Patients frequently seek treatment of cutaneous vascular lesions for both medical and cosmetic reasons. Advances in the use of laser and light sources enable physicians to effectively treat vascular lesions that were previously untreatable. The ultimate goal of laser treatment is to induce vessel wall damage through destruction of haemoglobin, while minimising injury to adjacent structures. Vessel destruction occurs either through photomechanical or photothermal means. When short pulse-widths (or pulse durations) are used, photomechanical damage occurs. This causes intravascular cavitation, vessel wall rupture, and haemorrhage.
The combination of the 532 nm and the 940 nm diode laser in the Multiple Iris can successfully treat individual vessels and pigmented lesions of the face and body. The Multiple IRIS has the advantage of the biggest vascular fractional scanner in the market, with a very functional and user-friendly colour touch screen.
The options of single pass or fractional scanning mode offer the clinician unique opportunities of treatment, regardless the size of the lesion. The 532 nm wavelength can be successfully used for superficial vascular lesions. When fractional mode is selected, skin rejuvenation can be achieved with improvement of the skin texture and tone, as well as larger areas, with poikiloderma of civatte, port wine stains and telangiectasia improving. For deeper vascular lesions such as spider veins or prominent facial veins and venous lake, the 940 nm wavelength laser is considered the best option.
The 532 nm wavelength in Multiple IRIS produces a green light, a high percentage of which is absorbed by oxyhaemoglobin. The device enables a wide variety of pulse settings to treat superficial lesions, such as superficial telangiectasias. With relatively short pulses, the vessels are heated without coagulating the surrounding tissue. The rupture of the vessels is avoided and purpura is not generally observed. In addition, the treatment is significantly less painful than with other pulsed dye lasers.
Genuine and iatrogenic telangiectasia can be successfully treated with the Multiple IRIS. For small, superficial and red vessels, low energy densities (15–22 J/cm2) is indicated with 532 nm handpiece, while vascular changes of large diameter, dark red colouration or deep localisation can be treated with 940 nm handpiece and higher energy densities (50–200 J/cm2). The treatment offers a high satisfaction rate.
Senile haemangioma are an easy target for the Multiple IRIS. Small lesions can be elegantly treated, usually with a single session. For larger haemangiomas, fractional mode can be selected, allowing for a pain-free treatment. In these cases, two or three treatments are recommended, with intervals of 4–6 weeks.
Low-energy densities (10–12 J/cm2) of 532 nm wavelength can be used in post-surgical scars. The wound healing is accelerated, the scar erythema is resolved sooner, and the cosmetic outcome is better — even with one laser treatment.
Skin rejuvenation, melasma and toning
After three-to-six treatments with the fractional mode of 532 nm wavelength in Multiple Iris, improvement in facial redness and pigmentation is observed, as well as skin tightening and improvement of the skin texture and rhytides is achieved.
As well as the 532 nm wavelength, the Multiple Iris offers a 940 nm wavelength laser. This wavelength penetrates approximately 3 mm into the skin and thus comfortably reaches most types of leg veins in the skin compartment. It efficiently targets blue vessels with a significantly decreased incidence of pitting. Treatment of linear blood vessels, venous lakes and spider veins with the 940 nm wavelength is relatively painless with non-existent postoperative crusting.
For smaller vessels, single treatments will be sufficient; however, large veins or multiple spider veins need two-to-four treatments at intervals of 4 weeks.
Some post-procedural erythema can be developed, which last 5–10 days. However, the patients can continue their daily normal activities.
Figures 1 and 2 show a female patient with venous lake of the lower lip, pigmented lesion on the tip of the nose, cherry angioma on the left cheek, and telangiectasias of the nose. A single treatment with the 940 nm handpiece (80 J/cm2) was sufficient to treat venous lake, and a single treatment with the 532 nm handpiece (12–18 J/cm2) to treat the other conditions.
Figure 3 shows a patient with linear blood vessels above the ankle area, and the immediate post-treatment result with 940 nm handpiece (80 J/cm2).
The unique combination of 532/940 nm wavelength in the Multiple IRIS has the ability to treat both red and blue vessels, and pigmented lesions. The variety of settings and the fractional option enables the device as an ideal option for any clinician that treats vascular lesions.