Small dilated facial blood vessels, known as telangiectases, are most common on the nose and cheeks. They can appear as an isolated event or be the first sign of rosacea. The flat red facial spots of rosacea (Grade 1) are caused by the accumulation of telangiectases. Often the vessels slowly increase in number and later smaller papules (bumps) and pustules (pus-filled lesions) develop, indicating the transition to rosacea (Grade 2). The treatment of these telangiectases is best accomplished with PROYellow-Laser therapy.
The PROYellow-Laser works with a wavelength of 577 nm – the target structure for the laser energy is the red blood pigment (hemoglobin) in the veins. The dilated veins stick together, are absorbed into the tissue and thus become invisible. The treatment should only be performed on untanned skin! Usually 3-4 treatments in 4-week intervals are recommended to achieve an optimal result. The treatment is relatively painless – anaesthesia is therefore not necessary.
Immediately after the laser treatment, redness is normal and sometimes slight swelling, or small hematomas can be seen. Initial cooling with cold packs accelerates the fading and the redness is completely gone by the next day. Pigment may come off in the form of tiny dark scabs – like finely scattered pepper. Consistent light protection is strongly advised during the treatment cycle to prevent pigment shifts after treatment. The dark season is therefore in principle more suitable for the treatment of couperosis and rosacea (Grade 1).
What are spider veins?
Dilated small vessels on the legs can be an isolated constitutional problem or an early sign of varicosis. The red or red-blue vessels develop net-like patterns in the superficial layers of the skin; they are most common on the thighs and calves. Duplex sonography of the superficial and deep leg veins should be performed prior to treating spider veins, if there are accompanying symptoms of heavy, painful or swollen legs, in order to exclude any disorders of the venous system.
Spider vein treatment
The standard approach is sclerotherapy. A sclerosing agent, usually polidocanol in 0.25-0.5% concentration is injected directly into the spider vein using the finest needles. The sclerosing agent spreads locally through the vessel and elicits an inflammatory reaction and following occlusion of the treated vessel. The occluded vessel is over time resorbed and thus the spider vein eliminated. In microfoam sclerotherapy the polidocanol solution is converted to foam to insure an even better vessel occlusion. The foam with its tiny bubbles (mixture of air and liquid sclerosing agent) is injected into the spider veins with a fine needle. The advantages of this technique are that the blood is forced out of the vessel and that the sclerosing agent stays in contact with the vessel wall for a longer period of time. Foam sclerotherapy can also be used to treat larger vessels.
The sclerosing fluid is degraded by the body over 48 hours. The injected amounts are minor and immediately diluted by the blood stream, so they have only direct and local effects. The treatment lasts around 30 minutes and in the hands of an experienced physician they are only slightly painful. Depending on the extent of the lesions, usually 3-4 treatment sessions at 4 week intervals are required to obtain optimal results. Solitary or a few vessels can often be eliminated in a single session. Regular sun protection during the treatment cycle is required to minimize the risk of light-exacerbated hyperpigmentation at the sites of injection. Even less common complications include red discoloration (matting), small scars or an inadequate response. Superficial solitary spider veins can also be treated with special lasers.