light-based treatment of pediatric port-wine birthmarks

Port-wine birthmarks (PWBs) are progressive vascular malformations with significant disfigurement and psychosocial morbidity; early light-based treatment has shown improved outcomes in the pediatric population. Somatic mosaic mutations underly the progressive nature of PWBs and explain the significant differences in response and heterogeneity of vessel architecture in the pediatric population when compared to the adult cohort. Here, we summarize a review of pediatric specific literature on the various light-based treatment modalities, including pulsed dye laser, near-infrared lasers, and intense pulsed light, providing the various indications, tips, advantages, and disadvantages for the pediatric dermatologist.

Artificial red blood cells increase large vessel wall damage and decrease surrounding dermal tissue damage in a rabbit auricle model after subsequent flashlamp-pumped pulsed-dye laser treatment

Artificial red blood cells (i.e. hemoglobin [Hb] vesicles [Hb-Vs]) function effectively as photosensitizers in flashlamp-pumped pulsed-dye laser (PDL) treatment for port-wine stains in animal models. Hb-Vs deliver more Hb to the vicinity of the endothelial cells. Both Hb-Vs and red blood cells absorb the laser energy and generate heat, supporting the removal of very small blood vessels and deeper subcutaneous blood vessels with PDL irradiation in in vivo experiments. Here, we analyzed the photosensitizing effect of Hb-Vs in PDL irradiation on large blood vessels and surrounding soft tissues. We histopathologically analyzed markers of damage to the large vessels and surrounding dermal tissue in a rabbit auricle model following PDL irradiation alone or subsequent to the addition of intravenous Hb-V injection. Markers were graded on a five-point scale and statistically compared. The changes in laser light absorption and reflection in a human skin model caused by the administration of Hb-Vs were evaluated using Monte Carlo light-scattering programs. Histological markers of damage to blood vessels were significantly greater in Hb-V-injected arteries and veins measuring 1-3 mm in diameter as compared with the controls. However, Hb-V injection significantly reduced PDL-induced necrosis and hemorrhage in the surrounding tissues. During computer simulation, photon absorption increased within the vessel layer and decreased around the layer. Intravenous Hb-Vs increase the extent of damage in larger vessel walls but significantly reduce damage to the surrounding skin after subsequent PDL irradiation. These beneficial effects are the result of improving vessel selectivity by Hb-Vs in vessels. Hb-V administration prior to PDL irradiation therapy could mechanically improve the outcomes and safety profiles of port-wine stain treatment protocols.

Retrospective study of the treatment of port-wine stains with 595-nm pulsed dye laser in 261 Chinese patients

Pulsed dye laser (PDL) at the wavelength of 595 nm is the common choice for the treatment of port-wine stains (PWSs). In this study, the efficacy of 595-nm PDL in treatment of PWSs in Chinese patients was investigated. A follow-up visit was performed on 261 Fitzpatrick skin type II-III Chinese patients with PWS who received more than two treatments with 595-nm PDL. Based on cosmetic improvement, treatment response was graded as follows: complete, if color blanching was > 90%; significant, if color blanching was 60-90%; moderate, if color blanching was 30-60%; and poor, if color blanching was < 30%. The efficacy of laser treatment on patients of different treatment numbers, ages, lesion locations, lesion colors, extents of hypertrophy, and laser pulse durations was evaluated. All patients improved following an average of almost 4 to 5 laser treatments. The earlier the intervention, the better the efficacy was. Lesions on cheek, neck, and forehead were better than that those on oral, eye periorbital, and nose areas. The purple group had a more excellent clearance, i.e., complete and significant clearance rate (53.6%), than the red group (36.1%). Treatment effect became worse as the extent of lesion hypertrophy increased. PWS lesions treated with short pulse durations of 0.45, 1.5, and 3 ms had better clearance (complete and significant clearance) rate of 56.5% than those treated with pulse durations of 6 ms or longer (34.8%). Pulsed dye laser with 595-nm laser equipped with dynamic cooling device is an effective option for the treatment of PWS in Chinese patients. Younger patients with lateral face position, larger vessel size (deeper color), and lesser hypertrophy received better clinical effect than the others. Treatment with short pulse duration of less than 3 ms for 4 to 5 times was recommended to treat PWS.

