Minneapolis Vein Treatment doctors

The Cutera CoolGlide laser is a 1064nm Nd/YAG laser with adjustable 10-100 msec pulse duration and fluence available up to 100J/cm2. This is predominantly used for hair removal, and is effective for this application. It is not a "wrong" laser for treatment of blood vessels, but 1064nm is not the best wavelength for blood vessel absorption. 577-585nm (pulsed dye laser) and 532nm (KTP laser) wavelengths are better for blood vessel treatment because of increased oxyhemoglobin absorption of laser energy at these wavelengths.

At this (1064nm) wavelength, the laser energy is less specific for oxyhemoglobin, penetrates slightly more deeply into the skin (perhaps up to a millimeter or two more), and has enough (actually plenty) energy to adequately coagulate superficial blood vessels.

So, by your description, you had blistering, scabbing, and good healing, and now have discoloration in the treatment areas (circular brown spots). This discoloration is likely from one of two (or perhaps a bit of both) potential causes:

• The clotted blood within and around the destroyed vessel has visible hemosiderin staining (from the breakdown products of the hemoglobin), and will gradually (weeks to as long as months) reabsorb over time.
• The treatment energy caused inflammation and this is post-inflammatory hyperpigmentation. This is similar to the dark discoloration around scars or injuries, particularly in darker-pigmented skin.

Both of these gradually get better over time, but careful avoidance of sun or other ultraviolet exposure (tanning beds) is critical to avoid making this a permanent discoloration. Skin "bleaches" such as 4% hydroquinone are available from your doctor by prescription, and can help with this also. Other similar medications can enhance the gradual reduction of the "brown spots" where the treatments were done.

I presume the vessels are gone. If so, be patient and things should get better over time. If not, consider cat's whisker electrocautery if these are high-flow nasal alar vessels, or one of the lasers above if these are other venous (low-flow) telangiectasias elsewhere on your face. Good luck!

Perhaps you did not see my answer to your other question on this topic (May 31, 2011), but I am quite certain that if you developed neuralgia after treatment of your lip, it was coincidental to the treatment and NOT a cause-and-effect relationship.

If indeed you had (have) neuralgia on the same side as your laser treatment, I would seriously look for other causes, even if they seem temporally related. Often two events, particularly when they occur near each other in time, "seem" as if they could be cause-and-effect. Truly, the science and anatomy of your lip and sensory nerves to that area do not support this conclusion.

But, if you do indeed have neuralgia, the chances of it resolving are the same as if you never had the laser treatment--nobody can "guarantee" it will resolve, but it certainly should, with little or no treatment or medication of any kind. You can, if your symptoms are persistent or severe, ask your doctor about a Medrol dosepak or short course of prednisone to reduce inflammation. Anti-inflammatory medications are other potential options as your neuralgia resolves. Good Luck!

With due respect to your GP, the diagnosis of neuralgia and your concern about myelin sheath damage and possible "lifelong" pain attacks are not supported by anatomy, science, or laser biophysics.

I'm not sure what you mean by a "thread vein" since that is neither a medical term nor a diagnosis. I presume you may be referring to a lip telangiectasia (a visible small dilated vein), which is very appropriate for laser treatment as they are superficial enough to be reached by the laser energy (close to the surface), appropriate diameter (small), and with a chromophore (hemoglobin) well-absorbed by several laser wavelengths (KTP at 532nm being one of the most common). Other lasers could also be used effectively, but all have similar characteristics if used for treatment of superficial vessels.

You clearly described severe pain, and felt "as if my nerve had been hit." Actually, at the surface of your lip skin, there are only many very sensitive tiny nerve endings, which is a good thing for being aware of food or a gentle kiss, but not so good when a painful stimulus like laser energy is focused there! Imagine using a magnifying glass to focus the sun on a tiny point on your finger tip, another area of many tiny sensitive nerve endings. Anywhere on your lip would have been equally painful--you did not have a nerve branch or larger nerve injured at all by the laser energy. It is anatomically impossible, despite your concern having been (incorrectly) validated by your GP's dismissive and quick-to-blame agreement!

First of all, the infra-orbital nerve branches to the upper lip (labial branches) are too deep to have been reached by the laser energy, which penetrates no more than 0.05-1.0mm below the surface of the skin at vascular-absorbing wavelengths. The same applies to the labial branches of the mental nerves that supply sensation to the lower lip. Furthermore, the formation of a tiny white blister indicates that the target vein was indeed coagulated, absorbing the laser energy (as intended) and causing the appropriate heat damage to create a "tiny white blister" indicative that the treatment went no deeper than the target vein. Little if any energy was "left" to penetrate deeper! Your blister turned into a scab because it was allowed to dry out (I would have suggested Bacitracin for the 3-6 days until healed), but even a tiny scab should heal as uneventfully as a pimple!

Neuralgia is defined as "paroxysmal pain which extends along the course of one or more nerves." You do not describe the pain you have (or had), but even initial persistent discomfort in the treatment area should quickly resolve without any concern or long-term sequelae. Your nerves' myelin sheaths were not damaged by the laser energy (see depth of penetration at vascular-absorbing  wavelengths above). Any (very) localized tissue damage (localized because of the collimated or focused laser beam) would quickly heal with very low likelihood of leaving a permanent scar, and high likelihood of eliminating the offending vessel!

In my humble opinion, your GP should have reassured you rather than fuel your anxiety! You need no medication at all for your laser treatment--if anything else is going on, it is independent of, and unrelated to, your vein removal! Relax and be well!