How does Cutera CoolGlide® laser removal of unwanted blood vessels work?

The Cutera CoolGlide® laser is a noninvasive light therapy device specifically designed to eliminate undesired blood vessels from all parts of the body. The Cutera CoolGlide® laser generates a pulse of intense, concentrated light which is directed through a small, cooled hand piece which is gently applied to the treatment site.

This laser energy passes through the skin to the blood vessels that you wish to have eliminated. The energy is absorbed by pigment in the blood, causing selective damage to the lining of the target blood vessel without damaging the surrounding tissues and skin. The deeply penetrating long wavelength of the Cutera CoolGlide® allows us to target blood vessels which other, shorter wavelength lasers cannot safely reach. The laser is pulsed, or "turned on", for only a fraction of a second. The duration of the pulses is carefully determined so that laser energy will be absorbed by the blood vessels without transferring excessive heat to the surrounding skin.

The blood vessels that have been destroyed are reabsorbed by the body, and the flow of blood is directed back down into the deeper vessels, where it belongs.

The surface of the skin is protected by a gold plated cooling head which glides over the skin half a second before the laser beam. This selectivity helps to protect the skin, while effectively treating the unwanted vessels.

The Cutera CoolGlide® laser can be used just about anywhere on the body, and usually requires no anesthesia or other treatment. Even sensitive areas such as the nose and cheeks can be treated easily and with minimal discomfort.

The system's unique design allows us to customize treatment, according to the size and color of your unwanted blood vessels, your skin color, and location on the body.

Cutera CoolGlide® laser treatment is a safe, fast, gentle and effective method for removal of unwanted blood vessels. In just a few treatment sessions (in some cases only a single treatment session) using the gentle power of lasers, you can greatly improve the appearance of skin which is disfigured by unwanted blood vessels and broken capillaries.

CoolGlide® also allows us to precisely adjust the power and the duration of the pulse of laser energy to best suit the diameter and colour of the unwanted blood vessels on different parts of your body. Some older laser systems lack this degree of fine control.

How does Cutera CoolGlide® blood vessel treatment differ from laser hair removal?

When used for laser hair removal, the Cutera CoolGlide® targets the pigment in the hair shafts. This heats up the hair follicle, which dies and is reabsorbed by the body.

When it is used for laser removal of blood vessels, the Cutera CoolGlide® target the blood in the vessels which you want to get rid of. The blood heats the blood vessel, coagulates the blood which is then reabsorbed by the body. The flow of blood is re-directed away from the surface of the skin, back down beneath the skin where it should have been in the first place.

When blood vessels are treated, the CoolGlide® has a special handpiece which allows us to choose 4 different spot sizes ranging from 3 mm to 10 mm. The 3 mm beam is used for tiny superficial vessels, the 5 mm beam for slightly larger vessels, and the 7 mm beam is used for the largest vessels and sometimes for areas where there are many vessels. These delicate small-diameter beams allow us to use higher energies on the unwanted vessels which are close to the surface of your skin. The 10 mm beam is only used for hair removal.

The 10 mm laser beam penetrates deeply enough to reach the roots hair anywhere on the body. The 3, 5 and 7 mm beams do not penetrate the skin as deeply, so they are unlikely to cause much unwanted hair loss (for example, from a man’s beard). The 5 mm and 7 mm beams may occasionally be used for the removal of small amounts of hair between the eyebrows and in other difficult areas.

What areas of the body can be treated?

ALL parts of the body can be treated with the Cutera CoolGlide® laser. In women, the most common areas for treatment are blood vessels on the thighs, lower legs and ankles. In men and women unwanted red blood vessels on the nose and face, including those associated with acne rosacea and with sun damage, are successfully treated. Cherry hemangiomas (sometimes called Campbell de Morgan spots", which are little red dots on the trunk, arms and legs), and spider hemangiomas (sometimes called "broken capillaries" or "broken blood vessels") on the face, upper chest and other parts of the body are other commonly treated lesions.

What are the benefits of laser removal of unwanted blood vessels compared to alternative treatments?