Strategies to prevent hypertrophic scar formation: a review of therapeutic interventions based on molecular evidence

Once scar tissues mature, it is impossible for the surrounding tissue to regenerate normal dermal tissue. Therefore, it is essential to understand the fundamental mechanisms and establish effective strategies to inhibit aberrant scar formation. Hypertrophic scar formation is considered a result of the imbalance between extracellular matrix synthesis and degradation during wound healing. However, the underlying mechanisms of hypertrophic scar development are poorly understood. The purpose of this review was to outline the management in the early stage after wound healing to prevent hypertrophic scar formation, focusing on strategies excluding therapeutic agents of internal use. Treatment aimed at molecular targets, including cytokines, will be future options to prevent and treat hypertrophic scars. More basic studies and clinical trials, including combination therapy, are required to investigate the mechanisms and prevent hypertrophic scar formation.

Numerical Modeling and Clinical Evaluation of Pulsed Dye Laser and Copper Vapor Laser in Skin Vascular Lesions Treatment

Introduction: Different yellow lasers have been successfully used for the treatment of vascular lesions. This study is aimed to ascertain the role and efficiency of copper vapor lasers (CVLs) and pulsed dye lasers (PDLs) for the treatment of vascular lesions using numerical modeling and to compare results with our clinical experience. In this study we aimed to develop criteria for the choice of more efficient laser exposure mode, investigate more relevant modes of laser irradiation to ensure selective photothermolysis of target vessels, and compare the CVL and PDL efficiency in the course of patients with skin vascular lesions (SVL) treatment. Methods: We performed numerical simulation of the processes of heating a vessel with CVL and PDL to temperatures at which its coagulation could occur. Calculated fluencies were compared with clinical results of laser therapy performed on 1242 patients with skin hemangiomas and vascular malformations (SHVM), including 635 patients treated with CVL and 607 patients treated with PDL. PDL and CVL provided excellent results in 40 and ten days after treatment. The treatment was not painful. Patients did not need anesthesia. Postoperative crusts were greater with PDL than with CVL. Results: Results of computer simulation of a selective vessel heating using PDL and CVL radiation are presented. By results obtained, depth of the location and sizes of vessels that could be selectively heated to more than 75°C are determined. Conclusion: Based on calculated and clinical data, the heating mode for dysplastic vessels using a series of CVL micropulses could be regarded to be safer and more efficient than the mode of a PDL short, powerful pulse.

Precise Spatially Selective Photothermolysis Using Modulated Femtosecond Lasers and Real-time Multimodal Microscopy Monitoring

The successful application of lasers in the treatment of skin diseases and cosmetic surgery is largely based on the principle of conventional selective photothermolysis which relies strongly on the difference in the absorption between the therapeutic target and its surroundings. However, when the differentiation in absorption is not sufficient, collateral damage would occur due to indiscriminate and nonspecific tissue heating. To deal with such cases, we introduce a novel spatially selective photothermolysis method based on multiphoton absorption in which the radiant energy of a tightly focused near-infrared femtosecond laser beam can be directed spatially by aiming the laser focal point to the target of interest. We construct a multimodal optical microscope to perform and monitor the spatially selective photothermolysis. We demonstrate that precise alteration of the targeted tissue is achieved while leaving surrounding tissue intact by choosing appropriate femtosecond laser exposure with multimodal optical microscopy monitoring in real time.

Single-exposure optical focusing inside scattering media using binarized time-reversed adapted perturbation

Light scattering inhibits high-resolution optical imaging, manipulation and therapy deep inside biological tissue by preventing focusing. To form deep foci, wavefront shaping techniques that break the optical diffusion limit have been developed. For in vivo applications, such focusing must provide high gain, high speed, and a high focal peak-to-background ratio. However, none of the previous techniques meet these requirements simultaneously. Here, we overcome this challenge by rapidly measuring the perturbed optical field within a single camera exposure followed by adaptively time-reversing the phase-binarized perturbation. Consequently, a phase-conjugated wavefront is synthesized within a millisecond, two orders of magnitude shorter than the digitally achieved record. We demonstrated real-time focusing in dynamic scattering media, and extended laser speckle contrast imaging to new depths. The unprecedented combination of fast response, high gain, and high focusing contrast makes this work a major stride toward in vivo deep tissue optical imaging, manipulation, and therapy.

