Excel V Roundtable

November 2013 | Volume 12 | Issue 11 | Features | 1231 | Copyright © November 2013

Macrene Alexiades-Armenakas MD PhD

Dermatology and Laser Surgery Center, New York, NY

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.


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.
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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 pulse durations.
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