The primary benefits of laser removal of unwanted blood vessels are:

• Larger areas may be treated with less discomfort than with sclerotherapy or vein stripping.
• The CoolGlide® combines speed, comfort and long lasting results.
• The CoolGlide® works on any area of the body where you wish to have blood vessels removed.
• Small blood vessels which are difficult or impossible to treat with sclerotherapy respond very well to Cutera CoolGlide® vascular laser.
• Because only a beam of pure laser light is used when the CoolGlide® treats an unwanted vessel, there is less risk of bruising compared with injection sclerotherapy which breaks the skin and the wall of the blood vessel, then places an irritating solution in the bloodstream of the unwanted vessel.
• Because the skin is not broken, there is no need for bandages, tape or support stockings after Cutera CoolGlide® laser treatment of blood vessels.

Cutera CoolGlide® laser removal of unwanted blood vessels offers long lasting results with minimal discomfort and little or no downtime after the treatment.

What are the advantages over sclerotherapy?

With injection sclerotherapy, the operator inserts a needle into the blood vessel and tries to inject an irritating solution into the unwanted vessel. The body detects that the vessel has been damaged, and reabsorbs the unwanted vessel.

Injection sclerotherapy can be an excellent technique for the removal of large vessels on the legs, and injection sclerotherapy is superior to any kind of laser treatment for the removal of large blood vessels -thicker than 3 mm in diameter (about 1/8 of an inch).

What are the risks of laser removal of blood vessels?

Short-term side effects may include a reddening of the skin over the treated vessels or local swelling which typically lasts less than a day, although it may infrequently last a few days. Fourth generation, long wavelength 1064 lasers like CoolGlide® are less likely than older lasers to cause prolonged irritation, pigment changes or blistering.

Occasionally there can be increased or decreased pigment in the treated area. This is seldom a major cosmetic problem, and generally resolves after several months. Even a single blister (rather like a tiny sunburn) is unusual, and generally will resolve within a week or two with some Polysporin or Aloe Vera.

Bruising can occur occasionally when treating vessels on the legs which are 2-3 mm in diameter. This is more of a nuisance than a major problem, and usually resolves within a few weeks without needing any treatment.

The light from the Cutera CoolGlide® Laser does not cause skin cancer.

How many blood vessels will grow back, and how fast will they grow back?

The regrowth of blood vessels after treatment by laser or by sclerotherapy is highly individual, and depends both on your genetic background and also on medical conditions like acne rosacea, medications you may be taking (like prednisone, for example) and on external factors like sun exposure (which can speed up the appearance of new vessels on the face and legs -- so this gives you one MORE good reason to protect yourself from the sun!)

If you take care to control medical conditions like acne rosacea, and protect yourself from sun damage, you can stop or at least slow down the rate at which new unwanted vessels appear on your skin.

Support stockings are useful to retard the growth of large, deep vessels and varicose veins which are treated by sclerotherapy, but support stockings are unfortunately not useful to prevent the unsightly 1-3 mm superficial vessels on the legs which are treated with Cutera CoolGlide® .

How many treatments are needed?

The number of treatments will depend on:

• the desired degree of blood vessel reduction
• hormonal status
• area being treated
• medication (for example medicines like prednisone can increase superficial blood vessel growth)

Typically, one or two treatments are needed for facial vessels; and two to four treatments may be needed on the legs. Treatment can be done every 6 weeks on the face, and every 8 weeks on the legs. Cherry hemangiomas (red dots on the body) usually only require one or two treatments.

Some people start with the area which troubles them the most, then when they can see the results they often return to have other areas treated.

Additional "touchup" treatments on small troublesome areas can be arranged at relatively low cost. There is no safety limit on the number of treatments a person can have. People who have been partially treated with other types of blood vessel removing laser and/or injection sclerotherapy might in some cases need a smaller number of CoolGlide® laser treatments.

Previous sclerotherapy or laser treatment? No problem!

