Treatment of leg and face veins with a cryogen spray variable pulse width 1064-nm Nd:YAG laser - a prospective study of 47 patients

OBJECTIVE : Throughout the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers capable of delivering high fluences with larger spot sizes, with variable pulse width have shown promising preliminary results. Experience with these lasers for the treatment of facial telangiectasia and periorbital reticular veins is even more scant. To the authors' knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064-nm Nd:YAG laser for the treatment of both leg and face veins, including larger periorbital reticular veins. METHODS : A total of 47 volunteers aged 32-67 years (30 skin type I-V with leg telangiectasia and reticular veins, and 17 skin type I-IV with face telangiectasia and reticular periorbital veins) were treated with the Nd:YAG laser. For leg vein patients, two to three sets of different leg veins were treated with a maximum of three 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 one treatment and were examined at 1 month post treatment. Treatment parameters for both leg and face veins varied with the size of vessels being treated. Pre and post treatment 35-mm photographs were taken. Improvement was judged by two experienced physicians both visually on patients and by comparison of pre and post treatment photos. Results were graded as percentage resolution, in five groups: 0%, 0-25%, 25-50%, 50-75% and 75-100%. RESULTS : In all, 23 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. In all, 17 of 17 patients completed the face vein segment of the study. A total of 32 sites were treated (24 on cheeks, nose, and chin telangiectasia and eight 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 occasionally was 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-mm reticular veins. Furthermore, this laser is also an outstanding tool for treatment of facial telangiectasia with little if any risk of purpura. For the first time it appears that there is a safe and effective treatment for 1-2-mm periorbital reticular veins. However, the use of topical anesthesia may be needed for some patients.