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The efficacy of a single-session pro-yellow laser in the treatment of facial

telangiectasia

Article  in  Lasers in Medical Science · March 2021

DOI: 10.1007/s10103-020-03082-3

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Lasers in Medical Science
https://doi.org/10.1007/s10103-020-03082-3

ORIGINAL ARTICLE

The efficacy of a single-session pro-yellow laser in the treatment

of facial telangiectasia
Dursun Turkmen 1 & Nihal Altunisik 1 & Serpil Sener 1

Received: 21 January 2020 / Accepted: 17 June 2020

# Springer-Verlag London Ltd., part of Springer Nature 2020

Abstract
Facial telangiectasia (FT) is a condition in which small dilated vessels visibly protrude on the surface of the skin. The aim of this
study was to evaluate the efficacy and safety of a single-session pro-yellow laser in the treatment of FT and spider angioma (SA)
to compare it with a limited number of studies conducted on this subject. In this pilot study, we reviewed 41 patients who
admitted to our dermatology clinic with FT and SA and were treated by using pro-yellow laser. The efficacy of the treatment was
evaluated using the recorded clinical information and digital camera images. The improvement was graded as complete (90–
100%), very good (75–89%), good (50–74%), moderate (25–49%), and weak (< 25%). Of the 41 patients included in the study,
37 (90.2%) had FT and four (9.8%) had SA. Twenty-two patients were female and 19 were male. Pro-yellow laser therapy was
generally well tolerated by patients, and minimal pain occurred during the application. In 1-month follow-up, good, very good, or
complete recovery was achieved in 51.4% of the FT patients. The new pro-yellow laser only has a yellow light wavelength. Its
unique wavelength at 577-nm yellow light is ideal for vascular lesions. In this study, 51.4% of the patients with FT achieved
good, very good, or complete improvement after a single session of 577-nm pro-yellow laser, and complete improvement was
achieved in all the four patients with SA.

Keywords Facial telangiectasia, . Laser therapy, . Pro-yellow laser, . Spider angioma, . 577 nm

Introduction therapy has become the treatment of choice for vascular

Facial telangiectasia (FT) is a condition in which small dilated
vessels visibly protrude on the surface of the skin.
Telangiectasias are variable in size (0.1–3 mm diameter), po-
sition, color (bluish to reddish), and pattern. Many patients are
genetically predisposed to FT, while others are associated
with various disorders such as connective tissue diseases, ex-
posure to sunlight, prolonged steroid use, increased estrogen,
liver disease, rosacea, radiation therapy dermatitis, surgical
trauma, and vascular genodermatoses. Millions of people have
this condition around the world, and since it is difficult to
conceal with makeup, cosmetic deformity is the most com-
mon symptom [1–4].
Laser therapy in vascular lesions is still one of the
most common uses of laser in dermatology. Laser
* Dursun Turkmen
dursunturkmen44@gmail.com
1
Faculty of Medicine, Department of Dermatology, Inonu University,
Malatya, Turkey
conditions such as hemangioma, port-wine stains (PWS),
and erythematotelangiectatic rosacea [5].
In telangiectasias, the intended target or chromophore is
largely intravascular oxyhemoglobin, but deoxyhemoglobin
and methemoglobin are also targeted. By applying the light
at the appropriate wavelengths, the energy transferred to the
oxyhemoglobin is converted into the form of heat and re-
leased. This energy or heat is transferred to the surrounding
vessel wall, causing damage to the vessel wall. The principal
absorption peaks of oxyhemoglobin are in the blue-green-
yellow portion of the visible range at 418, 542, and 577 nm.
There is also significant, although lesser, absorption between
700 and 1100 nm. The wavelengths that match the absorption
peaks of hemoglobin should produce the greatest effect, but
the penetration depth of the wavelengths of light and simulta-
neous absorption with melanin make it difficult to choose an
ideal wavelength [1]. Common laser types used to treat vas-
cular lesions include argon (488–514 nm), APTD (577 and
585 nm), KTP (532 nm), krypton (568 nm), copper vapor/
bromide (578 nm), PDL (585 nm-595 nm), Nd:YAG (532
and 1064 nm), alexandrite (755 nm), and diode [6–8].

