Treatment of Leg and Face Veins with a Cryogen Spray, Variable Pulse Width 1064 nm Nd:Yag Laser—A Prospective Study of 47 Patients

Abstract

Objective: Throughout the 1990s, laser treatment of leg veins was a challenge. Newer, longer wavelength lasers capable of delivering high fluences with larger spot sizes with a variable pulse width have shown promising preliminary results. Experience with these lasers for treatment of facial telangiectasia and periorbital reticular veins is even more scant. To our knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray—equipped 1064 nm Nd:Yag laser for both the treatment of leg and face veins, including larger periorbital reticular veins. Materials and Methods: Forty-seven volunteers aged 32–67 years (30 with skin type I-V with leg telangiectasia and reticular veins, and 17 with skin type I-IV with face telangiectasia and reticular periorbital veins) were treated with the Nd:Yag laser. For leg vein patients, 2–3 sets of different leg veins were treated with a maximum of 3 treatments. Patients were examined 1 week after each treatment and at 1, 2, and 3 months after the last treatment. All face vein patients received 1 treatment and were examined at 1 month posttreatment. Treatment parameters for both leg and face veins varied with the size of vessels being treated. Pre- and posttreatment 35 mm photos were taken. Improvement was judged by 2 experienced physicians both visually on patients and by comparison of pre- and posttreatment photos. Results were graded as percent resolution in 5 groups: 0%, 0–25%, 25–50%, 50–75%, and 75–100%. Results: Twenty-three of 30 patients completed the leg vein segment of the study. A total of 41 leg vein sites were treated. Greater than 75% improvement was observed at 85% of the treated sites. Greater than 50% improvement was observed at 95% of the treated sites. Less than 25% improvement was observed at 5% of the treated sites. Seventeen of 17 patients completed the face vein segment of the study, and 32 sites were treated (24 cheeks, noses, and chin telangiectasia and 8 periorbital reticular veins). Greater than 75% improvement was observed at 97% of the treated sites. Greater than 50% improvement was observed at 100% of the treated sites. Notably, 100% of the facial reticular veins treated had essentially 100% resolution. Pain during treatment was variably perceived by patients, but was occasionally sufficient for patients to decline further treatment. Transient hemosiderin pigmentation, as seen with sclerotherapy, was common with larger vessels. Conclusion: The cryogen spray-equipped 1064 nm Nd: Yag laser was remarkably effective and safe for skin type I-V patients. Excellent results for leg veins, approaching sclerotherapy outcomes, were obtained for both 0.3–1.5 mm telangiectasia and larger 1.5–3.0 mm reticular veins. Furthermore, this 1064 Nd:Yag laser is also an outstanding tool for treatment of facial telangiectasia with little if any risk of purpura. For the first time we appear to have a safe and effective treatment for 1–2 mm periorbital reticular veins. The use of topical anesthesia may be needed for some patients.