Lighting the way: An invention for safe vascular birthmark treatment transformed how lasers can be used in surgery

November 8, 2011 By Tom Vasich, University of California, Irvine
A surgeon at the Beckman Laser Institute & Medical Clinic treats an 8-month-old's port-wine stain with a DCD-equipped laser. Credit: Steve Zylius / University Communications

The concept that revolutionized laser surgery and earned UC Irvine more than $40 million came to Dr. J. Stuart Nelson in 1992 while he was watching a baseball game.

In the early 1990s, surgeons like Nelson were trying to adapt for medical use, and the Beckman Laser Institute & Medical Clinic was an epicenter for this effort. It was, at the time, the only facility in the world to house basic science and engineering labs and an outpatient clinic under one roof, letting researchers and surgeons quickly translate findings into patient-care breakthroughs.

As medical director of the BLIMC, Nelson had been striving to improve laser treatments for disfiguring vascular birthmarks, such as port-wine stains, in infants and young children. Laser’s utility was limited because its intense light also injured the fragile top layer of skin, causing pain, scarring and pigmentation changes. The challenge was to find a way to protect the outer skin while maximizing destruction of the deeper blood vessels that create a birthmark.

Nelson and his BLIMC colleagues — postdoctoral researcher Thomas Milner and visiting Norwegian engineer Lars Svaasand — had tried using ice cubes, running cold water and even the application of chilled metal plates to cool the skin’s superficial layer before laser exposure. Unfortunately, all of these methods proved too cumbersome and, more importantly, also cooled the targeted blood vessels, which inhibited the laser’s effectiveness.

“We needed to get something very cold onto the skin surface in perfect thermal contact and then off the skin surface — all within a fraction of a second,” Nelson says. “I remembered what I saw watching a baseball game.”

Over a Friday night dinner at the former Rusty Pelican restaurant in Irvine, he told his colleagues how, when a batter fouled a baseball off his foot or ankle, a trainer would emerge from the dugout and spray ethyl chloride onto the injury site to numb the pain. The three agreed that spray cooling might be effective with lasers if the cryogenic agent evaporated very quickly and, therefore, only affected the topmost layer of skin.

During the weekend, Milner and Svaasand hashed out ideas on how this concept could work; on Monday, they went to Pep Boys and purchased a Toyota Camry fuel injector valve, a hose clamp and air conditioning coolant to build the first prototype of the Dynamic Cooling Device.

To determine the optimal cryogen spurt duration and interval between spurt termination and laser exposure, all three researchers tested the DCD on themselves. “We still have scars on our arms to prove it,” Nelson says.

“It was a fairly simple construction,” says Milner, currently the Marion E. Forsman Centennial Professor in Engineering at the University of Texas at Austin. “That’s the beauty of the invention: It’s so simple and works so well.”

The device is incorporated into the laser’s hand piece and sprays a nonflammable, environmentally compatible freon substitute onto the skin surface, forming a liquid pool with a temperature of minus 60 degrees Celsius. This pool almost immediately evaporates, and milliseconds later, the skin is exposed to the laser. The process is repeated before each pulse of light.

“Because the spurt durations are so short, the cooling remains confined to the skin’s most superficial layer and does not affect the deeper targeted blood vessels causing the vascular birthmark,” Nelson explains. “This allows much higher laser light dosages to be used, while at the same time minimizing injury to the skin and pain to the patient.”

The DCD was patented in September 1998 and subsequently licensed to Candela Laser Corp. for commercial development and marketing. It’s now standard on more than 20,000 Candela lasers sold worldwide, as well as on the lasers of other companies that have sublicensed the technology.

Between 2001 and 2010, the device was among the 10 top-earning licensed inventions in the University of California system — and in 2005 and 2006, it ranked second and third, respectively. To date, the DCD has generated more than $40 million in royalties for UCI, of which almost $7 million has been returned to the BLIMC.

“The combination of basic research, engineering and clinical testing that went into the Dynamic Cooling Device is exactly what was envisioned over 30 years ago when the idea of the BLIMC was first conceived,” says Michael Berns, the Arnold & Mabel Beckman Chair in Laser Biomedicine and institute co-founder.

