Clinical Applications of the 532-nm Diode Laser for the Treatment of ...

The American Journal of Cosmetic Surgery Vol. 18, No. 2, 2001 71

ORIGINAL ARTICLES

Clinical Applications of the 532-nm Diode Laserfor the Treatment of Facial Telangiectasia andPigmented Lesions: Literature Review, History,and Discussion of Clinical ExperienceJoseph Niamtu, III, DDS

Introduction: Facial telangiectasias are common lesionsresulting from multiple factors. Multiple therapies and de-vices have been used for the treatment of facial telangiec-tasia with varied success and complication rates. The 532-nm diode (diode-pumped, frequency-doubled Nd:YAG) laseris compared with other laser and nonlaser modalities for theoffice-based cosmetic surgery practice.

Materials and Methods: This article provides a literaturereview and examines the history of laser treatment of facialtelangiectasia and the evolution of modern laser therapy.Clinical experience is also detailed in the treatment of facialtelangiectasia and pigmented lesions.

Results: 532-nm diode lasers are lightweight, extremelyportable systems that are effective in the treatment of facialtelangiectasia and various pigmented lesions. When com-pared to other popular modalities and laser wavelengths,the 532-nm diode laser can successfully treat facial telan-giectasia and some pigmented facial lesions with less chanceof collateral tissue damage and resultant complications.

Discussion: The 532-nm diode laser is representative oftechnological innovations that enable small, lightweight, andaffordable lasers to be used by the office-based cosmeticsurgeon. Distinct advantages are evident when it is com-pared with other wavelength lasers. Because of the smallerspot size and depth of penetration, this laser also has treat-ment limitations; however, it provides a welcomed additionto the armamentarium for the surgeon treating facial ectaticand pigmented lesions.

Conclusion: Because of its demonstrated clinical effec-tiveness, ease of use, and lack of resultant purpura, as wellas affordability and portability, this laser is well suited forthe office-based cosmetic practice.

Received for publication December 18, 2000.Dr Niamtu is in group private practice of Oral/Maxillofacial and

Cosmetic Facial Surgery in Richmond, Va.Corresponding author: Joseph Niamtu III, DDS, 10230 Cherokee

Rd, Richmond, VA 23235 (e-mail: [email protected]).I certify that I have no financial interest in any way with any of

the devices or companies mentioned.

Prior to the advent of laser technology, fine-wirecautery, cryotherapy, and sclerotherapy were used

to treat facial telangiectasia.1 Fine-wire radiosurgerycan be very effective, but is operator sensitive.2 In ad-dition, it can be painful, and it destroys normal tissuesurrounding the vessels. Because of the nonspecific tis-sue destruction, a significant risk of scarring exists.The use of cautery or radiofrequency also causes acutehemorrhaging of the vessels that is difficult to controland complicates visualization of surrounding telangi-ectasias.

Some of the earliest laser treatments for facial tel-angiectasia were performed with continuous wave CO2

(10 600 nm) and argon (488 and 514 nm) lasers, aswell as Nd:YAG (1064 nm) systems.3,4 Although suc-cessful outcomes were reported, the CO2 laser de-stroyed the ectatic vascular tissue as well as the over-lying epidermis in a nonselective fashion.5 The argonlaser, which emits a mixed blue and green light selec-tive for hemoglobin and melanin, also destroyed ec-tatic vessels and the overlying epidermis.5 This non-selective heat dissipation resulted in a high incidenceof scarring and hypopigmentation or hyperpigmenta-tion.6 These lasers were, in effect, sophisticated formsof electrocautery.7

In 1983 when Anderson and collegues,8 in a classicpaper, described the concept of selective photother-molysis, they hypothesized that selective thermolysiscould be predicted by choosing the appropriate wave-length, pulse duration, and pulse energy for a particularchromophore target.9 This simple theory revolution-ized laser surgery. The 2 key conclusions were that thewavelength of the laser light must be absorbed by thetarget in order to have a treatment effect and that thelaser energy must be confined to the intended target tospare the surrounding tissue from damage. As previ-ously stated, the target for vascular lesions is oxyhe-moglobin. The absorption peaks for oxyhemoglobinare approximately 418, 542, and 577 nm.

The theory of selective photothermolysis spurred thedevelopment of flashlamp-pumped, pulsed-dye, andcopper-vapor lasers. These lasers emit light between

72 The American Journal of Cosmetic Surgery Vol. 18, No. 2, 2001

Figure 1. The Diolite 532 nm diode laser is a compact, portable, and solid-state unit weighing only 6.8 kg.