Each of the different light energy–based methods used for the
treatment of FT has distinct therapeutic advantages and disad-
vantages. Alexandrite laser (755 nm) penetrates the dermis rel-
atively well, but it is less safe and effective in patients with dark
skin. Diode lasers with wavelength bands of 810–980 nm pen-
etrate the dermis well but require multiple treatment sessions for
FT [9].
The reliability and safety of PDL and KTP have been dem-
onstrated in many studies and both are recommended by the
European Laser Dermatology Association as a first-line ther-
apy for FT. At least 50 ± 90% improvement can be expected
after 1 ± 3 treatments. PDL is still the gold standard treatment
for facial capillary malformations, but modern large spot size
KTPs also appear to be effective [10]. The advantage of the
yellow PDL compared with the green KTP is the longer emis-
sion wavelength, enabling deeper penetration, and treatment
of larger vessels. In addition, oxyhemoglobin has higher ab-
sorption for yellow than for green wavelengths. Yellow wave-
lengths are known to have lower melanin absorption and al-
low treatment of darker skin phototypes with a lower risk of
epidermal damage [1]. These advantages of yellow wave-
lengths also apply to pro-yellow laser.
Nevertheless, yellow PDL has some disadvantages, such as
large size and high annual maintenance costs. A new laser tech-
nology, namely, optically pumped semiconductor disc laser
(SDL), has emerged to provide a compact and cost-effective
alternative to a yellow laser source. SDLs are known for their
power scaling capabilities, transverse mode control, and ability
to adapt emission wavelengths to specific application needs [10,
11]. The pro-yellow laser has an ideal wavelength at 577 nm for
the treatment of cutaneous vascular diseases. Immediate burning
of the lesion indicates thermal damage and is used as a clinical
indicator of the appropriate dose [12, 13]. On the other hand, the
disadvantage of the pro-yellow laser is the inadequate healing in
deep-seated lesions [13]. Various types of lasers have been used
in the treatment of FT [1–4, 8–10, 14, 15]. We found a limited
number of studies on the use of pro-yellow laser in facial vas-
cular lesions (12, 13, 16).
The aim of this study was to evaluate the efficacy and
safety of a single-session pro-yellow laser in the treatment of
FT and SA and to compare it with a limited number of studies
conducted on this subject.
Materials and methods
In this pilot study, we reviewed 41 patients who admitted to our
dermatology clinic with FT and SA and were treated by using
pro-yellow laser. All patients had been diagnosed clinically.
The study was conducted in accordance with the Declaration
of Helsinki, and written consent was obtained from all patients
or their parents (for patients younger than 18 years of age).
Lasers Med Sci
Topical anesthesia was not applied before the procedure.
The eyes of the patients were protected with appropriate
glasses. Pro-yellow laser with 577 nm was applied to all pa-
tients (QuadroStar PRO YELLOW® Asclepion Laser
Technologies, Germany). The spot mode of 1 mm was used.
Application was started with a fluence of 18 J/cm2, and in
patients that did not appear effective, the fluence was in-
creased by 2 J/cm2 during the procedure. A maximum dose
of 22 J/cm2 was used. After the procedure, ice was applied for
20 min and the patients were recommended to use at least 30
SPF sunscreen regularly.
The lesion site was photographed with the digital camera
before, immediately after, and 1 month after the procedure.
The efficacy of the treatment was evaluated using the recorded
clinical information and digital camera images. Vessel thick-
ness and density were evaluated by two different dermatolo-
gists. While evaluating the results, the photos of each patient
before and after treatment were placed side by side on the
computer screen and compared. Changes in vessel thickness
and total vessel length were evaluated globally by dermatolo-
gists. The improvement was graded as complete (90–100%),
very good (75–89%), good (50–74%), moderate (25–49%),
and weak (< 25%). All patients were observed in terms of
any possible complications in the treated parts of the face,
including formation of scatris, post-inflammatory hyperpig-
mentation, and hypopigmentation.
SPSS for Windows version 25.0 software was used for the
statistical evaluation of the study data. Quantitative variables
were expressed by using mean ± standard deviation (SD), and
qualitative data were expressed by using number (n) and per-
centage (%) values. Statistical analyses were performed by
using Pearson chi-square test and Fisher’s exact chi-square
test. A value of p < 0.05 was considered statistically
significant.
Results
Of the 41 patients included in the study, 37 (90.2%) had FT
and four (9.8%) had SA. Twenty-two patients were female
and 19 were male. The mean age was 40.1 ± 13.4 years
(min, 8; max, 70). Skin type 3 was found in 82.5% of our
patients. A family history of telangiectasia was present in
37.5% of the patients, and the duration of the disease was
more than 5 years in 57.5% of the patients. The patients in-
cluded in the study were over 18 years of age except 2; both
whom presented with SA. The sites of involvement were in
the lateral areas of the nose, bilaterally, in 57.5% of the pa-
tients. The prevalence and thickness of telangiectasia and de-
mographic data of the patients are shown in Table 1.
The fluence was increased to 20 J/cm2 in 4 (9.8%) patients
with FT and to 22 J/cm2 in 2 (4.9%) patients. The fluence of 18
J/cm2 was effective in all other 35 (85.4%) patients. Pro-yellow
Lasers Med Sci

