Surface Laser Treatment is when a laser beam is delivered externally onto the skins surface to treat leg veins. This is in contrast to Endovenous Laser Treatment when a laser beam is delivered internally through a catheter to treat the deeper veins.
Like all lasers, the laser we use to treat leg veins produces a beam of light of a particular wavelength. The wavelength of light that is used is attracted to the blood cells in the veins. When we concentrate light we get heat and if we can heat up the blood cells to a high enough temperature they coagulate and seal off the vein. The vein is then broken down by the body in the same way the body dissolves and breaks down bruises.
Various wavelengths (types of lasers) can be used. For bright red vessels we use either a 532nm laser or a Pulse Dye Laser (595nm) whereas for small blue veins we usually use a YAG ( Long Pulse1064nm) laser but sometimes use a 755nm Alexandrite or 940nm Diode laser. Having a range of vascular lasers for surface laser treatment of leg veins is important as not one laser suits all skin types and all types of surface veins.
Many patients attend our clinic with a preconceived idea that they want laser treatment to their surface veins. This seems to be because they think it will be easier and less painful and avoids the use of any needles. However whilst there is a place for surface laser to leg veins it is very much for a minority of patients. It is especially good for the very smallest of surface veins (telangiectasia) where it can be difficult to inject even with the smallest gauge needle and for patients who are severely ‘needle phobic’. It needs to be realised that laser treatment is painful (we are heating up the blood below the skin to a high temperature), it is more expensive than sclerotherapy (it requires expensive medical grade laser equipment), it has more side effects than sclerotherapy ( much higher rate of pigmentation on the skin after treatment) and it is less effective for the majority of patients (there are usually feeder veins into the area that need to be sealed off which are too large to respond to laser).
This depends on the type and extent of veins and the desired level of improvement but patients usually require 3 or 4 treatments spaced at least 4 to 6 weeks apart.
There are situations when we combine laser and sclerotherapy to treat surface leg vein problems. It may be that we treat the feeder veins by sclerotherapy then follow up with laser to treat the smaller veins; it may be that after sclerotherapy there is some blotchy redness (called matting) and we can use laser treatment to settle this down; and also in some cases there can be some iron staining of the skin after sclerotherapy and certain lasers can be very effective in treating this (especially Q switch 650nm or 694nm).
The advantage of a clinic like the Geelong Laser Medical Centre in treating leg veins is in having a range of treatment options, such as sclerotherapy and/or laser, allows us to tailor treatments for each individual case rather than being limited to just one method of treatment.
There may be immediate redness and a slight burning sensation like sunburn after laser treatment. Immediately after treatment an ice pack is applied and then a topical cream such as Centella can be applied. Minor blistering can occur on very sensitive skin. If we use a Pulse Dye Laser superficial bruising is not uncommon and can take 1-2 weeks to resolve. Some brown discoloration is also not uncommon in the weeks after treatment, which is due to iron (haemosiderin) from the blood, but typically resolves over several weeks and rarely may last several months.
Normal activities can be resumed immediately after laser treatment but common sense needs to apply regarding vigorous physical activity as the area will feel like a mild sunburn. We would advise caution with sun exposure for 4 weeks after laser treatment of leg veins.
This will be discussed at the ‘Leg Vein Consultation’ but whilst Medicare will provide some rebate for larger surface veins there is no rebate for Laser treatment of surface veins and the Government will apply GST of 10%. Private Health funds do not typically provide any rebate for this procedure.