577 and 585 nm. These wavelengths are selectivelyabsorbed by oxyhemoglobin, thus destroying the ec-tatic vessel with minimal damage to the underlyingtissue. This type of laser differs from previous lasersby emitting light in pulses rather than a continuousbeam.7

In addition to the pulses, the time between eachpulse allows thermal cooling of the target chromo-phore. If the pulse width is equal to or less than thethermal relaxation time (TRT) of the telangiectatic ves-sel (the time during which 50% of the incident heathas transferred out of the vessel to adjacent tissues),the resultant thermal damage will be confined to thevessel.10 Having a pulse duration that is shorter thanthe TRT of the treated vessel prevents the energy fromdissipating too far beyond the targeted vessel. For ves-sels as small as 50–75 mm in diameter, the TRT isapproximately 1 millisecond.10 Larger vessels, such asthose found on the ala, have a much longer TRT. Avessel with a diameter of 300 mm has a TRT of ap-proximately 42 milliseconds, about 10 times that of avessel one third its size. Vessels with a diameter of1000 mm (1 mm) have a TRT of about 500 millisec-onds.10

The 585-nm flashlamp-pumped, pulsed-dye laserhas become the gold standard by which other vascularlasers are judged. The flashlamp-pumped, pulsed-dyelaser has the significant drawback of posttreatmentpurpura, which is difficult to conceal and can persistfor up to 14 days. Other clinical drawbacks of thepulsed-dye laser include costly field service for tubeor dye replacements, mirror collimation, and over-heating of the machine and the treatment room.

532-nm Laser PhysicsJust as transistors made vacuum tubes obsolete,

semiconductor diode-pumped lasers are replacing vac-uum tubes and flashlamp-pumped lasers. The Diolite532-nm diode laser (Iridex Inc, Mountain View, Calif)is a lightweight, portable laser about the size of a videocassette recorder. The laser weighs only 6.8 kg anduses standard wall power, consuming less than 350 Wof electrical power (Figure 1). There is no installationcost, and operating costs are almost nonexistent. Theenergy-based control system delivers the specific treat-ment fluence in laser pulses between 10 and 25 mil-liseconds.

The 532-nm wavelength is a green light and is ob-tained by a process known as frequency doubling(FD). Diodes are commonly used in many devicessuch as bar code readers and compact disc players.They are typically made of gallium arsenide (GaAs)and can be mixed with other elements to change theircharacteristics. A high-powered diode laser at 808 nmis used to optically pump a Nd:YAG crystal that pro-duces 1064-nm light (Figure 2). This light is then fo-cused onto a potassium titanyl phosphate (KTP) crys-tal to double its frequency and split the wavelength inhalf, producing a 532-nm wavelength. A red diode-aiming beam is added to target the 532-nm beam. Thediode-pumped, frequency-doubled Nd:YAG laser is re-ferred to as the DP FD Nd:YAG laser. This laser isalso called a millisecond Nd:YAG to represent theability of the laser to vary the pulse duration accordingto the vessel diameter and location that determine theTRT. The absorption of green light at 532 nm by oxy-hemoglobin is very high, resulting in a high extinction


Figure 2. This diagram illustrates the 532-nm diode laser optical train.

coefficient. The 532-nm green light wavelength is alsoabsorbed by melanin. This is an advantage, for the532-nm (DP FD Nd:YAG) laser can be used to treatpigmented lesions. Although used frequently, careshould be taken when treating darker skin to avoidepidermal injury. The 532-nm diode (DP FD Nd:YAG)laser produces a 532-nm wavelength that is stronglyabsorbed by oxyhemoglobin. The pulsed-dye laser at585 nm and the Krypton laser at 568 nm also targetoxyhemoglobin. All 3 lasers penetrate tissues to a sim-ilar depth and react with oxyhemoglobin essentiallythe same way. With similar absorption coefficients,there are in fact significant differences that are largelythe effect of pulse durations (Figure 3).

Pulsed-dye lasers produce pulse durations of 450microseconds to 1.5 milliseconds. These pulse dura-tions produce selective treatment of vascular lesions;however, the 585-nm flashlamp-pumped, pulsed-dyelaser causes violent vaporization of blood within thevessel. The short pulses of 450 microseconds (0.45milliseconds) heat the oxyhemoglobin so rapidly thatit creates a steam bubble and bursts holes in the ves-sels. This destruction of the vessel, with resultant ex-travasation of red blood cells, gives rise to clinical pur-pura (Figure 4).

