original. It is a crowd pleaser because you can treat patients
of any age. What’s great about this handpiece is that there is
a temperature gage on the handpiece, which provides realtime
feedback and makes this a very easy treatment. There are
many studies, including the one that I published with Dr. Dover,
demonstrating that you want to maintain the surface skin
temperature at 42°C for a sustained period of time to attain effective
neocollagenasis within the dermis. The device also has
a counter that lets you know when you have delivered 5000
pulses, indicating that the treatment is done. In my hands, without
stopping, a treatment is completed in 20 minutes.
Green: You can choose between 4J – 7J and has a fixed spot
size of 8mm. I deliver about 6000 pulses and take about 15-20
min for an entire treatment. Another important factor is that the
1064nm wavelength allows you to treat any skin type, which is
great in this increasingly global community.
Vasily: This has become my go to device for leg veins. Its
been very interesting for a number of resions. Typically we
tell patients with spider veins that they will require a series of
threatments with other modalities. The big problem was that
we could see clearance after several treatments and the biggest
problem was that they would develop PIH pigment streaks
over the treated veins. We started playing with the Excel V and
have discovered settings that have worked amizingly well. This
patient was initially treated with 160J cm2 4mm 25ms 5C but
I have now adjusted my settings with most of my spider leg
vein (1mm-2mm) patients to a 40 ms pulse duration. It seems
to be magical. There is a little more discomfort but with the 40
ms pulse duration I can get a lot of clearance in treatment. The
most remarkable thing I have observed is that I see less than
1% PIH with my patients treated with Excel V.
Sadick: If you treat veins of varying sizes it is important to
remember to vary the pulse duration and the fluence. The very
small red vessels are superficial and need to be treated with
higher fluences and shorter pulse durations and the large blue
vessels need to be treated with more gentle fluences and extended
Alexiades: With the larger blue vessels you should expect
some clot formation and that can take three months to go away.
It is important to prepare the patients. It is better to do this treatment
in the fall and winter to allow time for the clot to resorb.
However, the clearance of these reticular blue veins is durable
on long-term follow up without evidence of recurrence.
None of the authors have disclosed a conflict of interest.
Macrene Alexiades-Armenakas MD PhDdralexiades@nyderm.org