Med Lasers 2023; 12(4): 256-259  https://doi.org/10.25289/ML.23.047
Therapeutic effect of long-pulsed 1,064-nm Nd:YAG lasers on venous lakes in Korean patients: a case report
Jiwon Lee1, Sang Ju Lee2, Han Kyoung Cho1
1Department of Dermatology, Myongji Hospital, Goyang, Republic of Korea
2Yonsei Star Skin & Laser Clinic, Seoul, Republic of Korea
Correspondence to: Han Kyoung Cho
E-mail: trpchk@hanmail.net
ORCID: https://orcid.org/0000-0001-6074-013X
Received: December 11, 2023; Accepted: December 17, 2023; Published online: December 21, 2023.
© Korean Society for Laser Medicine and Surgery. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Venous lakes are soft, compressible papules typically located in the superficial papillary dermis of sun-exposed skin, including that of the face, ears, and lips, contain dilated thin-walled venules and are surrounded by a thin fibrous tissue layer. The primary interventions for treating venous lakes include improving cosmetic appearance and managing bleeding. Laser therapy is favored because of its proven efficacy, safety, and convenience. Long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers, capable of penetrating tissue depths of 7 to 10 mm, are utilized to target moderately deep and large vessels. This report describes two successful cases of venous lake treatment in Korean patients using long-pulsed Nd:YAG lasers.
Keywords: Neodymium-doped yttrium aluminum garnet laser; Phlebectasia of lips; Venous lake
INTRODUCTION

Venous lakes are soft, compressible papules usually located on sun-exposed skin, including the face, neck, ear, and lips [1]. Histopathological examinations indicate dilated thin-walled venules surrounded by a thick wall of fibrous tissue in the superficial layer of the papillary dermis [1,2]. Treatment of venous lakes includes surgical excision, cryosurgery, sclerotherapy, and electrocoagulation [1]. However, these methods can take a long time, cause discomfort and lead to varying degrees of success [1,2].

Alternate treatments include laser modalities with fewer side effects [1]. Neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers with 1,064 nm penetrate into tissue with variable pulse durations up to 300 ms [3], generating more damage to larger vascular structures [1,2,4]. Current research indicates effective and safe application of long-pulsed Nd:YAG lasers in the treatment of venous lakes [5]. We report two cases of Korean patients with venous lakes treated with long-pulsed 1,064-nm Nd:YAG lasers.

The written informed consent was obtained from the patients for the publication of this case report.

CASE REPORTS

Case 1

A 62-year-old man came to our clinic because of a 1.0 × 1.0 cm asymptomatic violaceous papule in the center of his lower lip that had appeared 7 years previously after a trauma (Fig. 1A). He had no other medical or family history. Under the final diagnosis of venous lake, a total of two laser treatment sessions were performed using a 1,064-nm Nd:YAG laser (Vbeam Prima®, Candela) with a fluence of 110 J/cm2, a spot size 5 mm, and a pulse duration of 30 ms. After the first treatment session, approximately 90% of the lesion disappeared (Fig. 1B), and it disappeared completely after the second treatment session (Fig. 1C).

Figure 1. (A) Before the treatment. (B) Almost 90% of the lesion resolved after 1 month of the first treatment session. (C) One month after the second treatment session, the lesion had completely disappeared.

Case 2

A 58-year old woman visited our clinic for a 0.4 × 0.4 cm bluish papule on the right side of her lower lip that had appeared 7 years previously (Fig. 2A). She had no other medical or family history. After being diagnosed with venous lake, she was treated with a 1,064-nm Nd:YAG laser (Vbeam Prima®). One session was undergone with a fluence of 110 J/cm2, a spot size 5 mm, and a pulse duration of 30 ms. The lesion had completely resolved one month after the treatment (Fig. 2B).

