Excel V vs Vbeam vs yellow laser:
three wavelengths aimed at blood

What are Excel V, Vbeam and the yellow laser, and how do they differ?

All three are vascular lasers, and the name on the console matters less than the wavelength inside it. Excel V is a platform made by Cutera that carries two lasers: a 532 nm KTP, which is a frequency-doubled Nd:YAG, and a long-pulsed 1064 nm Nd:YAG, with a cooled sapphire window in contact with the skin. Vbeam is Candela's brand of pulsed dye laser; its light is generated in a liquid dye and emitted at 595 nm, with a cryogen spray that cools the surface a fraction of a second before each pulse. A yellow laser is any laser emitting at around 577 nm, usually a solid-state or diode source delivering longer pulses; several brands exist, and in Singapore the term is used for the category rather than one machine.

Oxygenated haemoglobin absorbs most strongly around 418 nm and again around 542 and 577 nm. The 532 nm KTP and the 577 nm yellow laser sit on or near those peaks, so they are absorbed avidly by blood and do not travel far; the 595 nm pulsed dye sits just past the peak, trading some absorption for slightly deeper reach; the 1064 nm Nd:YAG is absorbed far less by blood and by melanin, so it penetrates deepest and is used for larger or blue-purple vessels where the shorter wavelengths run out of depth. The Nd:YAG laser page explains that wavelength on its own; the Vbeam and other vascular lasers guide covers the pulsed dye family in more detail.

Which treats redness, which treats visible vessels, and which treats PIE?

The target decides. Diffuse redness, the fixed flush of rosacea across the cheeks, is a network of fine vessels near the surface; it answers wavelengths that blood absorbs strongly and that do not travel deep, which is why pulsed dye, KTP and yellow lasers are the usual choices in fair skin. In a split-face study comparing a 532 nm KTP laser with a 595 nm pulsed dye laser for facial telangiectasia and diffuse redness, both sides improved, and the KTP side tended to show more swelling and redness afterwards. In a randomised split-face trial in erythematotelangiectatic rosacea, non-purpuric pulsed dye laser and intense pulsed light both reduced redness and visible vessels with no significant difference between them. A visible thread vein is a single vessel with a calibre and a depth, and the wavelength is chosen for both: fine red vessels to 532, 577 or 595 nm, larger or blue-purple ones to 1064 nm, as set out on facial telangiectasia.

Post-inflammatory erythema, the flat red mark that stays after a pimple, is blood sitting in dilated capillaries rather than pigment, which the pressing-glass test in the PIE guide shows in seconds. Vessel-directed light across the field of marks, once the acne is controlled, is what the trial literature supports; none of the three devices on this page treats the acne itself, and new marks replace treated ones while acne is active. Flushing, as opposed to fixed redness, is a neurovascular event, and no laser switches it off; the rosacea page explains why laser sits inside a medical plan rather than replacing it.

“I do not choose a vascular laser by its brand. I ask how deep the vessel sits, how much melanin sits above it, and whether the redness is a vessel at all.”

Dr Sin YongOn choosing a wavelength for redness

Why do bruising, depth and skin type separate the three?

Bruising is a pulsed dye question. A short pulse at high energy heats blood faster than the vessel can dissipate it, the vessel ruptures, and purpura appears: purple bruising that is visible until it clears. That is deliberate at some settings, because a ruptured vessel closes decisively, and avoided at others, with a trade-off in how much each pass achieves. Yellow lasers at 577 nm are usually delivered as longer pulses that heat the vessel without rupturing it, so bruising is less often part of the picture, and the 532 nm KTP on a long pulse behaves similarly. Depth runs the other way: the shorter the wavelength, the stronger the absorption and the shallower the reach, so 532 and 577 nm are superficial tools, 595 nm slightly less so, and 1064 nm the only one of the four that reaches a deep or blue vessel.

Skin type decides the margin. Melanin absorbs 532, 577 and 595 nm well, so in Fitzpatrick III to V skin part of every pulse is taken up by the epidermis rather than the vessel, and the gap between closing the vessel and heating the surface narrows. Darkening after treatment, post-inflammatory hyperpigmentation, is the risk to plan around, and cooling, conservative fluence and a test area are how it is managed. The 1064 nm Nd:YAG is absorbed far less by melanin, which is why it is documented specifically in Asian skin for vessels, and why the deeper wavelength is often the more conservative choice in darker skin even for a vessel that a shorter wavelength could reach.

What to ask about any vascular laser

• Which wavelength, and why that one for this vessel and this skin?
• Will the setting bruise, and is that intended?
• How is the surface cooled, and has a test area been considered for Fitzpatrick IV or V skin?
• Is the redness fixed, flushing or a mix, and what is being done about the part a laser cannot reach?

What does Dr Sin Yong use for redness, and why not Excel V, Vbeam or a yellow laser?

Excel V, Vbeam and 577 nm yellow lasers are not used here. Facial redness is treated with the 675 nm 少女光 Laser on the DEKA RedTouch Pro, a wavelength absorbed by collagen that interacts with the vascular component of the dermis, which is considered where redness, pores and texture occur together; and with R2 Glow, a long-pulsed 755 and 1064 nm protocol directed at inflammatory activity, where the background is mainly inflammatory and once acne is controlled. Established individual vessels are a separate target: the wavelength is chosen for the vessel's colour, depth and the skin type at assessment, and deeper or blue-purple vessels go to long-pulsed 1064 nm, the same wavelength that Excel V carries in its second laser, delivered here on a different platform.

The reasoning is the population and the diagnosis. Most patients here are Fitzpatrick III to V, where the shorter vascular wavelengths give up margin, and most redness that arrives in clinic is not a single vessel but a mix of inflammation, fixed vessels and flushing that needs sorting before anything is fired. What decides the plan is what kind of redness it is, confirmed by examination and the pressing-glass test, whether acne or rosacea is active, the skin type, any darkening after earlier treatment, and sun exposure between visits. Someone who has had Vbeam or a yellow laser abroad is assessed on the same basis. Aftercare is broadly similar across vascular work: sun protection, no heat or vigorous exercise while the skin is warm, actives paused, and review timed to when any darkening would appear. Fees follow the plan and are set out in writing after assessment, as explained on how fees are quoted.