i have an ND:yag 1064 nm laser by sciton and i am having problems in veins treatment. sciton's protocol for treating veins refers only to width parameters (msec). i have tried the 3mm and 6mm handpieces but the results aren't good. been afraid of creating a burn, i keep the fluence at 110 joules (6spot) or at 160 joules (3spot). can anyone help me with the fluence adjustment, please?

I have a Cutera 1064. So should be similar but not exact. Remember facial veins respond at lower energy than lower extremity veins. The facial veins are under lower pressure. I assume you are spot treating and not using the scanner. You must also always pay attention to the skintype.

First, as a general rule the pulse width will go up as the size of the vein increases. Such as smaller or very fine telangectasias you will be at 10msec and for larger veins more like 30 to 40msec.

Second, I use mainly the 3mm spot for anything 1mm and under. The Cutera has a 5mm spot which I use for the 1 to 3mm size vessels. Any veins larger than 3mm I use the 7 or 10mm spotsize. Also remember the deeper the vein the larger the spotsize. I have a lot of Fitz 1 to 3 and can be fairly aggressive.

Third, with a 3mm spot on the face most veins respond around 120 to 150j/cm2 and 10 to 30msec. The lower extremity veins and 3mm spot tend to respond 150 to 180j/cm2 occasionally higher and 10 to 30msec. 5mm spot veins will respond to 140 to about 170j/cm2 and 20 to 30msec pulse width.

If you are looking to get the very fine vascular netting with the 1064 give up. You will need some form of IPL system that can focus on the redness.

I have a lot of hours with the 1064 on veins. I know we will have someone chime in about sclero but there are a lot of people that have had sclero and do not want to do it again.