Prof. Alessio Redaelli

Aesthetic Medicine
Specialist in Vascular Surgery

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Laser in the treatment of angiomas, legs’ capillaries, couperose

Introduction Capillaries of lower limbs and face represent a slight blemish, which is felt by women in particular, but also by men. They do not provoke damages, but the aesthetic aspect is very important. Then, when they become numerous, even the venous insufficiency becomes an important aspect. Women are more affected by this pathology compared to men, due to hormonal causes, predisposition, but especially for pregnancies. Few years ago we had only the sclerotherapy for lower limbs and sometimes the diathermocoagulation for the couperose. Now it is possible to correct this slight blemish even with particular type of laser with particular wavelengths. I personally use Laser Nd-Yag 1064 for lower limbs and the most dilated capillaries of face, while for very thin capillaries of face I use Laser 532, which is a true revolution, with very good results.

Advantages? The result sometime is super imposable to the treatment with sclerotherapy, but there is not needle, pain, and burning is very limited. The final result is good. Beside, we can treat more capillaries while with the sclerotherapy some were difficult to access, for example on foot and ankle, or the difficult ones along the saphenas, on the internal side of tight. Then, for “Matting”, those very thin capillaries that develop themselves after a surgical operation or after a major sclerotherapy, the laser is absolutely irreplaceable. In the end I think that the association of the two techniques gives the best results.

What is the laser? LASER, acronym that means Light Amplification by Stimulated Emission of Radiation, practically is a device that gives out light. Obviously a particular type of light and especially very variable because we can have numerous length waves that determine most of the characteristics of the laser: in particular the color on which it acts (the so called chromophores) and the deepness to which the radiation reaches the skin. The laser 1064 reads the color blue and dark red very well. It has a better penetration in the skin and it reaches the deepest dermal layers. It can be useful in the therapy for the venous grid, the bigger one, and it is very efficient for venous insufficiency. The laser 532 reads the bright red better and it has a shorter penetration. It is very useful for very thin capillaries, in particular the ones on the face.

How does the therapy take place? The capillaries of the inferior limbs are only the tip of the iceberg and they appear on the surface because the venous circle underneath, the reticular veins or the saphenes are wide. So, if this is the cause, first we need to treat the bigger veins, that creates the insufficiency and only in the end the telangiectasia. For this reason, in my opinion, the best therapy is an integrated therapy that sees at the beginning the care of the major venous insufficiency and in the end the minor one. Very often we talk about an integrated therapy both with sclerotherapy and laser to redefine the result. It is very important to be able to do a complete diagnosis, eventually with a venous echocolourdoppler of lower limbs. This will allow doing an accurate diagnosis of the venous insufficiency, mapping accurately the points of venous insufficiency. The therapy always starts with the treatment of the most wide veins and varices, for example with scleromousse. But it is the saphena that is insufficient, and then the operation of election can also be the radical saphenectomia. The laser Nd-Yag is one of the lasers with the best effect on capillaries and on venulas of a certain caliber. The capillary is closed by the energy of the laser that reads the specific color: the skin absolutely remains undamaged! Beside, the laser I used, foresees also a particular type of refrigeration on the tip, close to the skin, called Terma Cool, which allows to reduce the inflammation and the burning. However, in the end of sessions people need to wear elastic socks and all the preventive therapy normally prescribed has to be followed.

How many sessions do we need? If there are a lot of capillaries, a lot of sessions are needed, but with an average of 4-5 sessions we can treat an important defect.

Obviously the therapy does not have a definitive result, but with the years the capillaries that have to show, will surely show. This is not due to the fact that we close one capillary and the other one is opening, but it is due to the individual predisposition that provokes other capillaries to show with the years anyway.

Which pathologies can we treat? The thin capillaries of legs and the couperose represent the best targets. Also the ruby angioma, the single star angioma or multiples represent good target that disappear sometimes after only one treatment.

Informed Consent 1064 Nd-Yag
Informed Consent 532
Informed Consent IPL

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