Anyone using any sort of electrosurgical unit like the bovie aaron 940, vascutouch, or skin system or veingogh for the small facial telangiectasias?
What do you recommend?

I am using the EllmanSurgitron as I can use it for a lot more than some of the other units. The Veinwave and VeinGough only do veins as the other systems you can hyfercate, coagulate and with some such as the Ellman you cna make very clean incisions. The Ellman is also significantly less money even if you buy the most expensive system. I think they are asking WAY too much money for the 2 vein specific units. You will get a lot more use out of the other systems and I feel the Ellman is the way to go. I have the smaller unit and plan to purchase the larger unit at some point.

LH

So do you think the Ellman EMC (the most basic unit they have I believe) is good enough?
Do you perform blepharoplasty at all?

I use IPL & Nd-Yag for facial veins. Some red nasal alar veins seem very resistant to laser and IPL unless I go very high and bruise them which patients do not like. Is there any point in buying a KTP? would this be any better, I could try co2 in surgical mode with a very fine spot size or am I better off using pointed tip with hyfrecator. Any suggestions will be much appreciated.

UC,

It depends. I currently do not do blephs but plan on it and will likely use a CO2 laser or an Ellman Surgitron. If I start doing larger incisions I will either use steel or buy the larger Ellman Unit. I currently have the EMC unit and it works fine for "lumps and bumps" type of surgery but is not a good choice for anything bigger as the unit will only activate for a specific amount of time and then has to reset itself which only takes a few seconds but is irritating. So if you are going to be doing blephs etc get the bigger unit as it does not time out.

Dr. Sanjay,

I would be very cautious with the CO2 and the hyfercator. They will both cause significant trauma to the skin and may cause scarring. The Surgitron has small little hair thin insulated tips that work very well for small vessels. Foe facial vessels I use a variety of tools to include the Sciton BBL, Ellman Surgitron and Cutera 1064 Nd:yag. It depends on the size of the vessels and the color of the patients skin.

Hope this helps,

Lornell E. Hansen II, M.D.
www.LazaDerm.com

Dr S
Bruising?
Look into your pulse duration and keep them "supra-purpuric" - maybe not possible if yours is qswitched

From a recent ASDS meeting (Alster)
LP Nd Yag for perinasal telangiectasia
200-250j/cm2, 50msec pulse duration, 3 mm spot
No overlap, no pulse stacking
Think "spot-welding" go distal to proximal and hit all branch points of vessels. May take 2-3 treatments for best results

532 is not the answer for persistent perinasal or larger/deeper vessels
I use the 940nm on my varilite for these, venous lakes etc with great results
Real risk of atrophy if over treating, especially on very sebaceous noses

07.16 | Mark

Thank you LH and Mark.
Mark, how many sessions of 940 do you need on average? My Ndyag is long pulsed and works very well for blue vessels but not tiny red telangiectasias. I have q s yag but I have never used it on vessels. I have 1-2 resistant cases but vast majaority get great results. I am trying to explore further options to be able to help these patients before I accept that I am not going to get a 100% success rate.

Sanjay

2 to 4 sessions provide good results
Vessel closure upon treatment is my clinical endpoint
Durability?
Managing pt expectations is paramount
These should be sold as maintainence treatments and pts should expect repeats at regular intervals (yearly)

Nice overview on treating facial telangiectasias
http://www.skinandaging.com/article/6157

Best
Mark