The Krypton laser produces long pulse durations of0.1 or 0.2 seconds, which are beyond the TRT of mostfacial vessels, allowing for thermal conduction into thesurrounding tissue. These extended exposures do notcause purpura, but allow conduction loss from the tar-get vessel to the surrounding tissue, increasing non-specific injury.

In contrast, the 532-nm diode (DP FD Nd:YAG) la-ser delivers pulse durations from 1 to 100 millisecondsthat provide selective photothermolysis without pur-pura. Typically used between 10 and 25 milliseconds,the 532-nm diode (DP FD Nd:YAG) laser uses mod-erate pulses targeting the abnormal vascular structureswhile sparing the normal capillaries, hence producingno purpura. The much longer pulse duration of 1–100milliseconds seems to be well matched to the TRT ofmost facial vessels. It is this longer pulse of the 532-nm diode (DP FD Nd:YAG) laser that spares grossvessel damage.

Those with experience with the 532-nm diode (DPFD Nd:YAG) laser are familiar with the immediatedisappearance of the ectatic vessel after laser-light ex-posure. Active or passive vasoconstriction cannot ex-plain the total resolution or emptying of the vessel lu-men. With the longer 532-nm diode (DP FD Nd:YAG)laser pulses, the blood is more gently heated and dam-ages the endothelial cells, but it does not burst thevessel. There are theories that state that the laser en-ergy creates a small steam bubble that expands alongthe axis of the vessel, clearing the lumen and pushinga column of hot blood along the vessel. As the vesselcools during its TRT, the vapor bubble condenses andcollapses the vessel wall. Thermal coagulation of theblood, now ejected well beyond the actual exposuresite, creates an intravascular plug, leaving an empty,thermally damaged lumen at and around the site of thelaser exposure. This process is significant because gen-tle intravascular vaporization forces extremely hot


Figure 3. The oxyhemoglobin absorption vs wavelength chart is illustrated showing absorption coefficients ofvarious wavelengths.

blood to travel millimeters beyond the actual site oflaser impact.11

Multiple studies have shown the 532-nm diode (DPFD Nd:YAG) laser to be effective in treating facialtelangiectasia.6,11–13 Cassuto et al11 showed that 93% ofpatients (62 of 66) obtained 75–100% clearance. Theremaining 4 of 66 had 50–75% clearance, but weresatisfied. Hevia14 compared the 532-nm diode (DP FDNd:YAG) laser with the 585-nm flashlamp-pumped,pulsed-dye laser and found no significant clinical dif-ferences in the treatment of facial telangiectasia, buthe did report statistical differences between the 2 la-sers. Patients reported a significantly greater degree ofswelling, bruising, pain, and redness after the flash-lamp-pumped, pulsed-dye laser. Hevia concluded thatthe 532-nm diode (DP FD Nd:YAG) laser appeared tobe the optimal choice for the treatment of facial tel-angiectasia because of its effectiveness combined withpatient comfort. This study was well constructed, butwith a small sample size (N 5 15 patients). No per-manent pathologic skin changes were noted.

Clinical Applications

Vascular PathologyMillions of people, especially those with Fitzpatrick

skin-types 1 and 2, develop telangiectasias. The nasalala and medial cheeks are the most commonly in-volved areas. Telangiectasias are permanently dilatedcutaneous blood vessels visible to the naked eye andby definition do not exceed 1 mm in diameter. On the

basis of their appearance, telangiectasias are simple(linear), arborizing, spider- or star-shaped, and punc-tate (papular) lesions.15 Spider telangiectasias consistof red radiating arms stretching from a central pulsat-ing arteriole. Histologically, they represent dilated orectatic vessels in the superficial papillary dermal plex-us. Thin, wiry, and red telangiectasias extend from ar-terioles or from the arterial side of a capillary loop.Cordlike, blue vessels arise from venules or from thevenous side of a capillary loop.16 Red capillary telan-giectasias stretching from the capillary loop may alsobecome blue with time as hydrostatic pressure and ve-nous backflow increase.17 Telangiectasias occur in upto 48% of healthy children and 15% of normal adults.Telangiectasias of the lower extremities occur in 29–41% of women and 6–15% of men.20 Telangiectasiasderive from various factors.16 Some intrinsic factorsinclude congenital causes, primary cutaneous disorders(eg, Rosacea), systemic disease (eg, collagen vasculardisease), Cushing’s disease, metastatic carcinoma,pregnancy, venous incompetency, and inherited genet-ic disorders such as hereditary hemorrhagic telangi-ectasia. Some extrinsic factors can be drug induced byestrogens or chronic steroid use. Other extrinsic factorsinclude actinic and radiation dermatitis, postsurgicalrhinoplasty (wound closure under tension), radiother-apy, and trauma.21,22 Vasoactive mediators have beenimplicated in vascular neogenesis in the formation oftelangiectasia. The new vessels occur as a response toanoxia, alcohol, chemicals, hormones, direct trauma,


