Dr. Paula Casals

Vascular Surgeon – Brazil

Treatment

Superficial vascular lesions of the lower limbs are among the most frequent aesthetic complaints in clinical practice. In patients with skin phototypes IV and V, treatment requires special attention due to the higher concentration of epidermal melanin, which increases the risk of adverse effects. The development of these conditions is associated with genetic predisposition, hormonal changes, aging, pregnancy, prolonged standing, obesity, and superficial venous insufficiency.

Therapeutic options include sclerotherapy, vascular lasers, and a combination of these techniques. The 1064 nm transdermal Nd:YAG laser is particularly indicated for treating telangiectasias and reticular veins in phototypes IV and V, as it promotes selective photothermolysis of hemoglobin with lower melanin absorption, thereby ensuring greater safety and efficacy.

Combining the thermal damage caused by the 1064 nm Nd:YAG laser with the chemical damage from 75% glucose sclerotherapy enhances vascular occlusion through complementary mechanisms. The reduced vessel caliber and diminished flow resulting from the laser effect prepare the vessels, making them more responsive and potentiating the action of the sclerosing agent.

In this case—treating a 42-year-old patient with phototype IV skin and no saphenous reflux—1064 nm Nd:YAG laser application was performed, followed by sclerotherapy and tumescence using a modified Klein solution. A total of six sessions were conducted at 20-day intervals, with no complications regarding hyper- or hypopigmentation.

Result