Thread Vein Laser
Laser treatment of skin vascular lesions has progressed significantly over the past 25 years. Based on the pioneering work of Anderson and Parrish in the early 1980s, several vascular-specific laser systems have been developed using principles of selective photo-thermolysis. A concept well understood at Castleknock Cosmetic Clinic Dublin forming the basis of thread vein laser treatment.
Laser beams can selectively destroy specific targets colour pigment within the skin. By using an selective wavelength, laser pulse duration, and its energy setting one can successfully treat spider vein and other vascular blemishes. Because the energy deposited in the tissue is limited to targeted thread veins, significant thermal diffusion to adjacent skin is prevented.
Unlike early lasers, modern systems, such as the 585-nm or 595-nm laser have become the mainstays of therapy for both congenital and acquired vascular lesions. These thread vein laser devices offer excellent clinical improvement with a low risk of adverse events. Transient redness is the most common adverse effect of our laser treatment. Thanks to technological improvements including dynamic surface cooling and extended pulse duration, which enhance clinical results and minimise adverse effects.
Classification of Skin Vascular Lesions
Skin vascular lesions are categorised according to pathology and age of onset. Congenital lesions begin in infancy and include port-wine stains, haemangiomas, venous malformations, and lymphangiomas. Acquired lesions develop in persons of any age and include telangiectasias, cherry angiomas, pyogenic granulomas, venous lakes, poikiloderma of Civatte. Acquired lesions may occur spontaneously, or they may be caused by trauma, ultraviolet exposure, or hormonal changes. At Castleknock Cosmetic Clinic we treat all acquired vascular lesions.
Thread Veins
Telangiectasias is the medical term for thread veins. They are also called spider veins. They are small, dilated vessels that are 0.1-1.5 mm in diameter. Telangiectasias commonly occur on the face and legs and are due to a variety of causes. Facial thread veins can occur spontaneously and can readily be treated by thread vein lasers. At times thread veins can be caused by too much exposure to ultraviolet light. Medical causes include collagen-vascular disease, acne rosacea, and pregnancy. They are also associated with alcohol and oestrogen ingestion. Topical steroids application causes new vessel formation and development of thread veins. Children may develop small facial telangiectasias that persist into adulthood. Lower extremity spider veins are more common in women and may be genetic or may develop after pregnancy.
Sclerotherapy for Thread Veins
Treatment options are numerous and include sclerotherapy, electrodesiccation, lasers, and intense pulsed-light therapy. Shorter laser wavelengths have been found to be more effective for treating redder, more superficial vessels, but these parameters are not as successful for deeper blue venulectasia and reticular veins. The 1064-nm Nd:YAG laser has been shown to successfully improve lower extremity leg veins, especially blue venulectasia and reticular veins up to 4 mm in diameter. In one study, nearly two thirds of the patients achieved 75-100% clearing after only one laser treatment.
When sclerotherapy with 0.25% sodium tetradecyl sulfate was compared with 1064-nm Nd:YAG laser therapy for lower extremity telangiectasias (0.1-1.5 mm), significant clinical improvement was seen in all sites with either modality. However, earlier clearing and higher average improvement scores were seen with sclerotherapy. Both modalities were associated with pain and localised tissue redness and oedema. Temporary post-inflammatory dark pigmentation was seen only with sclerotherapy.
Despite recent advances in laser technology and the effectiveness of lasers for facial telangiectasias, treatment of lower extremity telangiectasias with vascular-specific lasers can be ineffective. Treatment failures are often attributed to the larger size and deeper site of lower extremity vessels and their association with deeper, feeding venous plexuses. For these reasons, sclerotherapy is considered first-line treatment for most telangiectatic leg veins.
Spider Veins
Large vessels around the nose present in branching formation of coloured thread veins called spider veins. We aim to eradicate them, but sometimes an improvement instead of complete resolution after the initial treatment is adequate. It is much safer to re-treat than to run the risk of scarring. Anticipate a re-treatment about a month after the initial treatment for the best results. You may need 3 – 4 treatments (1 month apart) for best results. To maintain the results, sunscreen and skin care with SPF needs to be applied during daylight hours. It is also important to avoid direct sunlight a few days post the treatment and to be cautious of extreme temperatures and environmental factors. Treating the skin with the broad band laser for redness will result in a marked improvement in the appearance of overall redness, visible spider veins and deliver a more even skin tone.
Cherry angiomas
Cherry angiomas are small, well-circumscribed, bright-red vascular proliferation that initially appear in early adulthood and increase in number with age. Although benign, growths are easily treated with vascular-specific lasers to improve cosmetic appearance.
Poikiloderma of Civatte
Poikiloderma of Civatte clinically appears as a reticulated, brown pigmentation of the neck, anterior chest, and lower face with prominent telangiectasias caused by chronic sun exposure. Poikiloderma may be successfully treated with either intense pulsed-light source. The intense pulsed-light source may prove more helpful in eliminating associated dark pigmentation because of its additional effect on epidermal melanin.
Rosacea
Rosacea and Broken Capillaries (also known as telangiectasia) is a condition characterised by facial redness, dilated blood cells, red blemishes and ‘spider veins’. It is a common skin concern that can be effectively treated with laser treatments. By using laser therapy, we can remove visible blood vessels, flare ups, diffuse redness and improve one’s skin complexion.
