Long-pulsed Nd:YAG laser treatment of venous lakes:: Report of a series of 34 cases

BACKGROUND Some venous lakes do not respond well to traditional vascular lasers. The Nd:YAG laser output at 1,064 nm is less well absorbed by hemoglobin but penetrates more deeply into tissue. OBJECTIVE This study was undertaken to assess the effectiveness of the long-pulsed Nd: YAG on venous lakes. METHODS Thirty-five consecutive adult patients presenting with a venous lake were studied. Four patients had failed to respond to polidocanol 1% sclerotherapy, and 1 patient to pulsed dye laser. Long-pulsed Nd: YAG was administered via a water-cooled tip. Either a 3-mm spot at 250 J/cm(2) and 55 ms or a 5-mm spot at 140 to 180 J/cm(2) was used depending on the size of the lesion. Clinical end points were characterized by hardening of the lesion, central blackening, minimal whitening of the periphery, and in most cases, an audible popping sound. Responses were assessed visually in 50% of cases or by phone contact in the remaining 50% if the lesion had completely disappeared. One patient was lost to follow-up. RESULTS After a single treatment, 94% cleared completely; incomplete clearance occurred in 6%. There were no reported complications. CONCLUSIONS The long-pulsed Nd:YAG laser is highly effective treatment for venous lakes of the lip and cheeks.