Table 1 Characteristics of all studied patients complete improvement was achieved, in 1 month follow-up
Features Groups N (%) p (Fig. 1). When 37 patients with FT were evaluated separately,
complete or very good (≥ 75%) improvement was achieved in
Age (mean ± SD) Male 42.1 ± 14.7 0.94 56.8% of the patients, immediately after the procedure. On the
Female 38.5 ± 12.3 other hand, telangiectasis recurred in 29.7% of the patients, in
Total 40.1 ± 13.4
Gender Male 19 (46.3) -
1-month follow-up (Table 2) (Figs. 2, 3 and 4). In 1-month
Female 22 (53.7) follow-up, good, very good, or complete recovery was achieved
Skin type Type 2 8 (19.5) - in 51.4% of the FT patients (Tables 2 and 3).
Type 3 33 (80.5) In the evaluation of the effect of laser according to age and
Reason for application Spider angioma 4 (9.8) -
Facial telangiectasia 37 (90.2)
gender, in FT patients, we observed that pro-yellow laser was
Family history Yes 15 (36.6) - more effective in female patients and those aged 40 years and
No 26 (63.4) older, but this difference was not statistically significant. In
Complaint time <1 year 2 (4.9) - addition, there was no significant difference in the effective-
1–3 years 7 (17.1)
3–5 years 9 (22)
ness of laser therapy between patients with skin type 2 and
5–10 years 10 (24.4) skin type 3 (Table 3).
10–20 years 9 (22)
≥ 20 years 4 (9.8)
Involvement site Nose (bilateral) 23 (56.1) -
Nose (unilateral) 5 (12.2) Discussion
Cheek 4 (9.8)
Nose + cheek 8 (19.5) FT lesions are vascular structures of various sizes, colors (pur-
Under the nose 1 (2.4) ple, red, pink), and shapes (linear, arborizing, random). FT
Density Little 23 (56.1) -
Medium 14 (34.1) may occur due to systemic reasons such as topical or systemic
Dense 4 (9.8) corticosteroid use and connective tissue disorders, but it is
Thickness of vein Thin 25 (61) - idiopathic in most people [2]. FT is one of the most important
Medium 14 (34.1) causes of cosmetic anxiety. Laser is a safe and effective treat-
Thick 2 (4.9)
Fluence of application 18 J/cm2 35 (85.4) - ment for FT and other vascular facial lesions, and it has been
20 J/cm2 4 (9.8) used increasingly in the recent years. The effect of the laser
22 J/cm2 2 (4.9) therapy varies depending on the size and shape of the telangi-
ectatic vessels [16].
Diode lasers with wavelength bands of 810–980 nm pene-
trate the dermis well but require multiple treatment sessions
laser therapy was generally well tolerated by patients, and min- for FT; 532-nm KTP has poor penetration and the risk of
imal pain occurred during the application. Mild crusting devel- scarring is high [8]. In the current study, the one-session suc-
oped after the procedure in an adult patient with thick telangi- cess rate and the lack of significant side effects in follow-up
ectasis and a child with SA, and the crusts recovered in 2 weeks suggest that pro-yellow laser may be a good treatment
with topical antibiotic pomade. A skin hyperpigmentation oc- alternative.
curred in a FT patient with skin type 3 and resolved after 2% Gao et al. compared the efficacy and safety profiles of
hydroquinone treatment. In all the four patients with SA, pulsed dye laser (PDL, 595 nm) with intense pulsed light

