transcutaneous laser, laser therapy

1. Transcutaneous Laser Therapy
Rodrigo Kikuchi
Vascular Surgeon
Venous Disease Comission - Brazilian Society of Angiology andVascular Surgery
Member SBACV, SBLMC,ABFL,AVF,ACP, SVS,AFI,ASLMS
Vascular Excellence Institute - Londrina/PR - Brazil
Vascular Excellence São Paulo - São Paulo/SP - Brazil
10 min

2. • Disclosure:
Training fees and teaching courses for Cutera, Alma Lasers and
Industra Technologies

3. Where we can use the trrancutaneous laser?
- rosacea
Wall TL. Current Concepts: Laser Treatment of AdultVascular Lesions.
Seminars in Plastic Surgery. 2007 Aug;21(3):147–58.
- poikiloderma
- angioma
- port wine stain
- facial telangiectasia
- reticular veins in the face
- bad hair formations (venous lake,
hemangioma ruby)
- telangiectasias of the lower limbs
- reticular veins of the lower limbs

4. The transdermal laser can treat all these vascular lesions
The same laser?

5. - Literature review on the performance of light sources in the vessels of
the lower limbs
- Although sclerotherapy is widely used lasers exhibit comparable
results
- Nd: YAG 1064nm long pulse laser is the most popular because it acts
in larger and deeper vessels, while promoDng more pain
A variety of lasers and their settings allows to adapt the
treatment to the variety of vascular lesions

6. Trancutaneous laser - Results
• single session with whitening > 75% in 71% of lesions analyzed 3
months after treatment
Rogachefsky AS, Silapunt S, Goldberg DJ. Nd:YAG Laser (1064 nm) Irradiation for Lower Extremity Telangiectases and
Small ReticularVeins: Efficacy as Measured byVessel Color and Size. Dermatologic Surgery. 2002 Mar;28(3):220–3.
• one or two sessions with good or very good improvement in 47/60
patients with an interval of 2 months analyzed in 6 months
Trelles MA,Weiss R, Moreno-Moragas J, Romero C,Velez M,Alvarez X.Treatment of leg veins with combined pulsed
dye and Nd:YAG lasers: 60 patients assessed at 6 months. Lasers in Surgery and Medicine. 2010 Oct 25;42(9):769–
74.
• up to 5 sessions at monthly intervals with significant improvement in
80% of vascular lesions of the lower limbs
Ozyurt K, Colgecen E, Baykan H, Ozturk P, Ozkose M.Treatment of Superficial CutaneousVascular Lesions:
Experience with the Long-Pulsed 1064 nm Nd:YAG Laser.The Scientific World Journal. 2012;2012(4):1–7.

7. Trancutaneous laser - Comparative results
• STS 0.5% x Nd:YAG 1064nm both with two sessions
-results not statistically significant, but with a tendency to be higher with
sclerotherapy
Lupton JR,Alster TS, Romero P. Clinical Comparison of SclerotherapyVersus Long-Pulsed Nd:YAG Laser
Treatment for Lower Extremity Telangiectases. Dermatologic Surgery. 2002 Aug;28(8):694–7.
• Polidocanol 0.5% x Nd:YAG 1064nm single session
-results no statistical difference
Levy JL, Elbahr C, Jouve E, Mordon S. Comparison and sequential study of long pulsed Nd:YAG 1,064 nm laser
and sclerotherapy in leg telangiectasias treatment. Lasers in Surgery and Medicine. 2004;34(3):273–6.
• Glucose 75% x Nd:YAG 1064nm both with 3 sessions
-photographic analysis for the laser superior (p = 0.002)
Munia MA,Wolosker N, Munia CG, Chao WS, Puech-Leão P. Comparison of LaserVersus Sclerotherapy in the
Treatment of Lower Extremity Telangiectases:A Prospective Study. Dermatologic Surgery. 2011 Dec 30;38(4):635–9.

8. Lasers Med Sci (2014) 29:481–492
Parameters and settings:
- Wavelength: hemoglobin absorption, no absorption to melanin, sufficient
penetration
- Pulse duration: must equal the thermal relaxation time
- Spot size: adjusted to the diameter and depth of the target, if correct can
minimize damage to surrounding tissue
- Radiation exposure: less possible

9. 1064nm 6mm spot, 15ms, 70J/cm2

10. 1064nm 3mm spot, 15ms, 150J/cm2

11. 1064nm 7mm spot, 20ms, 90J/cm2

12. 1064nm
3mm, 15ms, 125J/cm2
6mm, 20ms, 80J/cm2

13. Rua Itapeva, 202 12.andar
Bela Vista São Paulo-SP , 01332-000
(11) 3253-5587
Patient: Rosilene Lima
Date of Birth: Oct. 4, 1962
Date: 04/17/2015
Patient’s photos
R Posterior Thigh
Jan. 16, 2015
R Posterior Thigh
April 15, 2015
1064nm
6mm, 15ms, 70J/cm2
6mm, 20ms, 70J/cm2
2 sessions

14. March 13, 2014 July 14, 2014
1064nm
3mm, 15ms, 150J/cm2
6mm, 15ms, 80J/cm2
2 sessions

15. 3760 South Lindbergh Blvd Suite 101
St. Louis , Missouri 63127
(314) 849-0923
Patient: Tositto Valquiria
Date of Birth: Jan. 1, 1995
Date: 11/29/2014
R Posterior Thigh
Nov. 29, 2014
R Posterior Thigh
Nov. 29, 2014
1064nm
6mm, 20ms, 70J/cm2
only laser
1 session

16. Rua Itapeva, 202 12.andar
Sao Paulo-SP , 01322-000
Patient: Eloiza Rodrigues
Date of Birth: June 8, 1960
Date: 09/09/2014
R Posterior Thigh
July 29, 2014
R Posterior Thigh
Sept. 9, 2014
1064nm
6mm, 20ms, 70J/cm2
6mm, 15ms, 80J/cm2
1 session

17. Single session Nd:YAG 1064nm
6mm spot size, 40ms, 70J/cm2

18. Single session Nd:YAG 1064nm
2mm spot size, 10ms, 250J/cm2

19. Single session Nd:YAG 1064nm
3mm spot size, 15ms, 150J/cm2

20. Trancutaneous laser can you believe it?

21. kikuchi@excelenciavascular.com.br
+55 (11) 98111-9901
www.excelenciavascular.com.br
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