While DCD-equipped lasers are utilized for a number of cosmetic procedures — the removal of unwanted hair, scars and rosacea, for example — Nelson is pleased that his invention primarily benefits individuals born with port-wine stains. At the BLIMC’s world-renowned Vascular Birthmarks & Malformations Diagnostic & Treatment Center, he has handled more than 10,000 such cases.

Every other year, the BLIMC — in conjunction with the Vascular Birthmarks Foundation — hosts a conference at which families dealing with vascular birthmarks meet with researchers and surgeons in the field to discuss the latest findings and breakthroughs. This year’s conference will took place Nov. 4 and 5 at the Island Hotel in Newport Beach.

Nelson says events like these — where he interacts with new, current and former patients — remind him of the DCD’s impact.

“The technology has made possible the early, painless, safe and effective treatment of port-wine stains and other disfiguring vascular birthmarks in infants and young children in ways that Tom, Lars and I could never have imagined,” Nelson says. “That’s what I’m most proud of.”

Explore further: Best time to deal with varicose veins is spring

Related Stories

Best time to deal with varicose veins is spring

March 22, 2011
Like many women, Karen Special, 57, developed varicose veins during her first pregnancy. These unsightly veins became permanent while she was pregnant with her third child.

How fish swim: Imaging device shows contribution of fins

April 22, 2011
There are fish tales and then there are fish tails. And a report from Harvard researchers in the current issue of the journal Biology Letters seems to demonstrate that previous theories about how bony fish move through the ...

The kids are alright

May 26, 2011
Children should be seen and not heard... who says? A Philosophy academic at The University of Nottingham is challenging the adage by teaching primary school children to argue properly.

Skin cancer risk identified for organ transplant recipients

February 24, 2011
( -- Muba Taher, a clinical assistant professor in the Faculty of Medicine & Dentistry at the University of Alberta, is doing what he can to protect organ-transplant patients from a particular vulnerability: this ...

Proposed gamma-ray laser could emit 'nuclear light'

May 2, 2011
( -- Building a nuclear gamma-ray laser has been a challenge for scientists for a long time, but a new proposal for such a device has overcome some of the most difficult problems. In the new study, Eugene Tkalya ...

DARPA's compact high-power laser program completes key milestone

July 4, 2011
Enemy surface-to-air threats to manned and unmanned aircraft have become increasingly sophisticated, creating a need for rapid and effective response to this growing category of threats. A potential solution for countering ...

Recommended for you

Study may offer doctors a more effective way to treat neuroblastoma

December 7, 2018
A very large team of researchers, mostly from multiple institutions across Germany, has found what might be a better way to treat patients with neuroblastoma, a type of cancer. In their paper published in the journal Science, ...

Progress made in transplanting pig hearts into baboons

December 6, 2018
A large team of researchers from several institutions in Germany, Sweden, Switzerland and the U.S. has transplanted pig hearts into baboons and kept them alive for an extended period of time. In their paper published in the ...

'Chemo brain' caused by malfunction in three types of brain cells, study finds

December 6, 2018
More than half of cancer survivors suffer from cognitive impairment from chemotherapy that lingers for months or years after the cancer is gone. In a new study explaining the cellular mechanisms behind this condition, scientists ...

Hybrid prevalence estimation: Method to improve intervention coverage estimations

December 6, 2018
LSTM's Professor Joseph Valadez is senior author on a new study published today in the Proceedings of the National Academy of Sciences, which outlines proposals for a more accurate estimator of health data.

World's smallest wearable device warns of UV exposure, enables precision phototherapy

December 5, 2018
The world's smallest wearable, battery-free device has been developed by Northwestern Medicine and Northwestern's McCormick School of Engineering scientists to measure exposure to light across multiple wavelengths, from the ...

Are scientists studying the wrong kind of mice?

December 5, 2018
Mice represent well over half of the non-human subjects of biomedical research, and the vast majority of those mice are inbred. Formed by generation after generation of mating between brothers and sisters, inbred mice are ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.