Treatment Issue: Historically, treating vascular lesions, such as facial telangiectasias, has necessitated downtime with significant post-treatment purpura. This article discusses the reintroduction of using compression during laser procedures to minimize purpura following the procedure.
Introduction
Chronic sun exposure results in cumulative cutaneous changes that are frequent targets for the laser surgeon. Signs of photoaging or dermatoheliosis include wrinkling, epidermal thinning, blotchy hyperpigmentation, and the formation of diffuse telangiectasias.
Historically, treating such vascular lesions has necessitated downtime with significant post-treatment purpura. Recent adaptations to extant laser devices have greatly raised the purpura threshold and offer patients the option of returning to their schedules as quickly as possible.
For many years, laser surgeons have taken advantage of the principle of reducing purpura with the use of compression by using diascopy during laser treatments. Specifically, by using a glass slide to compress the blood vessels in the target, the vascular chromophore is removed and the creation of purpura greatly minimized. The slide effectively compresses the blood vessels, propelling the blood peripherally in order to reduce purpura.
Reintroducing Compression as a Purpura Reduction Strategy
The use of compression has recently been re-introduced by two laser manufacturers to assist with purpura reduction.
A device with integrated compression technology is the V-beam Perfecta pulsed dye laser (PDL) from Candela (Wayland, MA), while the Medlite C6 Purpura Lite tool is available bundled with the Conbio (Fremont, CA) platform or as a discrete consumable available for purchase.
With the Candela device, the decrease in purpura relates to two changes made to existing pulsed dye laser technology. With a classic PDL, fewer subpulses were delivered to the skin with the end result that each pulse delivered a higher peak power. In contrast to traditional pulsed dye technology, which used four 150-microsecond pulses with dissimilar energy distribution, the new Perfecta PDL delivers eight micropulses in a fashion that resembles one continuous pulse, thereby minimizing purpura. These subpulses are equivalent such that only one-eighth of the energy delivered per pulse comes with each subpulse. Consequently, there is insufficient fluence to produce purpura. In addition, the handpiece now has a built-in compression device (see graphics 1A to 1D) that serves the same function as the slide technique referenced above.
The Medlite PurpuraLite device works similarly, albeit with an elegant simplicity. It resembles a plastic spoon (image 2C) that when pressed against a target removes the hemoglobin that would be targeted by the 532 nm Q-switched laser. The tool pushes the blood out of the vessels so that there is no bystander hemoglobin absorption. In doing so, the potential exists for purpura-free treatment of tattoos and pigmented nevi with the known efficacy of Q-switched YAG technology.
This tool is available as an independent consumable and can be utilized in clinical practice with any vascular wavelength laser.
Treatment Tips
1. To apply diascopy during a treatment either with a slide or one of the aforementioned devices, the best effect comes with using the nontreating hand, or better still, having a second pair of hands to hold the skin taut while applying even pressure with the chosen device.
2. It is important to remember that many forms of protective skin cooling (including the use of cryogen spray or cold air) will be interfered with by using these techniques and alternative mechanisms for epidermal protection must be utilized.
3. A glass slide is an inexpensive option that can be used for diascopy of vascular lesions. It is important to recognize that skin cooling is limited with diascopy and must be compensated for accordingly.
4. Options for compression devices include the more costly pulsed dye devices with integrated handpieces from Candela or the relatively inexpensive consumable from Conbio, the PurpuraLite. n
Treatment Issue: Historically, treating vascular lesions, such as facial telangiectasias, has necessitated downtime with significant post-treatment purpura. This article discusses the reintroduction of using compression during laser procedures to minimize purpura following the procedure.
Introduction
Chronic sun exposure results in cumulative cutaneous changes that are frequent targets for the laser surgeon. Signs of photoaging or dermatoheliosis include wrinkling, epidermal thinning, blotchy hyperpigmentation, and the formation of diffuse telangiectasias.
Historically, treating such vascular lesions has necessitated downtime with significant post-treatment purpura. Recent adaptations to extant laser devices have greatly raised the purpura threshold and offer patients the option of returning to their schedules as quickly as possible.
For many years, laser surgeons have taken advantage of the principle of reducing purpura with the use of compression by using diascopy during laser treatments. Specifically, by using a glass slide to compress the blood vessels in the target, the vascular chromophore is removed and the creation of purpura greatly minimized. The slide effectively compresses the blood vessels, propelling the blood peripherally in order to reduce purpura.
Reintroducing Compression as a Purpura Reduction Strategy
The use of compression has recently been re-introduced by two laser manufacturers to assist with purpura reduction.
A device with integrated compression technology is the V-beam Perfecta pulsed dye laser (PDL) from Candela (Wayland, MA), while the Medlite C6 Purpura Lite tool is available bundled with the Conbio (Fremont, CA) platform or as a discrete consumable available for purchase.