Figure 4. Clinical purpura from 585-nm pulsed-dye laser treatment. These purpura are difficult to conceal andare a major drawback for patients.

sinus infection,23 and other physical factors that resultin angioneogenesis.24,25 It should always be kept inmind that the presence of numerous telangiectasias canindicate dermatologic or systemic internal disease.

The Iridex 532-nm diode (DP FD Nd:YAG) lasercomes complete with a polarizing magnified headlight(Seymour Light XL-2000 Illumination System) thatsignificantly enhances the contrast of the vascular le-sions (Figure 5). By eliminating the glare and reflec-tion, the surgeon has the illusion of seeing beneath theskin. This incorporates a retractable magnifying loopfor improved visualization. In addition, the 532-nm di-ode (DP FD Nd:YAG) laser requires wavelength-spe-cific eye protection for the patient and doctor. The pa-tient wears opaque metal goggles, and the operator andassistants wear safety glasses that are able to absorbthe laser wavelength.

The laser is accompanied by 5 separate handpiecesthat deliver spot sizes of 200, 500, 700, 1000, and1400 mm, respectively (Figure 1). The laser is used onvarious settings to treat vascular and pigmented le-sions. Telangiectasias, cherry angiomas, spider angio-mas, and smaller port-wine stains are vascular lesionsreadily and predictably treated with the 532-nm wave-length. A larger spot handpiece treats the same lesionwith less energy density. Ideally, the spot size utilizedshould match the diameter of the vessels being treated.

A general dictum is that if a vessel is large enough toaccommodate a needle, it is too large for this type oflaser. The author’s experience has shown more painperception by the patient with the larger spot sizes. Acomputerized scanning device is also available for theDiolite laser to treat larger areas or lesions, but theauthor has no experience with this device.

AnesthesiaAlthough most surgeons do not use any type of an-

esthesia, this is not necessarily in the best interest ofthe patient. The author feels that the treatment pain issimilar to a BOTOX injection, and most patients cantolerate the smaller spot sizes with no anesthetic; how-ever, some patients react poorly or are uncomfortableduring treatment. Single laser pulses are activated bytapping the footswitch intermittently, causing a minor,slightly delayed pain, which the author describes to thepatient as a rubber band snap. Holding down the footswitch will cause a continuous but adjustable repeatrate. Slower repetition rates (4–7 Hz) usually result inless discomfort. Using the 15 Hz repeat provides fastertreatment, but it is also considerably more uncomfort-able for the patient. The use of a thin layer of refrig-erated, water-based gel, such as aloe vera, will providea thermal sink for the skin, will result in greater com-fort, and will reduce the risks of epidermal injury.


Figure 5. A magnified polarizing headlight is used to more clearly contrast the individual vessels.

When treating very sensitive areas such as the nasalalae, upper lip, or periorbital areas, the author fre-quently utilizes local anesthetic blocks. An infraorbitalnerve block is used by injecting 1–2 mL of 2% lido-caine 1:100 000 epinephrine at the infraorbital foram-ina (Figure 6). This block can be performed transcu-taneously or intraorally. Transcutaneous injection isperformed in the midline of the pupil approximately5–7 mm below the inferior orbital rim. Intraorally, theneedle is placed through the vestibular mucosa be-tween the cuspid and first bicuspid about 20 mm abovethe tooth crowns. This blocks the lower eyelid, theupper lip, the lateral nose, and most of the nasal tipand the anterior cheek. Areas not amenable to nerveblock can be treated with local infiltration.

