THE DEEP IMPACT OF DYE LASER 595 nm and 1064 nm:
EVOLUZIONE IN UNA NUOVA TECNOLOGIA
Dott.Enrico Berne’- Dott.ssa K. Arcieri MAGENTA MEDICAL CENTER
Centro Laser Clinico
Centro Malformazioni Vascolari ASM-onlus
MILANO
TECHNIQUES OF TREATMENTS
SURGICAL
( SURGERY OR LASERSURGERY) STEROID THERAPY
PROPANOLOL EMBOLIZATION SCLERO THERAPY
LASERTHERAPY
COME SI INDAGA UNA MALFORMAZIONE VASCOLARE
FIRST APPROACH
ESAME CLINICO
CAPILLAROSCOPIA (MALFORMAZIONI
superficiali
) LASERDOPPLER
DOPPLER CW
ECOGRAFIA/ECOCOLORDOPPLER (MALFORMAZIONI “OCCUPANTI SPAZIO”)
IL PATTERN EMODINAMICO E LO SPETTRO DOPPLER FORNISCONO DATI ESSENZIALI PER IL SUCCESSIVO INDIRIZZO DIAGNOSTICO DEL PAZIENTE
VERSO
ANGIORM
ANGIOTC
ANGIOGRAFIA
COME SI INDAGA UNA MALFORMAZIONE VASCOLARE
DOPPLER CW/ECOCOLORDOPPLER
(indicazioni su direzione e tipo di flusso).
venoso
artero-venoso
spontaneo-inerziale
Alto/Basso flusso
Alte/Basse resistenze
ECOGRAFIA B-MODE ED ECOCOLORDOPPLER :
•
dimensioni,volumi,sede,margini e la diagnosi
differenziale tra emangioma ed altre neoformazioni
solide es. lipomi , cisti, forme sarcomatose
FROM “OLD” TO ”NEW” DYE LASER LOOKING FOR A GOLD STANDARD
HIGHER FLUENCE LONGER PULSE DURATION BIGGER SPOTS MORE EFFICIENT COOLING
SYSTEMS
BEST SELECTIVE
PHOTOTHERMOLISYS
PROFONDITÀ
Danno termico --- Disidratazione profonda--- Coartazione delle fibre dermiche--- denaturazione proteica---danno reversibile vascolare
Riparazione
Vasodilatazione---iperidrosi e reidratazione---
attivita’ cellulare riparativa--- collageno-genesi---
elastosi
INCREASED SPOT SIZE
WITHOUT COMPROMISING FLUENCE
A treatment that would take 100 pulses with a 12mm spot size would only take only 64 pulses with a 15mm spot size.
▪ The new laser system includes increased maximum fluence and spot size from 12mm to 15mm
▪ Deeper Penetration, Higher Effective Fluence
▪ 15mm spot allows for a faster treatment than previous machine
Spot size range
Fluence at 12 mm 10.6 J/cm2 Fluence at 15 mm 6.8 J/cm2
57% larger treatment area (12 vs 15 mm)
125% larger treatment area (10 vs 15mm)
▪ Eight equal energy pulses
▪ Closely mimics one continuous pulse
▪ Still Delivers Required Vessel Coagulation Fluence
VBEAM SYSTEM DIFFERENTIATOR – 8 MICRO- PULSES
Fluence
Time (ms)
Purpura Threshold
Classic PDL Technology, 4 pulses, dissimilar distribution
NEW PDL Technology, 8 pulses, equal energy
• Introducing new contact cooling option for the new laser system
▪ Chills the epidermis and upper
dermis level, where capillary vessels and nerve endings are located
▪ User controls and dispenses cooling to treatment site as needed, when needed
▪ Enables pre- and post-treatment cooling
▪ Cooling system can be used to treat vessels and pigment at the same time, in one convenient step
OPTIONAL
CONTACT COOLING WITHOUT CRYOGEN
1-STEP Vascular and Pigment Treatment
Cools deeper into the upper dermis level
PORT-WINE STAINS EVOLUTION
IN TIME
PORT-WINE STAINS:EVOLUTION IN
TIME
FOCAL RECIDIVA POST-TREATMENT
DYE 595 NM – 532 NM I.P.
2018 2017
2000
AFTER “NEVE CARBONICA” BEFORE DYE LASER 595NM ERA
ENRICO BERNE’
1997
Cheek and Neck PORT-WINE STAIN
3 SESSIONS – DYE LASER 585 nm
7-9 j/cm2 7 mm spot 400ms pulse
duration
THE “OLD STYLE ”DYE LASER 585 NM:
RETICULAR PATTERN AFTER ONE SESSION
DYE LASER
595 NM
THE DEEP IMPACT OF PRIMA LASER
LESS PORPORA
ANOMALIA VASCOLARE
TELEANGECTASICA SUPERFICIALE
MCV
5 SESSIONS DYE LASER 585/595NM (8/13 J - 7/10 MM – 0.45/3 MS)
532NM I.PULSE 2 FINAL SESSIONS
“THE DEEP IMPACT OF NEW
595 NM LASER”
UPPER LIP HEMANGIOMA
LASER 532 NM E 595 NM
3 SESSIONS
VASCULAR ANOMALY OF THE NOSE
532 nm I.P.(1 SESSION)
DYE 595 nm (2 SESSIONS)
PORT-WINE STAIN 595 NM INTENSE PULSE
4 SESSIONS
QUALE LASER ?