Use of optical skin phantoms for preclinical evaluation of laser efficiency for skin lesion therapy

Skin lesions are commonly treated using laser heating. However, the introduction of new devices into clinical practice requires evaluation of their performance. This study presents the application of optical phantoms for assessment of a newly developed 975-nm pulsed diode laser system for dermatological purposes. Such phantoms closely mimic the absorption and scattering of real human skin (although not precisely in relation to thermal conductivity and capacitance); thus, they can be used as substitutes for human skin for approximate evaluation of laser heating efficiency in an almost real environment. Thermographic imaging was applied to measure the spatial and temporal temperature distributions on the surface of laser-irradiated phantoms. The study yielded results of heating with regard to phantom thickness and absorption, as well as laser settings. The methodology developed can be used in practice for preclinical evaluations of laser treatment for dermatology.

Current status of surgery in dermatology

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

An overview of three promising mechanical, optical, and biochemical engineering approaches to improve selective photothermolysis of refractory port wine stains

During the last three decades, several laser systems, ancillary technologies, and treatment modalities have been developed for the treatment of port wine stains (PWSs). However, approximately half of the PWS patient population responds suboptimally to laser treatment. Consequently, novel treatment modalities and therapeutic techniques/strategies are required to improve PWS treatment efficacy. This overview therefore focuses on three distinct experimental approaches for the optimization of PWS laser treatment. The approaches are addressed from the perspective of mechanical engineering (the use of local hypobaric pressure to induce vasodilation in the laser-irradiated dermal microcirculation), optical engineering (laser-speckle imaging of post-treatment flow in laser-treated PWS skin), and biochemical engineering (light- and heat-activatable liposomal drug delivery systems to enhance the extent of post-irradiation vascular occlusion).

Laser treatment of pediatric vascular lesions

Since its introduction in 1967, laser therapy has benefited patients and physicians alike. After the first clinical application by Goldman (Anderson RR, Parrish JA. Science 1983;220:524-527), laser therapy has become indispensable in the management of vascular birthmarks. In selecting a proper balance of wavelength, pulse duration, and energy density (fluence), the physician can mold laser energy to effectively manage lesions once considered untreatable. Now, the vast array of lesions amenable to laser therapy continues to expand. By advancing our understanding of both laser technology and vascular lesion biology, the goal of providing optimal clearance with minimal morbidity moves ever closer.

TUNEL assay to characterize acute histopathological injury following treatment with the active and deep FX fractional short-pulse CO2 devices

BACKGROUND

This is a report of the histopathological evaluation of the acute damage profile in human skin following treatment with two novel short-pulsed fractional carbon dioxide resurfacing devices used independently and in combination in vivo.

METHODS

The panni of eight abdominoplasty patients were treated with either the Active FX, the Deep FX (Lumenis Ltd., Yokneum, Israel), or a combination of the two (Total FX) prior to the start of the excisional surgical procedure. Multiple combinations of energies, pulse widths, and densities were evaluated for each device. After surgical removal (two to five hours), each pannus was immediately biopsied and samples were processed for histopathological evaluation.

RESULTS

The Active FX system resulted in extensive epidermal injury with wide shallow ablation craters that, at higher fluences, extended through the basement membrane of the epidermis into the papillary dermis. The Deep FX fractional treatment caused deep microcolumns of ablation penetrating up to 3 to 4 mm from the epidermal surface into the deep reticular dermis with a variable rim of coagulated collagen surrounding each ablation column.

CONCLUSIONS

The in vivo histopathological evaluation of these devices furthers our understanding of the fundamental laser/tissue interaction following treatment with each device independently and in combination.

Port wine stain progression: a potential consequence of delayed and inadequate treatment?