Techniques and SettingsAny residual makeup is removed, and a test spot is

performed on an inconspicuous area of the face orneck to evaluate the patient’s pain response and theselected procedural parameters. Special care should beused when treating tan or pigmented skin, as a poten-tial for epidermal injury exists because of an affinityof the 532-nm wavelength for melanin. Generally, athin layer of water-based gel and moderate energy set-tings are adequate to prevent thermal injury. Pigmen-tary dyschromia, if it occurs, is transient and can typ-ically be treated with hydroquinone or similar agents.

The 532-nm laser wavelength penetrates to a dis-tance of about 1.5 mm. Other wavelengths such as the800 nm and 1064 nm penetrate more deeply and canbe more effective in the treatment of deeper vessels,

but will be less effective in the treatment of small di-ameter vessels of the face. Because the 532-diode lasercan penetrate 1.5 mm, the eyelids are never treatedwithout metal eyesheilds.

The handpiece size is matched to the diameter ofthe vessels being treated. The energy density is chosenby the lowest density needed to attain the disappear-ance of the vessels. Most frequently, the author usesthe 700-mm handpiece with a setting of 3 W and 24J/cm2. Most surgeons begin with a repeat rate of 4 Hzand increase this according to the patient’s comfort.The handpiece is moved quickly because the inducedflushing will obscure smaller telangiectasias. This isimportant to communicate with the patient as the en-suing erythemia can lead them to think they are treatedto resolution only to find that their vessels reappearseveral hours or days later.

The basic treatment technique is simple. The laserspot is used to trace individual vessels to an end pointof disappearance (Figure 7). The laser traces the in-dividual vessels and causes them to collapse, which isthe clinical endpoint. Some vessels may require severalpasses, and the skin should be allowed to cool betweenpasses. A moderate energy density such as 16 J/cm2 isinitially used, increasing the energy density until vesselcollapse is observed. Excessive thermal energy cancause linear hypopigmentation, hyperpigmentation,and possibly atrophic scarring.26

Arborized telangiectasias are treated by starting atthe branching and working toward the center, which ispainted with several pulses. Cherry angiomas, or roundpunctate lesions, are treated with multiple pulses at the


Figure 6. Local anesthesia block of the infraorbital nerve is effective in anesthestitizing common areas of facialtelangiectasias. The above photo illustrates the infraorbital nerve anatomy as well as transcutaneous andintraoral anesthetic technique.

Figure 7. The individual ectatic vessels are tracedwith the 532-nm laser light. The above photoillustrates the 1.4-mm handpiece.

center of the lesion (Figure 8). Matted ectatic vesselsor port-wine stains are better treated with a larger spotsize and lower fluence (Figure 9). This treatment usu-ally requires some form of anesthesia. A computerizedscanning device is also available for large areas or le-sions.

The 532-nm diode (DP FD Nd:YAG) laser willcause immediate erythema and edema that usuallyonly lasts a few hours (Figure 10). Prolonged treat-ments become difficult as the erythema obstructssmaller vessels. For these reasons, multiple short ses-sions are often used. Whereas most vessels can be ad-equately treated with a single session, some vessels arerecalcitrant or recurrent and can require additional ses-sions.

Because the epidermal integrity is not violated, nospecific postoperative treatment is necessary, andmakeup can be worn immediately. If excessive thermalenergy is induced, crusting or ulceration can appearand is treated with a triple antibiotic ointment for sev-eral days. Cool compresses are used for edema anddiscomfort; analgesics have not been necessary. Treat-ment sessions are spaced at least 2 weeks apart whenaggressive treatment is used or sensitive skin responseis seen. The 532-nm diode (DP FD Nd:YAG) laser isalso used to treat nonfacial pigmented lesions on non-facial areas and some promise exists for leg veins.11

Treatment of Pigmented LesionsThe absorption spectrum of melanin includes the ul-

traviolet, visible, and near-infrared portions of the elec-tromagnetic spectrum. Because of this, virtually everywavelength along the spectrum can theoretically beused to target melanin.27 Melanosomes are muchsmaller than blood vessels (10 vs 100 mm) and a much


Figure 8. Before and immediately postlaser treatment images of an arborizing telangiectasia of the lateral nose.

