Presidential Greeting - American Society for Laser Medicine and ...

16 American Society for Laser Medicine and Surgery Abstracts
Conclusion: Complex venous malformation cannot be cured, but
can be symptomatically controlled with the long pulsed Nd:YAG
laser. The treatment satisfaction is high, and there is a small but
definite risk of scarring from treatment.
#50
OPTIMIZED SPECTRAL OUTPUT AND PULSE
SHAPES FOR VASCULAR TREATMENTS
Robert Weiss, E. Victor Ross, Emil Tanghetti, David
B. Vasily, James Childs, Mikhail Smirnov, Gregory
Altshuler
Maryland Laser, Skin and Vein Institute, Baltimore, MD;
Scripps Clinic, San Diego, CA; Center for Dermatology and
Laser Surgery, Sacramento, CA; Aesthetica Cosmetic &
Laser Surgery Center, Bethlehem, PA; Palomar Medical
Technologies, Burlington, MA
Background: An optimized pulsed-light (OPL) device is
described and its performance is compared with two pulsed dye
laser (PDL) systems in a vascular phantom setup and with
computer modeling. Clinical case studies are described to evaluate
OPL treatment of facial vascular lesions.
Study: The OPL (MaxG TM , Palomar Medical Technologies)
provides a dual-band output spectrum from 500 to 670 nm and 850
to 1,200 nm with pulse widths 3–100 milliseconds and fluences to
80 J/cm 2 . Two PDL systems (VBeam and Perfecta, Candela Corp.)
provide 595 nm laser pulses (1.5, 3, 6, or 10 milliseconds). The OPL
spectral and power output is characterized and described. A
vascular phantom consists of quartz capillaries filled with
hemoglobin and placed beneath 1 mm thick porcine skin.
Capillary temperatures are measured with a FLR 4000 IR camera
during the pulse sequence. In order to determine PDL and OPL
settings to treat the phantom, purpuric threshold fluences for
each device and pulse width were determined clinically on back
skin. Typical clinical settings for OPL were 50–100 J/cm 2 ,
100 milliseconds and 28–38 J/cm 2 , 10 milliseconds.
Results: At purpuric threshold settings (PDL, 8 J/cm 2 ,
3 milliseconds and OPL, 38 J/cm 2 , 3 milliseconds), the OPL (88C)
caused 60% higher vessel temperature rise than the PDL (58C).
The fraction of near-IR energy from the OPL increases from 35%
to 60% with decreasing power or increasing pulse width
(3 milliseconds, 30 J/cm 2 to 100 milliseconds, 100 J/cm 2 ) and
contributes approximately 15% to phantom vessel heating at 36 J/
cm 2 , 3 milliseconds. Clinical results demonstrated effective deep
vessel closure and clearance of telangiectasia.
Conclusion: An optimized pulsed arc-lamp device is more
efficient at larger and deeper vessel treatments with lower risk of
purpura compared to the PDL devices using a vascular phantom
setup. Clinical correlation is seen with treatment of facial vascular
lesions of various sizes.
#51
SPLIT-FACE RANDOMIZED TREATMENT OF
FACIAL TELANGIECTASIA COMPARING PULSED
DYE LASER AND A NEW OPTIMIZED LIGHT
HANDPIECE
Emil Tanghetti
Center for Dermatology and Laser Surgery, Sacramento, CA
Background: This study was designed to compare treatment of
facial telangiectasia with a pulsed dye laser (PDL) and a new
optimized light handpiece (OPL) that provides enhanced spectral
absorption, shorter pulsewidths and higher fluences than
previous intense pulsed light (IPL) devices.
Study: Sixteen subjects were enrolled with unwanted facial
telangiectasia. This study was approved by IRB and all subjects
provided signed informed consent. Facial areas were split
vertically and the two sides randomized to receive up to three
treatments approximately one month apart with either PDL
(VStar 1 , Cynosure, Westford, MA) or OPL (MaxG TM Optimized
Light Handpiece, Palomar, Burlington, MA). PDL used 595 nm,
10 milliseconds, 10 mm spot and average fluence of 8.2 0.1 J/
cm 2 . OPL used spectral range of 500–670 and 870–1,200 nm;
10 milliseconds; 10 mm 15 mm tip, and average fluence of
35.5 0.9 J/cm 2 . Subjects were seen for follow-up at 48–96 hours,
and 1–2 months. Clinical photographs were taken at each visit to
score improvement on a 0 (0%) to 5 (100%) Telangiectasia Grading
Scale (TGS). Presence and severity of side effects were recorded.
Results: Most commonly reported side effects at 48–96 hours
were mild, transient purpura (62%), and mild to moderate edema
(21%) and erythema (18%) which resolved completely by 1–2
months and were comparable with both study devices. All subjects
improved with 12/15 (80.0%) subjects having a TGS score of 3 or
more (50–75%) with OPL versus 11/15 (73.3%) of subjects treated
with PDL. There were no differences in subject self-assessment
between the two devices.
Conclusion: The new OPL tested in this study, with enhanced
spectral specificity for vasculature, treated facial telangiectasia
successfully and was equivalent to PDL.
#52
ANGIOGENESIS MEDIATOR ALTERATIONS IN
ANGIOMAS AFTER PULSED DYE LASER
TREATMENT
Kristen Kelly, Belinda Dao, Janelle Marshall,
Amy Nguyen, Vivian Laquer, Elizabeth Rugg,
Ronald Harris
Beckman Laser Institute and Medical Clinic, University of
California, Irvine, CA
Background: Tissue effects of vascular lesion laser treatment are
incompletely understood. Injury caused by pulsed dye laser
treatment may result in altered expression of mediators associated
with angiogenesis. An understanding of laser effects on angiogenesis
may allow development of novel and improved treatment
techniques. Our objective is to evaluate tissue presence of vascular
endothelial growth factor (VEGF), basic fibroblast growth factor
(BFGF), matrix metalloproteinase 9 (MMP-9) and angiopoietin 2
(ANG-2) in angiomas before and 1 week after laser treatment.
Study: Three subjects had one angioma treated with a pulsed dye
laser (7 mm; 1.5 milliseconds; 9 J/cm 2 ; 30 milliseconds of cryogen
with a 30 milliseconds delay). One week later, three biopsies were
taken: normal skin; untreated angioma; angioma treated with
laser. Tissue was frozen and sections processed for
immunohistochemistry staining of VEGF, BFGF, MMP-9, and
ANG-2. Images were taken and were graded in a blinded fashion
by a board certified dermatopathologist.
Results: Untreated angiomas demonstrated a slight increase in
VEGF and ANG-2 expression compared to normal skin. Following
laser treatment, an increase in ANG-2 and MMP-9 was noted.
Conclusion: Alterations in angiogenesis mediators were noted
after laser therapy. Observed changes associated with laser
treatment were different as compared to those reported with other
injuries such as punch biopsies. Further understanding of laser
induced alterations may be used to optimize treatment outcomes.