Why sometimes after treating leg veins with an ND:YAG 1064, some new small veins appear peripherally from the treated vessel? Is this common? Can i do something to prevent it?
I also had one case of a 55 y.o. woman who developed persistent purpuric lesions for 7 months in the location of the treated vessel.

George Gr.,

Two things. When other veins appear it is most likely that you did not eliminate the "cause" of the veins. They have a deeper feeder that you did not eliminate. Think of the veins as a river with tributaries. You just dammed the tributaries but the river has rerouted, forming new tributaries.

The purpura you are seeing is probably due to too much power. Either your fluence is too high or your pulse width is too short (or probably both) for the veins. You are putting too much peak power into the vessel and are essentially exploding the vessel. It could also be that you are trapping blood in the vessel by spacing your pulses too far apart. If you clip off one side of the vein, and then the other but miss the middle you will trap blood. The middle portion of the vein has no oxygen to feed it so it eventually will turn purple due to no oxygen. this will last many months.

What are the settings you are using? We need to know what laser you are using, fluence, pulse width, spot size and cooling temp.

Dexter

We also need to know approximate size of vessel and degree of vascular problems on this particular patients leg.

in responce to your answer, i am using a Sciton's ND:Yag 1064. the vessel size in the pasient who developed purpura was of 1 mm and i used the 6spot hand piece at 90 Joules / 30 msec, placing shot 2-3 mm apart. i use a cooling sapphire window provided by Sciton at 2 deggres Celsius for a few seconds. after freazing the vessel i place the shots directly to the skin (without the cooling window -i think is more effective like that). the pacient had a few dilated superficial blue viens, treated in one session of 30 minutes - wasn't a difficult case in my opinion. although i have only experience of afew mounths with my laser... what did i do wrong?

George,

Was cooling 12 degrees or 2 degrees?

I would not space the pulses out by 2-3 MM. This will trap the blood in the vein as mentioned in my earlier post. If you had a straw full of water and coagulated the end of the straw you would leave water in the middle. If it was water no big deal, but you are leaving blood there. That blood will deoxygenate (no supply of fresh oxygen) and turn purple. It can become like a goo. It will take 6 months minimum for that do disappear, if not longer.

Is it true purpura (too much peak power, which I doubt) or it blue trapped blood?

Dexter

cooling window at 2 degrees celsius.
By Sciton's protocol, i must place pulses 2-3 mm apart. you thing this is too much?
in one case i had true puprura which speaded around the treated vessel and in another case i had purpura who lasted several days and finally turned out to hyperpigmentation (Too much fluencei think.in thw 2nd case i used 6mm hand piece at 110 joules - 25 msec...). i think that the removal of the cooling plate and treating directly on skin (as i do) leeds in these reactions, but is much effective this way. i hate treating through the cooling plate. what is your way of treating?

George Gr,

I have a Cutera 1064 and tend to use higher fluences than you have used with a pulse width of 10 to 40 ms and I have only had the purpura once. I use a zimmer chiller instead of the cooling tip.

Your overlap is definitely too much. The Sciton protocols teach you how to hurt someone, not necessarily what is effective. Use the 6 mm spot place the spots right next to each other. Only do 2-3 pulses and take a 1 second break. You should see the blood chased out of the vessel. There should be no flow in the vein. You can press on it to check flo. If you press and the blood goes out and then returns then you do not have enough energy to remove the vein.

If you turn your chilling up (12 degrees minimum) then you will not overcool and will not have to compensate by removing the chilling window. Be sure not to overchill the veins. The goal is to heat up the blood and close down the vein wall structure. If the structure is too cold you will have to turn the fluence up even higher to deliver energies that will increase the peak temperature to a point where it shuts down the vein.

Try the other cooling handpiece which is the atached single spot version. The paddle leads to overcooling.

If you want some additonal help post your email and I can email or call you to help. Good luck.

Dexter

I love this site! This is the kind of stuff I deal with every day. Thanks for all your experience and input.

Dexter, thanks for the help! The cooling plates reflects the the light from the ceiling, need oil so it will not blur, and returns a part of the heating energy directly on my face by reflection. These are the reasons that forced me stop using them (although the attached one is more easy to use). I also remove the plate while treating hairs. (I am using the same ND Yag to reduce hair growth - untill next year, that's when i hope i'll buy the BBL). Tell me the corect chilling adjustments for veins and hair treatment with and without the chilling plate. I am quite confused and i think that i do many things the wrong way. There are secrets to follow that i ignore. My Emai is doufas33@gmail.com (Jeff: I corrected Gerorge Gr's email here to the one he posted as correct.)

LH, you've been very helpful once more. This site is a great gift!!! My Email is: doufas33@gmail.com

George Gr,

Sounds like I would get rid of the chilling plate. I tend to use the smaller spot size for the superficial spider veins. It does not penetrate as deep and I have never had a burn from it. Remember I use a zimmer for cooling and I can cover a lot of area in a short amount of time.

I will use the 5mm spot on my Cutera for the 1.5mm and larger vessels. Remember the larger the vessel the longer the pulse width. It sounds as if the Sciton 1064 will need less fluence than I use on the Cutera. With the Cutera I have 3mm,5mm,7mm and 10mm spot size. I do use all of them for vein removal but mostly the 3 and 5mm. I have been able to get as large as 5 to 7mm reticular veins.

Practice on friends family and staff until you become very comfortable with using the 1064. You can scar people with it. Listen to Dexter he has the Sciton and will be able to help you more with the fluence settings than I can. I can only give generalities.

A long pulse Nd:YAG or 1064 nm Semiconductor laser diode will do it at around 60-80 millisecondss up to 120-140 milliseconds at a repetition of 5 Hz approximately (leaving 100 milliseconds between pulses.)