PROPRANOLOLO E DYE LASER 595 NM
1994
BLEEDING« HEMANGIOMA»
RESTORATION OF TISSUE WITH DYE LASER 595 NM - 1 SESSION
LASER 1064 NM
Absorbtion not elective
(Hb-Melanin-water)
Higher absorbtion by the water
Deep penetration
(4-7nsec>300 j>5-8mm)
Thermal effect no selective phototermolisis Control of thermal effects in phototermolisis?
CONSIDERATION ABOUT EVLT ND:YAG>>DIODE
Surgical tecnique echoassisted Transdermal - Transmucosal.
Treatment of deep lesions
Advantage in use of optical fiber High coagulative ability but High hemorragic risk
Accuracy in evaluation of thermal risk
Photocoaugulation – 2 sessions
Diode 980 – Fiber 360 mcr
VENOUS MALFORMATION SURGICAL OUTCOMES
ENDOLESIONAL - DIODE 980 NM
LYMPHATIC MALFORMATION
DIODO 1470 NM - OPTICAL FIBER 600 MICRON
HIGH-POWER, LONG-PULSE 1064 NM LASER
Good for full range of vessels from
fine telangiectasia to large, deeper vessels
3–7 mm spot w/ high fluence good for small, shallow vessels
3–7 mm spot w/ moderate fluence good for shallow spider veins
Large 10 mm spot size provides deeper
penetration for reticular veins
Epidermis Fine
Telangiectasia Spider
Veins Deep Reticular Veins
*Reduced melanin absorption at 1064 nm allows for safe use of greater fluences.
VENOUS MALFORMATION
LASER 1064 NM L.P. E 532 NM I.P.
THE DEEP IMPACT OF “1064
NM” LASER
VENOUS MALFORMATION
VENOUS MALFORMATION: 1064 nm + 595
nm
VENOUS LOW-FLOW ANOMALY: 1064 NM CRYOGENIC COOLING SYSTEM 160 J/CM2 -- 20 MS - SPOT 7 MM
EMANGIOMA LABBRO SUPERIORE
SINGLE LASER SESSION 1064 NM
SPOT 3 MM - 200 J/CM
2CONTACT
COOLING SYSTEM
THE DEEP IMPACT OF “PRIMA” LASER
THE DEEP IMPACT OF “1064
NM” LASER
COMPLEXITY IN VENOUS- CAPILLARY VASCULAR
ANOMALY (NOT SYNDROMIC) MORE SESSIONS WITH DYE 595
NM E 532 NM I.P. (AND A
TEMPATION TO YAG 1064 NM..)
MALFORMAZIONE VENOSA DEL LABBRO
ND:YAG 1064
NMUNICA SEDUTA
SKIN:
KTP 532nm i.p.
DYE 595nm LIP:
Diode 1064 Fiber 200nm
PORT-WINE STAIN IN
HYPERTROPHIC EVOLUTION WHEN WE TAKE A RISK..
TEST :
DYE 595 NM - 532 NM – 1064 NM DIFFERENT COOLING SYSTEM
HYPERTOPHIC SCARS DUE AT INADEQUATE
WAVELENGHTS AND PARAMETERS
ALTERATA CICATRIZZAZIONE CHELOIDE SINTOMATICO
POST-OTOPLASTICA CON SANGUINAMENTO ED INFEZIONE ; DYE LASER 595 NM
ASPORTAZIONE DEL CHELOIDE CON LASER
CO2 ULTRAPULSATO
7 SEDUTE CON DYE LASER 595 nm
NESSUNA RECIDIVA AD 1
AA
ALTERATA
CICATRIZZAZIONE-
TRATTAMENTO DEGLI ESITI DI USTIONE
RETRAENTI, CAUSA DI RIGIDITA’ AL MOVIMENTO
DYE LASER 595 nm
SEDUTE PER AREE CON LASER CO2 FRAZIONATO
2 AA DI TERAPIA (ANCORA IN CORSO)
Post-traumatic SCARRING outcomes
1. Dermoabrasion Laser CO2 Ultrapulse-Skanner
2. Dye 595nm 4 sessions: 7,5-10 j/cm2 7-10mm spot 3-10 ms
ESITI CICATRIZIALI POST-TRAUMATICI
PRE POST
LASER 532 I.P.- DYE 595 NM
CO 2 SKANNER FRAZIONATO
GRAZIE
Magenta Medical Center
Dott. Prof. Enrico Berne’
Laser Approach:
• Selected Tumor Lesions
• Benign Lesions
• Vascular lesions
• Aesthetics
LASERSURGERY
IN SKIN TUMORS
Laser Approach:
• Selected Tumor Lesions
• Benign Lesions
• Vascular lesions
• Aesthetics
LASERSURGERY
IN SKIN TUMORS
• particular anatomic districts
• tumor extension
• multiple lesions (ex. Sd Gorlin-Goltz)
• advanced age
• no indications to general anesthesia
LASER SURGERY INDICATIONS
DYE LASER TREATMENT 585
NM- 5 MM SPOT SIZE – 8,5 J/CM2
2 SESSION
COURTESY OF
T.ALSTER M.D.
Basal Cells
Carcinoma
Courtesy of N.Minars et Al.
DYE LASER LOOKING FOR A PRECISE PARAMETER
HIGHER FLUENCE LONGER PULSE DURATION BIGGER SPOTS MORE EFFICIENT COOLING
SYSTEMS
EVOLUZIONE DELLA FOTOTERMOLISI NEI LASER VASCOLARI
Dott. Prof. Enrico Bernè - Dott.ssa Katia Arcieri
