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1. Introduction
The laser treatment of spider angioma, facial telangiectasia, and spider veins, and varicose leg veins comprise a large majority of the patients seen in cosmetic dermatologic surgery practice [1–4]. The most commonly used laser devices for these treatments include the 532 nm potassium titanyl phosphate (KTP), 595 nm pulsed dye laser (PDL), the 755 nm alexandrite laser, intense pulsed light (IPL), and the 1064-nm neodymium yttrium-aluminum-garnet laser (Nd:YAG) [3–7]. Their mechanism of action is based on the theory of selective photothermolysis [8]. For effective laser treatment with selective photothermolysis, the laser needs to penetrate to the depth of the target vessel. In addition, the laser exposure needs to be long enough to cause sufficient slow coagulation of the vessel. The preferential absorption of photon energy by the target chromophore at specific wavelengths of light creates thermal energy, allowing for selective destruction of oxygenated and deoxygenated hemoglobin with only minimal damage to the surrounding tissues. This allows for selective destruction of superficial vascular lesions with minimal scarring [2, 9].
Predisposing risk factors of spider angiomas and facial telangiectasia include skin phototypes I through III, a history of significant sun exposure, and longstanding rosacea. The distribution of spider angiomas is usually focal, with single lesions on the face, neck, chest, and other sun-exposed areas; multiple lesions are present in some systemic diseases. A central feeder arteriole with superficial branches lead to a “spider-like” appearance of these commonly acquired lesions. The arteriole is an aberrant branch of the superficial vascular plexus, directly communicating with dilated superficial capillary branches. The vessel diameter is around 0.1–0.5 mm [1–4, 10].
Leg vein anomalies arise from gravitational dilatation, reflux, and incompetent venous valves. They include spider veins, reticular veins, perforators, tributaries, and varicose veins arising within the system of the greater and smaller saphenous vein. Laser treatment of leg veins is difficult because of a wide range in size and depth, a wide variety in flow, and the many different types of leg vein ectasias. An appropriate work-up should be performed before considering treatment options [4, 11–13]. Currently one of the more common treatment...