CoolGlide® has been successfully used on many people who were not able to tolerate -- or did not obtain satisfactory results with -- older short wavelength laser systems, including dye laser, ruby laser, alexandrite laser, and 800 nm diode lasers. CoolGlide® laser is also been beneficial for people who are having injection sclerotherapy for larger, deeper vessels and for people who have had injection sclerotherapy in the past.

In fact, depending on how many vessels are left, people who have been partially treated with other lasers or with injection sclerotherapy may need only one or two treatments with the Cutera CoolGlide® to "finish the job".

Am I a good candidate for laser removal of unwanted, unsightly blood vessels?

The unique design of the CoolGlide® laser, and the long wavelength, allows treatment of people with all skin colors. A smaller number of treatment is needed when the skin is light colored -- so to get maximum effect from each session avoid coming in with a fresh suntan or sunburn, but even people who have black skin can be successfully treated with the Cutera CoolGlide® .

Children can be treated, for example if they have a congenital hemangioma or have some spider nevi on the face or other parts of the body, but the child must be old enough (for example, 10 years old) to understand and cooperate with treatment. Tiny lesions, such as spider hemangiomas sometimes only require 2-3 pulses of the laser, and even very young children are able to co operate with this sometimes.

CoolGlide® laser removal of blood vessels is not just for "cosmetic" problems. Patients with unsightly blood vessels on the face and other parts of the body because of medications (for example, prednisone) can benefit from CoolGlide® laser treatment as can patients who have problems with unwanted blood vessels because of congenital conditions like port wine stains and disorders like lupus and rosacea.

Normal, reasonable people who have realistic expectations tend to be excellent candidates for Cutera CoolGlide® laser removal of unwanted blood vessels.

Which types of vessels respond best to treatment?

Blood vessels you can see with the naked eye tend to respond best to Cutera CoolGlide® laser treatment. Vessels so small that they can only be seen with magnification are difficult but not impossible to treat. Vessels larger than 3 mm in diameter, and vessels which are considerably elevated above the surface of the skin, respond better to injection sclerotherapy or surgical removal.

The color of the vessels can range from light pink to dark purple.

Questions to ask yourself when considering laser blood vessel removal.

• How much are you bothered by your unwanted blood vessels?
• How much are you bothered by the time you spend concealing your unwanted blood vessels?
• How uncomfortable do your facial or other unwanted blood vessels make you feel when you are dealing with other people?
• Does the appearance of your unwanted blood vessels inhibit you in exchanges of affection with your partner (for example, are you uncomfortable if your partner sees your legs?)
• How uncomfortable do your unwanted blood vessels make you feel when you meet new people?
• Do you fear that the appearance of red vessels on your nose and face makes people think that you might be a heavy drinker?
• How uncomfortable do your unwanted blood vessels make you feel when you go to social gatherings, dine out in a public restaurant, go to a beach, pool or gymnasium, or other public place?
• Do your unwanted blood vessels (for example, on you legs) inhibit your choice of clothing or limit the activities that you engage in (for example, swimming)?
• How uncomfortable do your unwanted blood vessels make you feel when you go to work or class?

What causes unwanted blood vessels?

• Unwanted vessels on the surface of the skin of the legs are to some extent an inherited tendency, and become more common with increasing age. They can also be made worse by sun exposure, and sometimes become more prominent after pregnancy. They can in some cases be made worse by or be associated with varicose veins.
• Unwanted blood vessels on the face (sometimes referred to as: broken capillaries) are more common in people who have a tendency toward acne rosacea; and are often made worse by sun exposure. As with unwanted vessels on the legs, there is sometimes a family history of other people with a similar problem.
• Spider hemangiomas on the face and other parts of the body are a common nuisance, and can be quite disfiguring. Most children and adults who have a few spider hemangiomas are perfectly normal and healthy. Rarely, numerous spider hemangiomas are found to be associated with serious liver disease or other disorders. People who are otherwise healthy and have just a few spider hemangiomas do not need any blood tests or other investigations.
• Telangiectasia on the face and other parts of the body can sometimes be associated with medications like prednisone and other corticosteroids, and with certain skin diseases like lupus.
• Sometimes children will be born with port wine stains or other types of hemangiomas, or these may become apparent as the years go on. Some of these hemangiomas can be improved or even eliminated by Cutera CoolGlide® vascular laser.

