Commentary on “The efficacy of the dual wave length
Gemini laser on resistant port wine stains: A pilot study”
(A. Liem et al.)
Received: 16 April 2008 / Accepted: 16 April 2008 /Published online: 4 June 2008
The gold standard in treating port wine stain hemangiomas in
facial flat lesion in children is the use of pulsed dye laser or
variable-pulse pulsed dye laser. The authors have tackled non-
responding and resistant port wine hemangiomas (PWS) with
the use of an interesting and seemingly effective combination
of Nd:YAG 1,064 nm and a frequency-doubled KTP 532 nm
using 5- and 10-mm spots.
A wavelength of 1,064 nm is used in thicker hemangio-
mas resistant to pulsed dye laser (PDL) and will result in
reduction in the vascular volume and its use is well known
in the treatment of type III–IV skin types.
The problem with using 1,064 nm is the learning curve and
the efforts in matching the pulse width and energy with the
vessel size, color, skin type, and depth of penetration, which
need well-trained laser personnel to conduct the treatment.
Using the scanner technique, 532 nm cannot be used on partly
pigmented or tan skin.
The combined 1,064 nm and 532 nm can be used with
benefit on diffuse redness and telangiectasia.
KTP is more efficient in treating individual telangiectasia
and telangiectatic erythema.
The frequency, 1,064 nm, is very useful in both superficial
telangiectasia 1 mm in diameter and in deeper larger blue vessels.
The complication rate increases with increasing the fluence
and the pulse duration to produce crusts or depressed scars
and may induce intravascular thromboses and perivascular
edema, which is slow to resolve.
Again, I congratulate the authors on tackling this delicate
and important subject with what will open a new avenue in the
treatment of vascular lesions in the face and the rest of the body.
Eur J Plast Surg (2008) 31:129
This commentary refers to the article http://dx.doi.org/10.1007/
H. Alani (*)
Department of Plastic Surgery, Providence Hospital,
Southfield, MI, USA