Selective Photodestruction of Facial Telangiectasia
with the Copper Vapor Laser
Igor V. Danishouk, Igor V. Ponomarev2
1The Central Institute of Dermatology and Venerology, 3, bld.4, Korolenko str., Moscow, 107076, Russia
2P.N. Lebedev Physics Institute, 53, Leninski prospect, Moscow, 117924, Russia
The results of the treatment of facial telangiectasias by selective laser coagulation (SLC) using the copper vapor laser “Yahroma-Med” are being reported. 111 patients with facial telangiectasias, with ages ranging from 13 to 55 years were treated with SLC. The treatment was carried out at an average laser power between 0.8 ÷ 1.2 Watts and with an exposure time between 0.1 ÷ 0.2 seconds depending on the lesions. 103 of 107 patients showed removal of more than 75% of the facial telangiectasias while 63 patients showed more than 90% removal. None of the patients had complications such as scarring, changing of texture of the skin or pigmentation change.
Keywords:telangiectasia, selective laser coagulation (SLC), copper vapor laser (CVL)
According to different studies up to 30% of adults with fair skin have telangiectasias on the face, neck, chest or legs. The term telangiectasia denotes superficial cutaneous blood vessels visible to the human eye .1They usually measure from 0,1 to 1 mm in diameter and originate from arterioles, capillaries or venues. The term telangiectasia originated from three Latin words: tel, angio, ectasia which denote tip, vessel, enlargement respectively. Hereditary telangiectasias are relatively uncommon. Facial telangiectasias are frequently encountered on the cheeks and nose. The most common factor in occurrence of facial telangiectasia is weakness of the vessel walls due to chronic sun exposure. Genetic predisposition, liver disease, surgical trauma, radiation therapy, chronic steroid use, deep chemical peeling of the face may also playa role .2
Some years ago different methods were used for treatment of telangiectasias -such as electrocautery, sclerotherapy, cryotherapy, dermabrasion and medical intervention trials with tetracycline, erythromycin, retinoids. However, these treatments are not acceptable due to high risk of adverse effects and low clinical efficiency. Sclerotherapy is the most common method of treatment for lower extremity telangiectasias, but it is used very rarely to treat facial telangiectasias due to the high risk of complications. The main concern of patients with facial telangiectasias is cosmetic disfigurement thus high risk of complications is unacceptable.
The concept of selective photothermolysis first described by Anderson and Parrish 3 has become the theoretical basis for successful laser treatment of cutaneous vascular lesions. According to this theory, the laser beam can produce accurate destruction of the tissues with minimal injury to the surrounding tissues. Selective photothermolysis is possible if the target tissue contains the chromophore which absorbs more of a specific laser wavelength than the surrounding tissue. The target chromophore in telangiectasias is hemoglobin, which has two absorption peaks in the visible light spectrum at 542 and 577 nm. Another significant chromophore in skin is melanin with an absorption peak in the ultraviolet range and with steadily decreasing absorption in the visible spectrum. Therefore, the laser which is used must produce light near 577 nm, since this wavelength light is absorbed by hemoglobin while only minimally by melanin. Other laser parameters such as exposure time, power, laser beam spots size on the skin are important for maximization of clinical effect and minimization of complications.Several types of lasers are used for selective destruction of telangiectasias, although there remains much debate as to which laser is better.