What will happen on the treatment day?

Other than your regular skin care routine, there is no standard "prep" for this procedure. There are no restrictions on what you may eat or drink prior to your appointment. Many people like to take 2 or 3 plain Tylenol or Advil (as you might do before having a flu shot or going to the dentist) to prevent or reduce discomfort.

Please shave or clip the areas to be treated before you come in for treatment. Freshly shaved skin is more sensitive, and there is less discomfort if you wait at least an hour between shaving and having laser treatment. Excess dark hair above the surface of the skin absorbs and wastes laser energy, and reduces the amount of energy that reaches the undesired blood vessels, where it is really needed. Excess hair above the surface of the skin also increases the chance of burning or irritating the skin. If there is just a bit of peach fuzz on your skin, this will not be a problem, because peach fuzz is very fine and fair and so does not absorb laser energy.

When you come for treatment, it is important not to wear any makeup -- or at least wear simple water-based makeup that can be easily removed -- because makeup can sometimes absorb laser energy. This could interfere with treatment, or even cause overheating of the skin surface and burning. Makeup also makes it hard for us to see the vessels you would like to have treated. Makeup can be re-applied immediately after Cutera CoolGlide® laser treatment, if you wish.

After all of your last minute questions have been answered and paperwork handled, the areas you wish to have treated will be cleansed and pre treatment photos may be taken. Everyone in the treatment room must wear protective goggles when the laser is turned on. The Cutera CoolGlide® is a high powered laser system, and can cause eye injury if proper eyewear is not worn while the laser is used.

The length of the procedure itself can range from a few minutes for a few spider hemangiomas to an hour or more for very extensive blood vessels on the thighs and lower legs.

If you decide before coming in that you would like to have additional areas treated, please call ahead so that we can schedule enough time to accommodate your needs.

Does it hurt?

The laser emits only light. You may feel a tingling or snapping sensation like a rubber band. There is no bleeding and no open wound is created. Some people find the FIRST laser treatment more uncomfortable than subsequent treatments. Maybe this is because there are more blood vessels which are destroyed during the first treatment; and perhaps also because some people are more apprehensive during the first treatment, because they are not sure of what to expect.

Many patients find that they have less discomfort if they shave the area to be treated at least a couple of hours BEFORE coming in for treatment, because freshly shaved skin is often somewhat more sensitive.

While some areas of the body like the nose are more sensitive than others, many patients report little or no discomfort. If there is unusual discomfort, please let us know so that we can apply more cooling or adjust the settings on the laser.

People who have had injection sclerotherapy (or treatment with the electric needle, or with other lasers like the KTP laser) usually report that CoolGlide® causes less discomfort, and sometimes there is almost no discomfort.

Our careful use of cooling gel pads, and application of the gold-plated cooling head of the CoolGlide® contributes greatly to the comfort and safety of our patients. In addition, with our CoolGlide® Excel laser we have the ability to adjust the frequency of laser pulses, the power level, the pulse duration and the beam width in sensitive areas, to maximize your comfort. We also may use the Zimmer cryo device to blow cold air on the area being treated.

Anesthetic cream is occasionally used in very sensitive areas or by those who think they have a very low pain threshold. Most people find it helpful to simply take two or three Tylenol and/or Advil 2 hours before coming in for treatment. Some women who find that they are less sensitive after their menses prefer to schedule their treatment sessions to avoid the premenstrual and menstrual time. You should pamper yourself on laser day: for example, make sure you are not hungry or thirsty when you arrive for your laser appointment, because people who are hungry or thirsty tend to be more sensitive.

What will happen after treatment?

Redness often has faded greatly by the next day. It would not be uncommon for the skin to be slightly drier that evening and to require more of your favorite moisturizer.