With the Candela device, the decrease in purpura relates to two changes made to existing pulsed dye laser technology. With a classic PDL, fewer subpulses were delivered to the skin with the end result that each pulse delivered a higher peak power. In contrast to traditional pulsed dye technology, which used four 150-microsecond pulses with dissimilar energy distribution, the new Perfecta PDL delivers eight micropulses in a fashion that resembles one continuous pulse, thereby minimizing purpura. These subpulses are equivalent such that only one-eighth of the energy delivered per pulse comes with each subpulse. Consequently, there is insufficient fluence to produce purpura. In addition, the handpiece now has a built-in compression device (see graphics 1A to 1D) that serves the same function as the slide technique referenced above.
The Medlite PurpuraLite device works similarly, albeit with an elegant simplicity. It resembles a plastic spoon (image 2C) that when pressed against a target removes the hemoglobin that would be targeted by the 532 nm Q-switched laser. The tool pushes the blood out of the vessels so that there is no bystander hemoglobin absorption. In doing so, the potential exists for purpura-free treatment of tattoos and pigmented nevi with the known efficacy of Q-switched YAG technology.
This tool is available as an independent consumable and can be utilized in clinical practice with any vascular wavelength laser.
Treatment Tips
1. To apply diascopy during a treatment either with a slide or one of the aforementioned devices, the best effect comes with using the nontreating hand, or better still, having a second pair of hands to hold the skin taut while applying even pressure with the chosen device.
2. It is important to remember that many forms of protective skin cooling (including the use of cryogen spray or cold air) will be interfered with by using these techniques and alternative mechanisms for epidermal protection must be utilized.
3. A glass slide is an inexpensive option that can be used for diascopy of vascular lesions. It is important to recognize that skin cooling is limited with diascopy and must be compensated for accordingly.
4. Options for compression devices include the more costly pulsed dye devices with integrated handpieces from Candela or the relatively inexpensive consumable from Conbio, the PurpuraLite. n
Treatment Issue: Historically, treating vascular lesions, such as facial telangiectasias, has necessitated downtime with significant post-treatment purpura. This article discusses the reintroduction of using compression during laser procedures to minimize purpura following the procedure.
Introduction
Chronic sun exposure results in cumulative cutaneous changes that are frequent targets for the laser surgeon. Signs of photoaging or dermatoheliosis include wrinkling, epidermal thinning, blotchy hyperpigmentation, and the formation of diffuse telangiectasias.
Historically, treating such vascular lesions has necessitated downtime with significant post-treatment purpura. Recent adaptations to extant laser devices have greatly raised the purpura threshold and offer patients the option of returning to their schedules as quickly as possible.
For many years, laser surgeons have taken advantage of the principle of reducing purpura with the use of compression by using diascopy during laser treatments. Specifically, by using a glass slide to compress the blood vessels in the target, the vascular chromophore is removed and the creation of purpura greatly minimized. The slide effectively compresses the blood vessels, propelling the blood peripherally in order to reduce purpura.
Reintroducing Compression as a Purpura Reduction Strategy
The use of compression has recently been re-introduced by two laser manufacturers to assist with purpura reduction.
A device with integrated compression technology is the V-beam Perfecta pulsed dye laser (PDL) from Candela (Wayland, MA), while the Medlite C6 Purpura Lite tool is available bundled with the Conbio (Fremont, CA) platform or as a discrete consumable available for purchase.
With the Candela device, the decrease in purpura relates to two changes made to existing pulsed dye laser technology. With a classic PDL, fewer subpulses were delivered to the skin with the end result that each pulse delivered a higher peak power. In contrast to traditional pulsed dye technology, which used four 150-microsecond pulses with dissimilar energy distribution, the new Perfecta PDL delivers eight micropulses in a fashion that resembles one continuous pulse, thereby minimizing purpura. These subpulses are equivalent such that only one-eighth of the energy delivered per pulse comes with each subpulse. Consequently, there is insufficient fluence to produce purpura. In addition, the handpiece now has a built-in compression device (see graphics 1A to 1D) that serves the same function as the slide technique referenced above.
The Medlite PurpuraLite device works similarly, albeit with an elegant simplicity. It resembles a plastic spoon (image 2C) that when pressed against a target removes the hemoglobin that would be targeted by the 532 nm Q-switched laser. The tool pushes the blood out of the vessels so that there is no bystander hemoglobin absorption. In doing so, the potential exists for purpura-free treatment of tattoos and pigmented nevi with the known efficacy of Q-switched YAG technology.
This tool is available as an independent consumable and can be utilized in clinical practice with any vascular wavelength laser.
Treatment Tips
1. To apply diascopy during a treatment either with a slide or one of the aforementioned devices, the best effect comes with using the nontreating hand, or better still, having a second pair of hands to hold the skin taut while applying even pressure with the chosen device.
2. It is important to remember that many forms of protective skin cooling (including the use of cryogen spray or cold air) will be interfered with by using these techniques and alternative mechanisms for epidermal protection must be utilized.
3. A glass slide is an inexpensive option that can be used for diascopy of vascular lesions. It is important to recognize that skin cooling is limited with diascopy and must be compensated for accordingly.
4. Options for compression devices include the more costly pulsed dye devices with integrated handpieces from Candela or the relatively inexpensive consumable from Conbio, the PurpuraLite. n