Figure 9. Before and immediate postoperative photo of a small port-wine stain of the upper lip. This lesionrequired 3 treatments with the 532-nm laser for resolution.

shorter pulse duration is required as compared to tel-angiectasias.27

Pigmented lesions such as lentigines, keratoses,ephledes (freckles), and dermatosis papulosa nigrahave been successfully treated with the 532-nm wave-length (Figure 11).28 Early hypertrophic scarring andkeloids that possess significant vascularity have beensuccessfully treated.28 For most macular lesions, suchas lentigines, the endpoint is a uniform gray color anda popping sound that occurs when a tissue becomesplasmoid (Figure 12).28

The pigmented lesions exfoliate over 1–2 weeks(Figure 13). Larger or thicker lesions may need retreat-ment until clinical clearing is achieved. Lesions withvaried areas of pigmentation will respond differentlyto treatment in that the darker areas will absorb morelaser energy. Nonpigmented lesions have been treatedwith artificial chromophore such as ink.28

ComplicationsAs with any laser, attention to clinical endpoint is

paramount to successful treatment. Undertreatment


Figure 10. Erythema manifests immediately duringthe 532-nm treatment. Localized edema is common inaggressive treatment, beginning soon after treatmentand lasting for several hours.

Figure 11. Shows before and after images of successful treatment of multiple dermatosis papulosa nigra lesionson an African-American patient.

will not remove the ectatic lesions, and overtreatmentcan cause linear hypopigmentation, hyperpigmenta-tion, and possible scarring because of extravascular tis-sue destruction. Attention to the clinical endpoint ofvessel collapse is the best treatment indicator. Testspots and conservative initial treatment are recom-mended until the patients healing response is deter-mined. Special care should be exercised in the areas

of the upper lip, mandibular border, and neck that areprone to scarring. As mentioned earlier, the 532-nmdiode (DP FD Nd:YAG) laser has a high affinity formelanin. Conservative parameters should be usedwhen treating patients with suntans or darker skin. Themanufacturer recommends not treating suntanned skinand not tanning 3 months after treatement. The reac-tive hyperpigmentation that could arise from tannedskin will usually heal, but like any laser that targetsmelanin, tanned skin should be treated with caution.

The 585-nm flashlamp-pumped, pulsed-dye laserhas a larger spot size that enables more rapid treat-ment. In contrast, the 532-nm diode (DP FD Nd:YAG)laser has a much smaller spot size and tracing the in-dividual vessels with it requires more manual dexteritywhen compared to a laser with a larger spot size. Theuse of magnification and individual vessel tracing isalso more tedious than the larger areas covered withthe 585-nm handpiece.

Finally, 532-diode laser therapy may require multi-ple sessions. The author’s experience shows approxi-mately a 50% resolution with a single treatment. In-dividuals prone to telangiectasia, or those who fre-quently pursue physical exercise or consume alcohol,may experience reformation of telangiectasias. In thesepatients, 532-nm diode laser treatment should bethought of as maintenance therapy because futuretreatments may be necessary.

Nd:YAG Frequency Doubled LasersOther 532-nm wavelength lasers exist for the suc-

cessful treatment of telangiectasias and pigmented le-sions. The VersaPulse laser (Coherent Medical Group,Palo Alto, Calif) offers larger spot sizes (2–10 mm)and therefore must be very high powered to provideadequate energy densities. This laser is used for treat-ing facial and lower extremity telangiectasia. In con-trast to the 6.8-kg Diolite, 532-nm diode laser, theVersaPulse is a large 135-kg unit. The VersaPulse alsohas a water-cooled handpiece, which may be awkwardaround contours such as the nose.

The Aura 532-nm KTP laser (Laserscope, San Jose,Calif) is a flashlamp-pumped, frequency-doubled Nd:


Figure 12. The endpoint of treating pigmented lesions is a uniform gray color, as shown above. A poppingsound also is indicative of sufficient laser exposure.

Figure 13. Shows the successful treatment of multiple seborrheic keratoses of the right cheek. (Photo courtesy ofThomas Spoor, MD)

YAG laser. Although the laser is similar to the Diolite532 laser, it is significantly larger at 27 kg. This laseris also effective in the treatment of facial telangiecta-sia.

DiscussionMultiple 532-nm lasers are available for the treat-

ment of telangiectasias and pigmented lesions. The Ir-idex Diolite 532 (DP FD Nd:YAG) laser is an extreme-ly portable solid-state laser that enables transportationbetween offices or treatment rooms. The small hand-pieces are very flexible and are well suited for theprecision tracing of individual telangiectasias. The532-nm wavelength has been shown in multiple stud-ies to be effective for the treatment of facial telangi-ectasia, minor vascular lesions, and some pigmentedlesions.6,11–13 The portability, affordability, ease of use,and efficacy of the 532-nm diode laser makes it wellsuited for office-based cosmetic surgery practice.

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