BACKGROUND AND OBJECTIVES

Port wine stains are congenital low-flow vascular malformations of the skin. Unlike hemangiomas, PWS do not involute with time, but rather if left untreated can hypertrophy and develop nodularity. Laser therapy of PWS particularly with pulsed-dye lasers, is a safe, well-established treatment that is successful in the majority of patients, especially for younger patients. Patients that fail to receive treatment early in life may subsequent develop lesions more likely to progress.

STUDY DESIGN/PATIENTS AND METHODS

A case report and review of the literature are presented. We report a 43 year-old man born with a port-wine stain on the right side of his face that extended in the V2 distribution on his face. He had undergone several sessions with a pulsed-dye laser, the sequential dual-wavelength (595 nm and 1064 nm) laser and a CO2 resurfacing laser from the age of 26 but failed to follow through with a sufficient number of treatments to prevent hypertrophy.

RESULTS

Due to an insufficient number and interval of treatments (with only 7 treatments over 16 years starting at age 26) with the various lasers, the patient's port wine stain continued to progress in color and development of nodularity.

CONCLUSIONS

Patients born with port wine stains should have early laser treatment to achieve optimal results. Delay in treatment, as in this patient until age 26, may result in hard to treat PWS that can continue to progress in nodularity. This case illustrates the hypertrophy and nodularity that can occur due to progression of a PWS with failure to follow through with sufficient number of laser treatments.

Laser leg vein treatment: a brief overview

Laser treatment of leg veins has been associated with a number of disadvantages, but the introduction of new devices has increased the role of lasers in the treatment of leg veins. This paper reviews the role of laser devices applied from the surface in the treatment of reticular and spider veins. Success is determined by the proper selection of wavelength, fluence, pulse duration, spot size, and number and frequency of treatments.

Optimising the design of a broad‐band light source for the treatment of skin

Phototherapy has become a treatment of choice in many areas of medicine. Light can be used to deliver energy to tissue selectively targeting specific structures in order to induce the desired therapeutic outcome. The choice of optical parameters for a specific application is not simple. Wavelength, energy, exposure time and fluence can be varied and induce a wide range of tissue effects. The treatment of the skin with light is probably the one phototherapy application that is most developed in terms of technology and market maturity. White light systems are extensively used to address a range of skin conditions. However, different conditions have different physiology and hence require differing optical parameters. The technology standard is based upon systems, which have a number of different optical filters allowing the output to be tailored to the specific application. This paper discusses the advantages of a different type of system, namely the iPulse i300 (Cyden Ltd, Swansea, UK), which uses a single dichroic reflectance filter and whose optical output is changed by varying other parameters in a carefully controlled manner.

Treatment of a resistant port-wine stain with a new variable pulse-duration pulsed-dye laser

BACKGROUND AND OBJECTIVES

Because of the heterogeneity in port-wine stains, a number of them prove resistant to treatment with the pulsed-dye laser (PDL). A new variable pulse-duration PDL improves a refractory port-wine stain.

STUDY DESIGN/MATERIALS AND METHODS

A 26-year-old man with a congenital port-wine stain underwent eight treatments with the 1.5-ms pulse-duration PDL resulting in minimal improvement. A single treatment was then administered with the 3-ms pulse-duration PDL.

RESULTS

Initial results of treatment with the 3-ms pulse-duration PDL on this patient's port-wine stain show dramatic clearance in areas previously treated with significantly higher fluences, an identical spot size, but with a pulse duration half as long.

CONCLUSION

Vessel heterogeneity may require changing pulse durations once a port-wine stain or a portion of a port-wine stain becomes refractory to given pulse-duration.

Vascular lasers and IPLS: guidelines for care from the European Society for Laser Dermatology (ESLD)

