Treatments

Treatments with pulsed light systems involve direct contact to the skin, and can involve multiple passes when the treatment warrants it. One of the unique features of a pulsed light system is the extremely large range of pulse duration options that are available. On some of the top of the line systems, an operator can choose between 5 and 100 ms, depending on what condition they are treating. The cases involving larger vessels in the Alar area are usually the ones that require a multiple pass approach. For vessels with larger diameters (Fig. 4.10), a multi pass approach, working from longer pulse duration to shorter pulse duration, may be the best choice. For example, a 0.7 mm vessel may require a 100 ms pass at 50-70 J/cm2, followed by a 20 ms at 30-50 J/cm2, using correct contact to the skin, so as to utilize the contact cooling sapphire. For smaller vessels, a 20 ms pass followed by a 10 ms pass may be necessary. The idea is to “chase the vessel size” as the vessel is injured by light, and the diameter is reduced. Although the larger vessels are treated by a long pulse with high fluence, oftentimes, a small amount of blood flow still remains. The shorter pulse follow-up will create a higher peak power, which is necessary to treat the smaller amount
of oxyhemoglobin left in vessel. The same type of multiple pass, variable pulse duration treat­ment approach is also used in the fighting acne, and in some resistant hair removal cases. While even the best pulsed light systems are limited by their depth of penetration, they are now regarded as an alternate new gold standard for the treatment of all superficial blood ves­sels, sun-based pigmentation, hair removal, and also helpful in fighting acne. It is this type of versatility that makes the right pulsed light system an important part of any practice.