Fig. 1 A 48-year-old female pa-

tient with SA before (a) and 1
month after the treatment (b).
(Complete improvement in b)
 Lasers Med Sci

Table 2 Improvement of facial telangiectasias and spider angiomas after the treatment with pro-yellow 577-nm laser

Recovery (%) SA (immediately SA (1 month later), n = 4 FT (immediately FT (1 month later), n = 37

after the laser), n = 4 after the laser), n = 37

Complete (90–100) 2 (50%) 4 (100%) 1 (2.7%) 2 (5.4%)

Very good (75–89) 1 (25%) - 20 (54.1%) 9 (24.3%)
Good (50–74) 1 (25%) - 12 (32.4%) 8 (21.6%)
Moderate (25–49) - - 4 (10.8%) 10 (27%)
Weak (< 25) - - - 8 (21.6%)

FT facial telangiectasia, SA spider angioma

(IPL) configured by three different wavelength bands in the
treatment for FT. They found that PDL (595 nm) and M22
vascular filtered IPL (530–650 nm and 900–1200 nm) had
similar and best clinical efficacy as compared with IPL with
other wavelength bands. After two sessions, they achieved
excellent or marked success in 63% of patients in the PDL
group and in 43% of patients in the IPL group with vascular
filter [9]. When we compared our study, our single-session
pro-yellow results were less successful than two sessions of
PDL but were close to two sessions of IPL.
It has been stated that PDL laser is effective for superficial
vascular lesions but may cause significant vascular disruption
and purpura that last for 10–14 days [15, 17]. New-generation
PDLs, which offer advantages over previous generation
PDLs, have also been prevented from this side effect. In a
study by Gao et al., purpura was not observed in any patient
[9]. In a study conducted by Nam et al., 532-nm KTP laser
was compared with PDL and it was reported that there was no
difference between the two for superficial vascular lesions.
However, there were fewer side effects and less pain during
the KTP laser [14]. In our study, as in the few pro-yellow
studies conducted before, no long-term side effects were ob-
served and the procedure was well tolerated by patients with
minimal pain.
The pro-yellow laser only has a yellow light wavelength.
Its unique wavelength at 577-nm yellow light is ideal for vas-
cular lesions. The copper bromide laser has the wavelength
closest to the pro-yellow laser but contains two wavelengths
with 90% yellow light and 10% green light [18]. However, the
green light of the copper bromide laser has been associated
with the side effects and is thought to be the main factor in the
low success rate and the resulting post-inflammatory hyper-
pigmentation in patients with dark skin color. The pro-yellow
laser has a yellow light wavelength, which makes it suitable
for use in dark-skinned patients in the treatment of vascular
lesions. In addition, minimal risk of hyperpigmentation or scar
development and shorter erythema after treatment are other
advantages [12].
In this study, 51.4% of the patients with FT achieved good
or better results after a single session of 577-nm pro-yellow
laser, and complete improvement was achieved in four pa-
tients with SA. To the best of our knowledge, there are four
studies on pro-yellow laser, in the literature [12, 13, 16, 19].
Two of these studies included patients with FT as well as those
with other facial lesions. Kapıcıoglu et al. investigated the
effect of pro-yellow laser for facial lesions on 11 patients with
FT and reported that an average of 3.36 sessions of laser for
total healing (> 80%) was required. They reported the rate of
reduction in telangiectasis after each session and achieved an
average improvement of 66.3% after the first session [12]. In
our study, we grouped the levels of recovery to evaluate the
results of a single session. In our study, 37 FT patients were
included and we achieved 51.4% good and better success in 1
month after the one session laser.