Dermatology and dermatologic surgery have rapidly evolved during the last two decades thanks to the numerous technological and scientific acquisitions focused on improved precision in the diagnosis and treatment of skin alterations. Given the proliferation of new devices for the treatment of vascular lesions, we have considerably changed our treatment approach. Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has recently been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. The list is a long one and includes pulsed dye (FPDL, APDL) lasers (577 nm, 585 nm and 595 nm), KTP lasers (532 nm), long pulsed alexandrite lasers (755 nm), pulsed diode lasers (in the range of 800 to 900 nm), long pulsed 1064 Nd:YAG lasers and intense pulsed light sources (IPLS, also called flash-lights or pulsed light sources). Several vascular lasers (such as argon, tunable dye, copper vapour, krypton lasers) which were used in the past are no longer useful as they pose a higher risk of complications such as dyschromia (hypopigmentation or hyperpigmentation) and scarring. By properly selecting the wavelength which is maximally absorbed by the target--also called the chromophore (haemoglobin in the red blood cells within the vessels)--and a corresponding pulse duration which is shorter than the thermal relaxation time of that target, the target can be preferentially injured without transferring significant amounts of energy to surrounding tissues (epidermis and surrounding dermal tissue). Larger structures require more time for sufficient heat absorption. Therefore, a longer laser-pulse duration has to be used. In addition, more deeply situated vessels require the use of longer laser wavelengths (in the infrared range) which can penetrate deeper into the skin. Although laser and light sources are very popular due to their non-invading nature, caution should be considered by practitioners and patients to avoid permanent side effects. These guidelines focus on patient selection and treatment protocol in order to provide safe and effective treatment. Physicians should always make the indication for the treatment and are responsible for setting the machine for each individual patient and each individual treatment. The type of laser or IPLS and their specific parameters must be adapted to the indication (such as the vessel's characteristics, e.g. diameter, colour and depth, the Fitzpatrick skin type). Treatments should start on a test patch and a treatment grid can improve accuracy. Cooling as well as a reduction of the fluence will prevent adverse effects such as pigment alteration and scar formation. A different number of repeated treatments should be done to achieve complete results of different vascular conditions. Sunscreen use before and after treatment will produce and maintain untanned skin. Individuals with dark skin, and especially tanned patients, are at higher risk for pigmentary changes and scars after the laser or IPLS treatment.

Photothermolysis of blood vessels using indocyanine green and pulsed diode laser irradiation in the dorsal skinfold chamber model

BACKGROUND AND OBJECTIVE

For the treatment of vascular lesions, the use of laser light absorbed by the endogenous chromophore hemoglobin may still be improved.

MATERIALS AND METHODS

Laser treatment (lambda(em) = 805 nm; fluence rate: 106 kW/cm2; fluence: 3.2 J/cm2 (3 milliseconds)), of blood vessels directly after i.v. application of indocyanine green (ICG) (ICG-concentration: 0, 2, or 4 mg/kg body weight (b.w.)) (n = 14,117) was investigated in the skinfold chamber model. Vessel diameters (1-351 microm) were measured using intravital fluorescence microscopy up to 24 hours following irradiation. Histology was taken 1 or 24 hours after irradiation. Results were compared to a mathematical model based on the finite element method.

RESULTS

The reduction of blood vessel perfusion was proportional to ICG-concentration and pulse duration; only a 30 milliseconds pulse duration (2 or 4 mg/kg b.w. ICG-concentration) induced a loss of perfusion even of blood vessels with a diameter <30 microm. Histology revealed photocoagulation of blood vessels up to 24 hours. Results were in agreement with mathematical calculations.

CONCLUSION

ICG-mediated laser irradiation induces irreversible photocoagulation of blood vessels of all diameters in this model.

Laser therapy of spider leg veins

BACKGROUND

Spider leg veins are a common aesthetic problem in females. The standard treatment is sclerotherapy but lasers have been used for decades to solve this problem as well.

AIM

To review recent advances in laser physics and its tissue interactions with skin vessels. The different laser types used to treat spider leg veins are discussed, including their advantages, limitations and possible adverse effects.

METHOD

The international literature on laser therapy for spider leg veins has been reviewed with particular emphasis on the last decade.

RESULTS

Recent developments in laser technology allow a more selective and well-tolerated therapy. Efficacy has also improved. Most studies report a greater than 75% improvement in spider leg veins as a realistic goal for laser therapy. Clinic response depends upon wavelength, fluence, pulse width and pulse duration, cooling and the diameter and colour of spider leg veins.

CONCLUSIONS

Sclerotherapy remains the gold standard treatment for spider leg veins. Nevertheless, laser therapy has become increasingly efficacious and convenient. Laser selectivity has been improved by technological progress. The ideal laser, however, has yet to be invented.