Laser treatment of cutaneous vascular lesions has progressed significantly over the past 25 years. Laser irradiation can selectively destroy specific targets (chromophores) within the skin by using an appropriate wavelength, pulse duration, and energy setting. To limit damage to surrounding structures, pulse duration must be less than or equal to the targeted thermal relaxation time of the chromophore, ie, the time necessary for the target to cool by half of its peak temperature after laser irradiation. Because the energy deposited in the tissue is limited to targeted sites, significant thermal diffusion to adjacent skin is prevented. In addition, because wavelengths corresponding to absorption peaks for various skin chromophores are known, absorption of laser energy can be localized without damaging neighboring structures. The targeted chromophore for vascular lesions is intravascular oxyhemoglobin; thus, thermal damage is largely restricted to cutaneous blood vessels. The targeted chromophore for brown spots is melanin.
The typical outcome when treating facial vessels is immediate disappearance with minimal bruising or crusting. One to three treatments are usually required with 2-4 weeks recommended between treatments. Treatments are performed in the office. Anesthesia and special skin preparation are not necessary prior to laser treatment of facial or leg veins but tanned patients should wait until their skin returns to its normal color. Brown spots may darken, crust and flake off in 1-3 weeks. Dr. Hodge uses a Icon intense pulsed light (IPL) or Gemini 532/1064nm laser.