Laser vs. Sclerotherapy
Those seeking cosmetic treatment for their legs often request laser, as they believe it to be more effective, less painful and less invasive vs. sclerotherapy. With the advent of newer, advanced technology lasers, physicians debate heatedly over which laser is best to treat veins.
It must be understood that for leg spider veins telangiectasias, sclerotherapy remains the gold standard of treatment. The newest technological improvements of lasers have improved the rate of success and are slowly beginning to challenge these perceptions. Combination treatment of lasers and sclerotherapy may be the best solution for some patients.
A complicating factor for laser treatment of leg veins is that most telangiectasias are associated with high reverse pressure from associated recticular veins. Most lasers or IPL (except possibly the 1064 nm lasers) will not treat associated high pressure reticular veins.
- Laser is more painful
- Sclerotherapy can cover a larger treatment area
- Laser has a higher risk of injuring your skin
- You can treat tanned legs with sclerotherapy (and possibly 1064nm lasers)
- Laser is more expensive and requires more treatments
In 1981, Anderson and Parrish introduced the theory of selective photothermolysis, which is the basis of most of the lasers and light sources in use today. Basically, you want selective destruction of the target to take place with minimal damage to surrounding structures. Ideally you want to select a wavelength that is maximally absorbed by the targeted structure combined with a pulse duration that is less than the thermal relaxation time of the target, or the time required for the target to dissipate 50% of the heat acquired from the laser or light source. Oxyhemoglobin’s primary absorption peaks are in the blue-green-yellow portions of the visible range of 418, 542 and 577 nm but 418 is strongly absorbed by melanin and cannot be utilized, 542 is also too close to the melanin absorption. There is another absorption peak from 800 nm to 1000 nm which may penetrate deeper into the dermis.
Lasers & Intense Pulsed Light
The pulsed dye laser is considered the laser of choice for most vascular lesions because of its superior clinical efficacy and low risk profile. The V-beam laser (595 nm) features ultra-long pulse duration so greater energy is directed at the target blood vessels over a longer period of time, resulting in more uniform blood vessel damage. This reduces the bruising seen with the earlier pulse dye lasers. The addition of dynamic cooling (DCD) increases comfort during treatment enabling higher fluencies (energy) to be delivered safely and effectively, so fewer treatments are required.
The Gentle-Yag (1064 ND:YAG, infrared) is a laser with long pulse durations, the wavelength is absorbed by both hemoglobin and water , but to a much lesser degree by melanin. The Gentle-Yag, like the V-Beam has DCD for increased comfort. IPL or the Sciton BBL systems work on the same principles as lasers in that light energy is absorbed into particular target cells with color (chromophores) in the skin. The light energy is converted to heat energy, which causes damage to the specific target area. IPL systems are different to lasers in that they deliver many wavelengths (or colors) in each pulse of light instead of just one wavelength. Most IPL systems use filters to refine the energy output for the treatment of certain areas. This enhances penetration without using excessive energy levels and enables targeting of specific chromophores (these are skin components that absorb light). Typically filters used are the 550nm for lighter skin and 570-590 filter for darker skin types.
The treatment of facial telangiectasias are generally more predictable than that of the legs. The skin heals quickly and is much less likely to scar. Treatment results are often seen much more quickly as healing is much faster on the well-oxygenatated skin of the face. Facial vessels have a more uniform depth than the legs. The walls themselves are much thinner and uniform and hydrostatic pressure plays no major role. Whereas the cause of telangiectasias on the legs is predominately hydrostatic pressure, facial vessels appear to result from damage to the collagen of the vessel wall by sunlight. Sun exposure damages and weakens collagen. We typically would treat facial vessels and rosacea with BBL and/or the V-Beam laser.