Laser treatment of pigmented and vascular lesions in the office

The treatment of vascular and pigmented lesions has been greatly improved since the introduction of laser technology. Utilizing the principles of selective photothermolysis, physicians can be very specific in their treatment, maximizing injury of the selected target and minimizing damage to surrounding structures. Treatment of vascular lesions is accomplished with a variety of wavelengths. The pulsed-dye laser system remains the gold standard with which all others are compared. A variety of advances in technology in recent years have greatly improved laser treatments. These include the addition of longer pulse widths, variable spot sizes, and a variety of skin-cooling techniques. With today's laser technology, most facial telangiectasias can be treated in a single session with minimal downtime. Angiomas often require more than one treatment. Port wine stains and hemangiomas still require multiple treatments, but treatment sessions are less painful and recovery is quicker. The treatment of pigmented lesions has also improved with new technology. Q-switched systems provide optimal treatment for most pigmented lesions. In general, superficial pigmented lesions are treated with shorter-wavelength systems, and deeper lesions are treated with longer-wavelength systems. The CO2 laser continues to have a role in difficult-to-treat lesions.