Laser & light based therapies

Case Based Discussion

Dr. Faramarz Didar

CEO, Cosmetic Facial UK Limited

www.cosmeticfacial.co.uk

info@cosmeticfacial.co.uk

Non Surgical Facial Aesthetics

1

Selected patient

• Mr Jones

• 37 year old male. Lesion present at birth. Feels self conscious about lesion and does not wish to wear make-up to conceal it.

2

Laser/light based system of choice

• The first laser(argon) introduced in 1970.

• Vascular malformation like Port Wine Stain(PWS), Haemangioma, telengectasia can be treated by Laser technology.

• PDL(pulse Dye Laser) is the gold standard for treatment of PWS and other vascular malformation in dermis.

• Effective PDL parameters are as the following

– Wavelengths of 585 to 600 nm

– Fluences of 6 to 15 J/cm square

– Pulse duration of 0.45 or 1.5 ms

– This system is more effective to treat PWS in infant in the early stage of life.

• Neodymium YAG (Nd: YAG) is used to treat the nodules may have developped in some adult type of PWS.

Justification for system choice• Oxyhaemoglubulin is the chromophore for the Vascular lesion with the

500 to 600 peak absorption wavelengths peak.

• OxyHaemoglubulin absorbs the wavelengths and generates heats. This absorption coagulates the vessels but do not damage the surrounding tissues.

• The vessel diameter is important in choosing the duration of pulse as well as thermal Relaxation Time(TRT).it means large diameter of vessels requires longer optimal Pulse width.

• The PDL should come with a cooling system as the vessels are in dermis. The wavelengths to treat this vascular lesion is close to the peak of Melanin absorption wavelengths in epidermis.

Alternative treatment options Non-Laser Treatment

• Freezing

• Surgery

• Radiation

• Tatooing

• Covering with Cosmetic

Alternative treatment options other Laser Treatment

• The potassiumtitanylphosphate (KTP) with 532 wavelengths.

• Long wave lengths lasers like long pulse Alexandrite 755 lase, long pulse Nd:YAG(1064nm), Dual 595nm PDL can be used to treat PDL resistant PWS or adult PWS.

• 1064 Nd:YAG laser coupled with adequate cooling

• Light therapy– IPL (Intense Pulse Light)

• Green yellow wave band

• Lowest pulse duration

• Photodynamic therapy

Pre-treatment procedure• PWS is associated with SWS(Struge-Webber-Syndrome) and other vascular

and neurological anomalies. Based on the presentation of this malformation an extensive parent counseling and investigation is granted prior to the treatment.

• Facial PWS;– Ophthalmological examination to exclude cataract and glaucoma

– MRI or CT scan of brain to exclude any abnormalities

• Spinal PWs(associated with spinal anomalies like spinal dysraphism)– Neurological exam and imaging studies

• PWS in Extremities:PWS ia associated with capillaries-venous malformation or capillary-lymphatic-venous malformation. Follow up and leg measurement and investigation are recommended.

• Epidermal cooling prior and during the procedure is recommended.

Typical clinical endpoint • Bruising is the necessary side effect to obtain efficacy of treatment.

• Lesions in the face and childhood response better to the treatment. the lesions in the extremities have the least respond.

• The later the treatment , the least effective respond

• Chance of scaring increase with using Nd:YAG

• In the absence of successful treatment, hypertrophy (increased tissue mass) of the stains may produce deformity, loss of function (especially near the eye or mouth), bleeding, and increasing disfigurement. These complications are usually seen later in life.

Post treatment procedure • Treatments should be ceased when the patient is satisfied with

lightening,

• Most complications following laser treatment are caused by failure to properly take care of the skin after laser therapy.

• The skin must be kept moist with topical cream or ointment.

• The skin must be kept clean, all secretions and skin debris removed

• Sun block and prevention is essential.

• Topical vitamin C and vitamin K could also be used to achieve favorable results. Vitamin K decreases the pooling of blood under the skin commonly associated with telangiectasias or PWS.

• vitamin C has been shown to strengthen capillary walls, therefore decreasing the chances of further damage.

• Four to twelve laser sessions with 4-to-8-week intervals are usually required in order to achieve significant blanching of the PWS.

Typical follow-up/regime

• Four to twelve laser sessions with 4-to-8-week intervals are usually required in order to achieve significant blanching of the PWS.

• Patients should be counseled that PWS display a variable response to treatment. More extensive and thicker lesions respond less well when compared to superficial lesions.

• Facial PWS responds best.

• Laser treatment may produce partial improvement.

• Treatments should be ceased when the patient is satisfied with lightening, or when no further benefit has gained, that is, after two subsequent treatments.

References:

• Port wine Stain: Wikipedia

• Cosmotic dermatology: principle and practice:Lesslie Baumann,McGraw-Hill Education; September 2008

• Colour atlas of Cosmetic Dermatology:ZienaTannus2011 McGraw-Hill companies.

• Dermatological and cosmotic Procedures: Richard P. Usatine et al.2012 by Saunders