The treated blood vessels, in particular on the legs, may appear slightly more obvious or a bit darker for the next week or two, but this is seldom a major cosmetic problem, and generally less obvious than after injection sclerotherapy. Occasionally on the legs and infrequently on the face there can be isolated superficial bruising which generally is a nuisance and resolves within a week or two on the face, or several weeks on the legs without needing any treatment.

Why do the blood vessels sometimes look more obvious for several weeks after treatment?

After the blood vessels are treated with laser energy, they sometimes swell up slightly, and the body moves in to begin the job of removing the treated vessels.

Sometimes portions of the vessels will seal off immediately, and a bit of blood stays behind in the treated vessels, causing temporary red or purple coloration. If this happens, the blood in the vessels is usually reabsorbed along with the vessels themselves by the body over a period of several weeks to a couple of months on the legs, without needing any additional treatment. If a little pocket of old blood persists it can easily be removed if you wish.

Because the CoolGlide® laser can produce a longer, gentler pulse there is much less chance of purpura or bruising compared to treatment with tunable dye lasers like the V-Star™ or V-Beam™. Patients who have previously been treated with dye lasers are always impressed by the fact that they look good immediately after CoolGlide® treatment, with little or no discoloration of the skin.

Are there any restrictions on my activity after treatment?

Since the laser does not burn or cut the skin in any way, no bandages are necessary. You can return to work the same day and resume all your regular activities. To reduce the chance of uneven tanning in the treated area, you should minimize sun exposure and tanning for a week or two after treatment.

Pre-treatment instructions:

1. Please try to minimize tanning for a week or two before treatment: a fresh tan can interfere a bit with the effectiveness of the CoolGlide® Laser treatment, though this is less of a problem than with older, short wavelength lasers.
2. Please do not wear makeup on the areas to be treated, or at least wear makeup that is easy to remove before treatment so that we can easily see all the vessels you would like to get rid of. If makeup absorbs laser energy, less energy will reach your unwanted blood vessels, and if the makeup heats up it could irritate or burn your skin. Makeup can be re-applied immediately after Cutera CoolGlide® laser treatment, if you wish.
3. Please shave or clip the areas to be treated the day before treatment or on the morning of treatment. This way, the skin will be less sensitive. Excess hair above the surface of the skin absorbs and wastes laser energy, and reduces the amount of energy that reaches the unwanted blood vessels where it is really needed. Excess hair above the surface of the skin also increases the chance of burning or irritating the skin.
4. Some people find it helpful to simply take two or three plain Tylenol and/or Advil 2 hours before coming in for treatment. Some women who find that they are less sensitive after their menses prefer to schedule their treatment sessions to avoid the premenstrual and menstrual time. You will be less sensitive if you are well rested, well fed, and not thirsty when you have your treatment. You should pamper yourself on laser days!

During the treatment, remember that: We want to be doing this FOR you, not doing it TO you. Unexpected discomfort is Nature’s way of telling us something is wrong, so please tell us and we will go slower, apply more cooling, or adjust the power of the laser for you. The laser does not work better if it hurts more, so there is no point being really tough.

Post-treatment instructions:

1. Redness often has faded greatly within a day or two. It would not be uncommon for the skin to be slightly drier that evening and to require more of your favourite moisturizer, for example, Cliniderm™ Moisturizing Cream. The treated blood vessels may appear slightly more obvious for the next week or two, but this is seldom a cosmetic problem, and generally much less obvious than after injection sclerotherapy.
2. Try to avoid tanning for a week or two after treatment, because occasionally the tan could be somewhat irregular (lighter and/or darker in the treated areas.) Ombrelle-60™ and Anthelios-60 are excellent sunscreens.
3. You do not need to purchase support stockings or special creams, and there is no special routine for you to follow.

Blistering or scaling after Cutera CoolGlide® laser removal of blood vessels is very rare, but usually resolve over a few days or a week with a bit of Polysporin or aloe vera cream several times a day. Please call us if this happens, or if you have any other problems or questions.