Fig. 2 View of a 31-year-old female patient with telangiectasia under the nose before (a), immediately after (b), and 1 month after treatment (c). (50–
74% improvement in b and c)
Lasers Med Sci
Fig. 3 A 70-year-old man with telangiectasia of the lateral aspect of the nose before (a), immediately after (b), and 1 month after treatment (c). (≥ 50%
improvement in b and c)
Mohamed et al., in their study on 16 patients with FT, used
pro-yellow laser treatment for all facial vascular lesions and
grouped their success rates similarly with our study. They
achieved a good or better improvement in 62.5% of patients,
after an average of 3.63 sessions. The authors attributed this
relatively low success rate to the fact that the majority of
patients had skin type 4 and they applied laser at a lower
frequency [16]. The skin types of the patients included in
our study were 2 and 3, and we achieved good or better suc-
cess in 51.4% of the patients with FT after a single session.
Kapıcıoglu et al. used screening (form) mode in the initial
session for FT and then continued with spot mode, while
Muhamed et al. did not report which mode they used [12,
16]. In our study, we used only spot mode for FT and SA.
While the screening mode is suitable for large lesions such as
PWS and erythema, we think it would be more appropriate to
use the spot mode for FT. However, we think that it would be
Fig. 4 A 39-year-old man with intense telangiectasis on the lateral aspect of the nose. Before treatment (a), immediately after (b, 75–89% improvement),
and 1 month after treatment (c, 50–74% improvement)
appropriate to use screening mode if telangiectasias consist of
thin and very close and diffuse veins.
In addition, in our study, we compared the photographs
immediately taken after the procedure and 1 month after the
procedure. We found that 89% of FT patients had good or
better improvement, immediately after the procedure, whereas
this rate decreased to 51.4%, 1 month later. This finding em-
phasizes the importance of comparing patients at least 1
month later, for a healthy evaluation. Previous pro-yellow
laser studies did not include SA patients. In our study, 4 pa-
tients with SA were included. We observed that all 4 patients
with SA showed complete recovery after a single-session laser
therapy.
In conclusion, in our study, one-session pro-yellow laser
therapy was effective on FT. It is necessary to check the pa-
tients after 1 month, to make a healthy evaluation. It is impor-
tant to apply ice for about 20 min after the procedure and to
 Lasers Med Sci

Table 3 Comparison of the effect

of pro-yellow laser treatment on Groups Improvement (< 50%) n (%) Improvement (> 50%) n (%) p values
facial telangiectasia by age and
sex Gender Male 10 (52.6) 9 (47.4) 0.86
Female 8 (44.4) 10 (55.6)
Age 8–39 12 (60) 8 (40) 0.24
≥ 40 6 (35.3) 11 (64.7)
Skin type Type 2 3 (50) 3 (50) 1.00
Type 3 15 (48.4) 16 (51.6)
Total All patients 18 (48.6) 19 (51.4)

apply sunscreen. Pro-yellow laser appears to be quite effective
on SA, but further studies including a larger number of SA
patients are required to make a definitive conclusion.
Compliance with ethical standards
The authors have no conflict of interests and received no funding for this
work. The study was conducted in accordance with the Helsinki
Declaration. The study received the local ethics committee approval on
17 December 2019 (#134). Written consent was obtained from all pa-
tients or their parents.
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