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A prospective, side-by-side comparison study of two different lasers for the treatment of solar- induced telangiectasia was carried out in 14 patients at the Beckman Laser Institute and Medical Clinic. The argon tunable dye laser (Coherent, Palo Alto, Calif.) was used in the method modified from Orenstein and Nelson to completely treat discrete telangiectasias on one cheek. Specifically, the argon tunable dye laser (ATDL) was set at 0.7 - 0.8 watts, 585 nm wavelength, shutter-pulsed at 0.1 second duration with a spot size of 0.1 mm, and individual vessels were 'traced out' with 4X loupe magnification. Each patient's opposite cheek was then treated in the standard fashion with the flashlamp pulsed dye laser (Candela, Natick, Mass.) using a technique similar to Polla's et al. Specifically, the flashlamp pulsed dye laser (FPDL) was set at 585 nm wavelength, pulsed mode of 450 microseconds pulse duration, spot size of 5 mm, overlapping 10 - 20%, with power densities of 5.5 to 6.5 joules/cm2. All patients had symmetrical cheek telangiectasias of several years' duration. Patients were treated on day 0, and examined on weeks 2, 4, and 6. Photos were taken at each visit, and evaluation was done by questionnaire and direct observation, as well as by photographic slides later projected to an impartial panel. Final evaluation by the panel at week 6 showed 11/14 patients with excellent results (75 - 100% clearing) at sites treated with the FPDL, compared with 4/14 with the ATDL. In contrast, 4/14 FPDL sites were graded as fair to minimal improvement, and 9/14 as fair for the ATDL. The patients' self-evaluations graded the final results very similar to that of the panel. Most patients were bothered by the ecchymosis and hyperpigmentation associated with the FPDL, resulting in less than 50% of the patients preferring the FPDL despite its more impressive results. We conclude that the final results favor the FPDL over the ATDL for treatments of facial telangiectasia. However, non- ecchymosis producing methods of treating these lesions are an important option to be optimized in order to improve patient acceptance.
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