Objectives: The objective of the presentation is to introduce the long pulsed Nd:YAG laser discussing it's characteristics and use in dermatology. Both conventional and unconventional use will be covered.

Introduction: The 1064 nm long-pulsed Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser is a versatile and widely used device in dermatology.

Materials / method: At 1064 nm, the scattering is very low as well as the absorption by the major chromophores in the skin. Increasing the radiant exposure compensates for the low absolute values of absorption at 1064 nm. As a consequence, this laser is known for its deep penetration into the skin and homogenous heating of larger structures. The low absorption coefficient by melanin makes it a safe choice for treating darker skin types with lasers. Conventional use includes both vascular and hair-related indications.

Results: The long-pulsed NdYAG laser is commonly used for the treatment of blue telangiectasia in the face, leg veins and bulky vascular lesions like hypertrophic port wine stains. Moreover, it is the first choice for laser assisted hair reduction in skin types V and VI. Beyond these established indications there are many unconventional indications in dermatology. The skin disorders that have been published to improve with the NdYAG laser are numerous and can be classified into vascular conditions, inflammatory disorders, hair follicle related disorders, infectious disorders and malignant disorders.

Conclusion: However, the evidence to support the routine use of the Nd:YAG laser for these unconventional indications is poor. Future research is needed to proof the benefit for these indications. The LEAD registry, which is supported by the EADV and the ESLD, will provide evidence for the uncommon medical indications for different lasers including the Nd:YAG laser.

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Objectives: To assess the effectiveness and safety of long-pulsed 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for infraorbital visible prominent veins.

Introduction: In the periorbital region, the venous system is sometimes prominent causing by its ungraceful blue-green tint a frequent pattern in esthetics. The reticular venous plexus extends from the temple to the lateral commissure of the eyelid along the lower eyelids.
Classically, two techniques are dedicated to the management of periorbital veins: Sclerotherapy is used exceptionally because of the risk of diffusion of the sclerosing product towards the eye. Phlebectomy is the treatment of choice before the advent of the laser. It is an effective and safe method.

Materials / method: Fifteen tunisian women with periorbital veins on the lower eyelids are treated with Laser Nd Yag 1064 nm. After properly protecting the eyes with shells and adequate cooling, a 3mm handpiece and long pulse times (20-30ms) are used. We start with a fluence of 120j/cm² and then increase gradually by looking for the End-point (erasure of the vein). For very thin vessels we use a 1.5mm handpiece with higher fluences (160j / cm²) keeping the same exposure time.
We start with the small branches by pushing the flow towards the largest branch in diameter. We work step by step to avoid sclerothrombus

Results: The long pulse Nd Yag laser represent a remarkable alternative therapeutic for the big veins on the face. He indeed allows a simple and fast treatment with many precautions to avoid certain complications such as thrombus, necrosis and eye complications. As for the varicosities of the lower limbs, we aim the treatment of large vessels. We work in photocogulation mode. It is necessary to be satisfied with only one passage and never to look for purpura. We are seeing some mild side effects (erythema and edema). The danger is the diffusion of heat to adjacent tissues causing burns and pigmentation

Conclusion: Nd-yag 1064 long pulse laser treatment of periorbital veins is easy and fast. It is a feasible treatment in minutes and in one session. It should be proposed as first-line especially as some patients have noted an improvement in their dark circles.

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请注明名称（个人，公司，学会等等）: Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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这项工作的完成感谢以下机构的支持： Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran