What is Laser Treatment of Vascular Lesions?

Effectiveness, Application and Complications
Vascular skin lesions can be congenital or acquired. Today, laser technologies are both effective and reliable options in the treatment of such lesions. Successful results are obtained especially in many lesions such as hemangiomas, port-wine stains, telangiectasias, rosacea and spider angioma. However, appropriate patient selection and correct application conditions are very important in order to increase the effectiveness of the treatment and prevent complications.

Laser Mechanism of Action: Selective Photothermolysis
Laser treatment of vascular lesions is based on the principle of “selective photothermolysis”. Laser beams provide energy transfer by targeting oxyhemoglobin in the vessel. This energy is converted into heat and creates coagulation and occlusion in the vessel walls. Since the absorption peaks of oxyhemoglobin are in the wavelengths of 418, 542 and 577 nm, laser systems are designed in these ranges.

Laser Types Used
Pulsed Dye Laser (PDL, 585–595 nm)

KTP Laser (532 nm)

Alexandrite Laser (755 nm)

Diode Laser (800–900 nm)

Nd:YAG Laser (1064 nm)

In recent years, dual wavelength systems (e.g. 595 nm PDL + 1064 nm Nd:YAG) and microsecond Nd:YAG lasers have also entered the treatment options.

In Which Cases Is It Used?
Congenital: Hemangioma, Port-Wine Stain, Blue Rubber Bleb Nevus syndrome

Acquired: Telangiectasia, spider angioma, pyogenic granuloma, Civatte poikiloderma, rosacea, venous lake

Lasers are often sufficient alone, but in some cases they can be used in combination with systemic treatments.

Preoperative Evaluation and Patient Selection
A detailed evaluation should be conducted with the patient before starting treatment and the following should be considered:

Natural history of the lesion, potential for spontaneous regression

Alternative medical treatment options (e.g. beta blockers, steroids)

Anatomical features of the location (e.g. risk of glaucoma if PWS is present in dermatome V1)

Necessary radiological evaluations (MR, Doppler USG)

Previous treatments

Skin type: Energy level should be adjusted according to Fitzpatrick type

Documentation of the treatment process with digital photography

Contraindications
Absolute Contraindications:

Active local infection

Dermatological diseases that are aggravated by light

Relative Contraindications:

History of vitiligo, psoriasis, keloid scarring

Isotretinoin use (recent studies have shown no absolute contraindication)

Patients with unrealistic expectations

Possible Complications
Complications are divided into acute and chronic periods:

Acute Period
Erythema: Disappears within hours

Purpura: Especially seen after PDL, passes in 1-2 weeks

Edema: Especially in the under-eye and neck area; cold application is recommended

Pain: Anesthesia is generally not recommended, pain is a risk indicator

Bulla and crust: Minimized with appropriate energy and cooling

Infection: Rare, can be prevented with hygienic measures

Hematoma/Bleeding: Usually due to parameter errors

Chronic Period
Hyperpigmentation: More common in Fitzpatrick type 4-6

Hypopigmentation: Usually temporary; may be permanent in neck and shoulder areas

Scar formation: Rare but increases in probability with high energy applications

To prevent pigment changes:

SPF 50+ sunscreen use (before and after treatment)

Topical hydroquinone use (can be started 2 weeks before laser)

Treatment Planning
Before the procedure, detailed information should be given to the patient and written consent should be obtained

Average healing time is 7–10 days, several sessions may be required for a full response

Session intervals are usually 4–6 weeks

Conclusion
Laser treatment of vascular lesions has a high success rate with correct patient selection and appropriate device parameters. Although there is a risk of complications, these risks can be greatly reduced with a well-planned treatment process. Due to both aesthetic and functional gains, these treatments have an important place in dermatological applications.