Sadick: This patient has an area of telangiectasia and a little bit
of flaring of the vessel. For any vascular lesions it is important
to use conservative settings with both 532nm and 1064nm. With
532nm you can be more aggressive and we find that using between
9 and 16 J is the optimal fluence for getting rid of a vessel
like this. You can go to the central area, which is the area you
want to blanch and do some degree of vaso spasm, a little bit of
erthacation around there, and you don’t want to stack your pulses.
The settings used for this patient was 10Jcm2 , 4mm, 15ms,
and 10C and got very nice clearance after a single treatment.
Alexiades: In my case, I’ve had great success in treating these
types of lesions at a slightly lower fluence between 8 and 9, usually
8.5J, slightly shorter pulse durations of 10ms and a spot
size of roughly 5 mm. What’s nice about this handpiece is that
while you are treating you can manually dial up and down by
increments of 0.1mm spot size, so you can target your individual
vessels as you are treating. That is a feature that is very helpful.
You can treat any vessels around the nose in an ideal manner.
Dover: I frequently use a larger spot size 10mm 7J 10ms and my
patients always tolerate it. I never use topical anesthesia with
this device. If they clear I don’t always use a smaller spot size to
treat these types of vessels. Aelar telangiectasia can be stubborn
and in my experience these vessels recur most of the time. I tell
my patients that they are the most difficult vessels on the face to
treat and that almost always some of them will come back.
Vasily: Genesis is a fascinating component to this device.
When you are buying an expensive device you want versatility
and the combination of KTP, Nd:YAG and a long pulse 300ms
genesis mode allows you to treat almost anything. It turns out
that the genesis mode has become the single most effective
modality in my practice. It’s immensely popular and my extenders
can use it. The pulse duration is fixed at 300ms and there is
no cooling. The object is to heat evenly so you can maintain a
temperature of about 42°C and you deliver 6000 to 8000 pulses
in a treatment session. This patient had some residual redness
after two photofacial treatments. She was treated every other
week and got almost complete clearance.
Alexiades: I have two genesis devices and have been involved
with this technology for the past 10 years. The genesis mode
on the Excel V is twice as strong and more efficient than the
