Addressing The Common Pitfalls In Laser Therapy

The laser treatment of leg veins is not free of common pitfalls (see Box 16.3). Retreatment or double pulsing of the target vessels vessel should be avoided to prevent excessive thermal damage that potentially can result in scarring and ulceration. The physician or the medical personnel admin-

BOX 16.3 Common Pitfalls

• Avoid immediately retreating or double-pulsing vessels when no instantaneous changes are present.

• Allow treated areas to cool before attempting a second pass.

• Always use the lowest possible effective fluence.

• Space adjacent laser pulses at least 1-2 mm apart to reduce excessive thermal damage.

BOX 16.4 Side Effects

• Transient hyperpigmentation

• Telangiectatic matting

• Thrombosis

• Epidermal damage

• Incomplete clearance istering the treatment should be aware that change of the target vessel may take up to several minutes given the time that it takes for thermocoagulation to occur even when the appropriate parameters are utilized. In the setting of a clearly resistant vessel, it is better to work on a distinctly separate treatment area and return to the resistant vessel in 5 to 10 minutes. It is also important to use the lowest possible fluence that will effectively treat a selected vessel to minimize complications. As a rule a rule of thumb, the physician should always start at the lowest fluence and incrementally increase to higher energy levels as needed depending on the vessel response. Blanching of the skin is a physical manifestation of excessive thermal injury and should be avoided at all costs. Furthermore, the physician should take note of the lateral spread of the thermal energy into surrounding areas, particularly with the longer wavelength 1064 nm laser. Nontreated vessels connected to or adjacent to the desired treatment pulse area may receive enough thermal damage to unintentionally coagulate. All pulses, consequently, ideally should be separated by 1-2 mm. Because of high cytokine, treatment sessions should be spaced at least six to eight weeks apart in order to reduce the risk of post-inflammatory hyperpigmentation.

Side Effects, Complications, and Alternative Approaches

Complications of the laser therapy of leg veins include epidermal damage, thrombosis, hyperpigmentation, matting, and incomplete clearance (see Box 16.4). During the actual procedure patients typically complain of discomfort, but rarely do they feel uncomfortable postoperatively. For those patients who develop telangiectatic matting of incomplete vessel clearance, retreatment should be offered with either laser or microsclerotherapy as deemed appropriate. Localized areas of thrombosis may resolve independently from treatment or easily can be expressed with an 18-gauge needle. Post-procedure hyperpigmentation is usually transient and has become less of an issue with the advent of the longer wavelength technologies and improvement of epidermal cooling devices. Moreover, wound care should follow any procedure that results in epidermal damage, thereby decreasing the incidence of scarring.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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