In the world of aesthetic medicine, the ability to precisely target specific structures within the skin is paramount. When it comes to treating vascular lesions, this precision is even more critical. While a variety of lasers can effectively treat superficial redness, the deeper, more stubborn blue and purple vessels require a different approach. This is where the Nd:YAG 1064nm laser comes into its own. With its unique properties, this powerful laser can penetrate deep into the skin to safely and effectively treat a range of deep vascular lesions that are beyond the reach of other devices.
Understanding the Challenge of Deep Vascular Lesions
Deep vascular lesions, such as venous lakes, periorbital veins, and the nodular components of port wine stains, present a unique challenge for practitioners. These vessels are located deeper in the dermis, and their darker colour indicates that the blood within them is deoxygenated. To treat these lesions effectively, a laser must be able to penetrate deep enough to reach the target vessel and deliver enough energy to heat and destroy it, all without damaging the overlying skin.
This is where shorter wavelength lasers, such as the KTP 532nm, fall short. While these lasers are excellent for treating superficial redness, their energy is readily absorbed by melanin and haemoglobin in the upper layers of the skin, preventing them from reaching the deeper vessels. Attempting to treat deep lesions with these lasers would require excessively high energy levels, which would inevitably lead to burns and other complications.
The Nd:YAG 1064nm Advantage: Deep Penetration and Selective Targeting
The Nd:YAG 1064nm laser overcomes these challenges thanks to its longer wavelength. The 1064nm wavelength is in the infrared spectrum, which means it is less readily absorbed by melanin and haemoglobin than shorter wavelengths. This lower absorption allows the laser energy to penetrate more deeply into the skin, reaching the deeper vessels where it is needed most.
But deep penetration is only half the story. The Nd:YAG 1064nm laser is also highly effective at selectively targeting the haemoglobin in the blood. While the absorption of the 1064nm wavelength by haemoglobin is lower than that of shorter wavelengths, it is still significant enough to generate the heat required to destroy the vessel wall. This selective targeting is further enhanced by the use of a longer pulse duration. By delivering the energy over a longer period, the heat can build up in the vessel, causing it to coagulate and collapse, without causing a rapid, explosive heating that could damage the surrounding tissue.
The Importance of Thermal Relaxation Time
The concept of thermal relaxation time (TRT) is crucial to understanding how the Nd:YAG 1064nm laser can be used to safely and effectively treat deep vascular lesions. The TRT is the time it takes for a target structure to dissipate about half of the thermal energy that has been delivered to it. The TRT is related to the size of the target, with larger targets having a longer TRT.
Deep vascular lesions are typically larger than superficial capillaries, and therefore have a longer TRT. This means that we can use a longer pulse duration to heat the vessel, without the heat dissipating into the surrounding tissue. The Nd:YAG 1064nm laser can be set to a pulse duration that matches the TRT of the target vessel, ensuring that the energy is delivered in the most effective way possible.
Clinical Applications of the Nd:YAG 1064nm Laser for Deep Vascular Lesions
The unique properties of the Nd:YAG 1064nm laser make it the ideal choice for treating a variety of deep vascular lesions.
Venous Lakes: These dark blue or purple papules, most commonly found on the lips, are dilated venules that respond exceptionally well to treatment with the Nd:YAG 1064nm laser. A single treatment is often all that is needed to achieve complete resolution. The endpoint for treatment is often a characteristic “popping” sound as the vessel collapses.
Periorbital Veins: The delicate skin around the eyes can be a challenging area to treat, but the Nd:YAG 1064nm laser can be used to safely and effectively treat the blue veins that can appear in this area. By using a small spot size and pointing the laser away from the eye, the practitioner can precisely target the vessel without risking damage to the eye.
Nodular Port Wine Stains: While the flat, pink component of a port wine stain is best treated with a shorter wavelength laser, the deeper, nodular components require the deep penetration of the Nd:YAG 1064nm laser. By combining different laser modalities, practitioners can achieve a significant improvement in the appearance of these complex birthmarks.
What to Expect During an Nd:YAG 1064nm Laser Treatment
An Nd:YAG 1064nm laser treatment for deep vascular lesions is a quick and relatively comfortable procedure. After a thorough consultation and assessment, the practitioner will cleanse the skin and may apply a cooling gel. The laser is then used to trace the vessel, delivering precise pulses of light to the target area. The sensation is often described as a series of hot snaps against the skin.
After the treatment, it is normal to experience some redness and swelling, which usually subsides within a few days. The treated vessel may initially appear darker, but it will gradually fade as the body clears away the damaged tissue. The results are often visible within a few weeks, with a significant improvement in the appearance of the lesion.
The Future of Deep Vascular Lesion Treatment
The Nd:YAG 1064nm laser has revolutionised the treatment of deep vascular lesions, offering a safe, effective, and minimally invasive solution for a range of conditions that were previously difficult to treat. As our understanding of laser tissue interaction continues to grow, we can expect to see even more advanced applications of this versatile technology. If you are concerned about deep vascular lesions, I encourage you to seek out a qualified and experienced practitioner who can guide you on your journey to clearer, more confident skin.
Dr Tina Fang MBBS FRACGP FACAM is a cosmetic physician with 10 years of experience in aesthetic medicine, with experience in advanced laser technologies. To book a consultation and learn more about Nd:YAG 1064nm laser treatments, contact us at 07 3472 7477 or visit bookings.drtinafang.com. Located at Level 2, 1808 Logan Rd, Upper Mt Gravatt, QLD 4122.
