皮膚科 劉權毅醫師

Venous lakes are usually acquired venous lesions occurring on the face, neck and lips. These lesions commonly appear in people in their 40s or 50s and tend to become larger with time. They usually occur on sun-exposed parts of the lips, face and ears. They are also, commonly, benign growths.

Laser treatment of venous lakes usually yields a typical good response. These lesions are located at a depth which needs deep penetrating lasers, such as, PDL, diode and Nd: YAG. The Nd: YAG laser at 1,064 nm is less absorbed but penetrates deeper. For treating superficial venous lakes, PDL with the help of diascopy is quite effective. PDL with diascopy still remains the first line of treatment for superficial venous lakes.

Thicker and more nodular lesions require lasers with more penetration. For the safe and effective treatment of such lesions, Nd: YAG, alexandrite lasers and diode lasers, provided with contact cooling and adjustable pulse durations, are used. The long-pulsed Nd: YAG laser is highly effective treatment for venous lakes of the lip and cheeks. This treatment is painful. Therefore, local anesthesia is recommended. For instance, when treating lower lip lesions, mental nerve blocks are used. If local anesthesia is used, epinephrine should be avoided.

The clinical endpoint of PDL treatment is mild swelling and bruising, whereas the immediate endpoint of diode laser treatment is disappearance of the vessels and flattening of the lesions, after the laser pulse. Similarly, Nd: YAG lasers may be used for treating hypertrophic and nodal lesions, located deep inside the tissue. With a spot size of 3mm, pulse widths between 30 to 100ms and power density of around 100 to 150J/sq.cm, vessel occlusion can be achieved, giving the endpoint of clinical vessel clearance. Whatever be the mode of treatment, two or more treatment sessions may be required for treating, especially, hypertrophic and nodal lesions, located deep inside the tissue. Better clinical outcomes are expected when a combination of different wave lengths are used. Scarring is common side effect in all treatments.

There is currently a huge demand for treating facial vascular lesions, such as, venous lake, because demand stems from both medical and cosmetic needs. The laser techniques, in use offer safe and satisfactory treatment. Lately, there has been a perceptible shift in laser treatment, with the emphasis being laid more on less downtime and more treatments, rather than on single treatment and the ensuing treatment related marked side effects. For instance, pulse dye laser treatment produces significant bruising that may take as long as 10 days to cure.

Patients are no more willing to undergo such long duration treatments, for side effects at that. As a result, intense pulse light laser treatment, despite its limitations, is becoming very popular with patients. Newer laser technologies, with variable pulse widths and power densities, and integrated skin cooling systems are able to provide safer and better treatments with long term benefits.

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