Figure 2. (A) Before the treatment. (B) The lesion had completely disappeared 1 month after the treatment.
DISCUSSION

The pulsed dye laser (PDL) was used for the first time to treat superficial vascular lesions based on the principle of selective photothermolysis [1]. The target chromophore in vascular lesions is oxyhemoglobin, which has absorption peaks at 418, 542, and 577 nm and optimal absorption at 577-600 nm [3]. PDL uses short pulse durations and is therefore ideal for the treatment of smaller vascular lesions such as telangiectasias and venous lakes [1]. Gonzalez et al. [6] used 577 nm PDL to treat 5 venous lakes, and all lesions resolved after 1 to 3 treatment sessions. Thanks to recent technological advances, PDL can target deeper vessels by emitting longer wavelengths from 585 nm to 600 nm [1,7]. However, Cheung and Lanigan [7] treated eight venous lakes patients with 595 nm PDL and only three patients had sufficient resolution. This limitation was explained by the fact that the thermal energy was not sufficient to permanently close all the blood vessels [7]. Additionally, PDL is known to cause complications such as scarring, keloid formation, and post-inflammatory hypo- and hyperpigmentation [3,5]. Since melanin also absorbs light at 577 nm, PDL is limited in darker skin types due to the risk of epidermal damage [3,5,6].

1,064-nm Nd:YAG lasers penetrate up to 7 to 10 mm and can deliver pulse widths of 50 to 60 ms, causing greater damage to deep, large vessels [1-3,5]. The absorption coefficient of blood at 1,064 nm is 0.4/mm, which is substantially higher than that of the surrounding dermis (0.05/mm) at the same wavelength, allowing higher selectivity of treatment of deep blood vessels [3].

Previous studies have shown that the use of long-pulse Nd:YAG is effective and safe in the treatment of venous lakes [1]. Bekhor [2] treated 35 patients with venous lake using 1,064 nm Nd:YAG lasers at pulse duration of 55 ms, and 94% of patients had complete healing after a single treatment session. John et al. [8] used the pulse duration of 20 ms to treat 31 patients with venous lakes and 87% of them had complete healing without signs of recurrence. Specific parameters used on each study are summarized on Table 1.

Table 1 . Specific laser parameters used at previous studies using 1,064-nm long pulsed Nd:YAG lasers for the treatment of venous lakes

ReferenceNo. of patientsSpot size (mm)Fluence (J/cm2)Pulse duration (ms)
Bekhor, 2006 [2]35325055
5140-180
John et al., 2016 [8]31760-12020


Recently, multiwavelength laser treatment, including PDL at 595 nm followed by Nd:YAG at 1,064 nm was reported as a promising tool for venous lakes [1,9]. PDL targets shallow vascular structures whereas Nd:YAG targets deeper ones, thus able to treat vessels at different dermal levels during a single session [9]. In addition, PDL transforms oxyhemoglobin to methemoglobin, which is more easily absorbed by Nd:YAG. This enables the use of lower fluences, maintaining its effectiveness and reducing the risk of side effects [1,9]. Yang et al. [9] used multiwavelength lasers to treat 17 venous lakes in 15 Chinese patients, with laser parameters of a spot size 7 mm, fluence 7-11.5 J/cm2, pulse duration 2-10 ms for PDL and fluence 30-40 J/cm2, pulse duration 15-40 ms for Nd:YAG. Complete resolution was observed in 14 lesions after 1-2 treatment sessions and only one lesion was recurred after 1 year.

In this study, 1,064-nm Nd:YAG lasers with a pulse duration of 30 ms were used to treat venous lakes in Korean patients. Both patients had a response of over 90% after a single session and the patients were very satisfied. Further research is required to compare the effectiveness of long-pulsed Nd:YAG laser with other laser modalities and with multiwavelength lasers for the treatment of venous lakes in Korean patients.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

Conceptualization: SJL. Project administration: SJL, HKC. Supervision: SJL, HKC. Resources: SJL. Visualization: SJL, JL. Writing–original draft: JL. Writing–review & editing: all authors.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

DATA AVAILABILITY

None.

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