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My clinic is mainly visited by patients with benign pigmented, vascular or other skin conditions. Pigmented lesions include melasma, blemishes, post-inflammatory hyperpigmentation and moles; vascular lesions include diffuse redness and telangiectasia. Other skin conditions include acne, scars, warts and skin rejuvenation.
The treatment of these conditions is typically the same in most dermatologic clinics: CO2 fractional laser, Q-switched Nd:YAG laser, IPL and/or pulsed dye laser (PDL). While our clinic is equipped with these machines, our PDL is now being replaced by a long-pulsed KTP and Nd:YAG laser called V-laser, developed and manufactured by Wontech Co.
, Ltd. (Daejeon, South Korea).
PDLs have widely been used for vascular lesions because of its high hemoglobin absorption coefficient, which offers the advantage of more selective treatment of vascular lesions. However, due to the heavy burden of device usage time and maintenance costs, PDLs are being replaced by long-pulsed lasers with 500 nm wavelengths. I have been using V-laser’s KTP for over two years and am very pleased with its performance.
V-laser is an FDA-approved long-pulsed laser with dual wavelengths of 532 nm KTP and 1064 nm Nd:YAG. It is equipped with various spot sizes, pulse duration, fluence and frequency, allowing physicians to freely adjust these parameters within a wide range to effectively and safely treat various indications, including benign vascular lesions, pigmented lesions, acne, skin rejuvenation and more.
To protect the skin’s surface during the procedure, V-laser uses a sapphire window as a cooling method. Therefore, no consumables are required, as with cryogen cooling methods. In addition, V-laser uses a solid medium; therefore, its operation is very stable and the maintenance cost is much lower than PDLs.
In my clinic, we mainly use the V-laser’s 532 nm for benign vascular lesions, especially in the treatment of diffuse redness and facial telangiectasia. Diffuse redness is treated with a toning technique that uses multiple passes of a low fluence with a large spot size of 10 mm.
For this, a transparent ultrasonic gel is thinly applied to the skin with cooling at 5° C to cool the surface of the skin, enabling faster handling. Then, mild to moderate erythema and edema will appear. The patient can see immediate effects, and after three treatments given every two weeks, more noticeable results are obtained.
Since 532 nm has a high absorption coefficient for melanin as well as hemoglobin, the same technique can be used to effectively treat pigmented lesions in large areas such as epidermal melasma, blemishes and/or full-face skin brightening.
Facial telangiectasia is also one of the indications frequently treated with the V-laser’s 532 nm. As mentioned above, the 532 nm’s high absorption coefficient for hemoglobin is suitable for treating vascular lesions, but there is a limitation of low penetration depth. This limitation can be overcome, and the therapeutic effect can be increased by using a relatively large spot size (5 mm, instead of 3 mm).
To treat facial telangiectasia, I use a spot size of 5 mm with a pulse dura- tion of 10-20 ms, moderate fluence and cooling at 5° C. Immediate vessel clearance or contraction are observed as good endpoints. Typically, this procedure is carried out three to five times every three to four weeks. No side effects are observed, but the results of the treatment are very satisfactory.
The advantage of using the V-laser is the square pulse, which is a true long pulse, that decreases the incidence of purpura and is safer than PDL treatment. Additionally, since a higher frequency can be used than with PDL, the procedure is performed very quickly, enabling more patients to be treated in a given period of time compared to PDL.
KTP is also used to treat other dermatologic conditions. For example, acne can be excellently cured.
In my clinic, patients with acne, acne redness and acne with dyschromia, are all satisfied with V-laser treatment. A spot size of 6 mm with a short pulse duration and medium fluence is used with cooling of 5° C. Immediately post- procedure, mild to moderate erythema, edema and purpuric symptoms appear on the lesion. After five treatments at two-week intervals, we see significant improvements in acne vulgaris, acne redness and post-inflammatory hyperpigmentation.
We have also treated warts on the hand with the 532 nm KTP, a spot size of 4 mm, a short pulse duration and a high fluence with no cooling. We deliver
three stacked pulses. The color of the lesion turns out greyish, which is a good endpoint. For the wart on feet, I prefer to use 1064 nm Nd:YAG with cooling, based on the lesion location and laser penetration depth.
As a dual wavelength, V-laser’s Nd:YAG can be utilized to treat various indications as well. Skin rejuvenation is a popular procedure that uses the 1064 nm.
When performing a skin rejuvenation treatment, I use a large spot size of 10 mm, longer pulse duration from 30-40 ms, a moderate fluence and cooling at 5° C for skin tightening. I usually deliver 200 pulses per cheek area. Patients have been surprisingly satisfied, with improved nasolabial folds and a lifted appearance of the lower face.
Considering space limitations, time and cost efficiency, it is very important to have a device that effectively and safely treats a variety of indications. In addition, consideration should be taken as to whether parameters can be adjusted freely, durability is excellent and maintenance costs are low.
V-laser is a multi-purpose laser that can effectively and safely treat various indications, including benign vascular lesions, pigmented lesions and other skin conditions. In particular, the therapeutic effect is excellent in aging, tanned and/or erythematous skin. That is why I chose V-laser, use it extensively, and am satisfied with the clinical outcomes. V-laser is one of the most often used energy-based devices in my clinic.
About the author
Ryu Han Won, MD, PhD
Dr. Won is president of The First Dermatology Clinic in South Korea. He is also a member of the Korean Society of Dermatology, the American Society of Dermatology and ISDS, World Dermatology Society. Dr. Ryu actively lectures and presents his clinical papers at Korean and international conferences.