The Treatment of Spider Veins and Vascular Lesions
Spider veins are very common and most adults will develop them. They can result from heredity, sun damage, general aging and certain diseases. Although not dangerous, they are cosmetically disturbing for most patients.
The treatment of spider veins with the VariLite laser is very simple and is truly a “lunchtime” procedure. For most patients, only a topical anesthetic cream is required. For larger veins Dr. Niamtu may inject local anesthesia in the area. Patients with severe spider veins may elect to have treatment with IV sedation.
The laser works by tracing the veins and actually erasing them. This process happens in seconds and for most patients there is no recovery and the treated area will be pink for several hours. Most patients can wear make up immediately. The treatment of larger veins may cause skin crusting or minor blistering, but this is the exception and not the rule.
Many patients experience permanent resolution while other patients may require periodic touch up procedures. It is recommended not to perform laser treatment of facial spider veins on patients with tanned skin, so sun exposure right before or right after laser vein treatment is avoided.
The VariLite dual wavelength laser offers the ultimate in clinical versatility.
The Iridex VariLite laser is used by Dr. Niamtu to treat the following:
- Vascular Lesions
Telangiectasia (spider veins)
Spider Angiomas (radiating spider veins)
Cherry Angiomas (red dots)
Neovascularization (redness in new scars)
Venous Lakes (blue spider veins)
Rosacea (adult acne and flushing)
Port Wine Stains (red birth marks)
- Pigmented Lesions
Lentigines (sun spots and age spots)
Dermatosis Papulosis Nigra (black skin tags and mole-like lesions seen in African American patients)
Poikiloderma of Civatte (red flushing of the neck)
- Cutaneous Lesions
Keratoses (brown, thickened lesions)
- Inflammatory Acne
- The 532 nm wavelength is used to treat superficial vascular lesions, pigmented lesions, cutaneous lesions and acne. It can also be used with the ScanLite to perform MicroSpot laser facials.
- The 940 nm wavelength is used to optimally treat medium diameter to larger vessels (0.3 – 1.5 mm) and deeper vessels.
Other product features include:
- Vascular lesions, benign pigmented lesions, cutaneous lesions and unwanted hair are amenable to laser treatment using visible and near infrared wavelengths. Laser light is absorbed by oxyhemoglobin and melanin selectively targeting and heating lesion components. To maximize treatment outcome, the laser wavelength is chosen to penetrate to, and optimally interact with, the target structure.
- High absorption 532 nm treatments are preferred for smaller and more superficial vessels. Superficial and small-diameter vessels are most selectively treated with wavelengths that are strongly absorbed by oxyhemoglobin as the vessels can be heated to clinical response temperatures with minimal incident energy. However, high oxyhemoglobin absorption can limit the depth to which laser light penetrates into skin, making it difficult to treat large or deep vessels with these wavelengths.
- Moderate absorption 940 nm treatments are preferred for larger and deeper vessels. Less strongly absorbed wavelengths penetrate more deeply, and can more uniformly heat through larger diameter vessels. Higher fluences are used to overcome the lower absorption coefficient and successful treatments can be achieved with good selectivity. Of the near infrared wavelengths, 940 nm is optimal since it has the highest oxyhemoglobin absorption coefficient for improved selectivity, reduced discomfort, and fewer side effects.
Dr. Niamtu has published a scientific article on the use of the 532 diode laser in the American Journal of Cosmetic Surgery in 2001. Read more of Dr. Niamtu‘s scientific publications.
The 532 laser treatments do not require any anesthesia and are frequently done as a lunchtime procedure.
The following pics represent a typical result after 2 sessions of 940 laser treatment.
The Iridex Varilite 940 laser is designed for deeper penetration of larger and bluer veins. The image below shows a before and after picture of a patient who underwent treatments for a large facial vein around the eye.
The Iridex Varilite 940 laser is very effective for facial spider veins and other vascular lesions, but is also very effective for various types of birthmarks or developmental vascular lesions such as hemangiomas, venous lakes, and smaller port wine stains.
Surgical Removal of Periorbital Veins (veins around the eye)
Although lasers are effective for many type of veins, the larger and bluer veins may require surgical treatment. This is done with local anesthesia to numb the area. Next, small micro incisions are made over the vein and it is removed with a special instrument. This procedure only takes several minutes, but bruising is common afterwards.
Miscellaneous Vascular Lesions
Venous lakes, lip varicose veins, lip hemangiomas
The patient is shown before, immediately after and one month after treatment.
This patient is shown before, immediately after 940 laser and 2 weeks after treatment for a blue vein birthmark on her left upper lip.
See the spider vein gallery links in the gallery section for more impressive vascular laser treatments.
Some comments from our patients
The following letter and image are from a patient in the Washington, DC area.
Dr. Niamtu has published a 1,000 page comprehensive textbook on cosmetic facial surgery which includes a large chapter on treating vascular lesions of the head and neck. Few surgeons receive the honor to publish such a text with a major medical publisher like Elsevier.
More information about Spider Veins from Dr. Niamtu's library of articles
Dr. Niamtu treats this patient with Facial Spider Veins using a Iridex 940 Laser
Researchers from Boston University School of Medicine (BUSM) have concluded that the 940-nm wavelength laser is superior for treating facial spider veins (telangiectasias) as compared to the 532-nm-wavelength laser. The findings, which appear in the recent issue of Lasers in Surgery and Medicine , are the first time these lasers were tested against each other for superiority.
Telangiectasias are open (dilated) blood vessels in the outer layer of the skin usually caused by sun damage or aging. When they appear on the legs, they are often called spider veins. They are common to a number of diseases, including acne, rosacea, birthmarks (port-wine stains), scleroderma, several types of inherited disorders (ataxia-telangiectasia, hereditary hemorrhagic telangiectasia, xeroderma pigmentosum, and others), or with prolonged use of oral or topical corticosteroids.
According to the researchers, while both the 532-nm and 940-nm-wavelength lasers are effective for facial telangiectasias, they lacked evidence to support whether one wavelength was superior to the other until now.
A total of 24 facial anatomic sites were treated with the 532-nm and the 940-nm-wavelength lasers. The presence and severity of side effects such as pain, erythema, crusting, swelling, and blistering were assessed.
The researchers found that pain associated with the laser treatment was significantly less for the 940-nm wavelength compared to the 532-nm wavelength. Erythema post-treatment was significantly less with 940 nm relative to 532 nm. Significant crusting and swelling were reported only with the 532-nm wavelength. Visual improvement with the 940-nm wavelength was greater than that achieved with the 532-nm wavelength. On photographic evaluation, the 940-nm laser was significantly more efficacious for larger-caliber vessels than the 532-nm laser. Both wavelengths were equally effective for smaller-caliber vessels.
“The 940-nm diode laser was found to have greater efficacy for deeper blood vessels based upon its superior penetration of the dermis with a longer wavelength. In addition, the 940-nm wavelength corresponds with a lesser absorption peak of oxyhemoglobin than that for 532 nm, resulting in slower and more uniform heating of the vessel,” said lead author Emily Tierney, MD, an assistant professor of dermatology at BUSM. “In addition, there is minimal melanin absorption at the 940-nm wavelength, and thus, there is less risk of postinflammatory change or scarring,” she added.
Given the efficacy and safety of the 940-nm-wavelength laser, the researchers recommend this wavelength be added to the standard treatment facial vasculature.
[Source: Boston University School of Medicine]