Lasers for facial thread veins | Birth marks
Introduction
This section focuses on the Pulsed Dye Laser (and similar lasers) for the treatment of vascular (red/ blue) marks, with particular emphasis on thread veins. This type of laser is not to be confused with ablative lasers which are used for facial resurfacing (see separate sections).Pulsed Dye Laser has been used for the treatment of various benign vascular lesions in Scotland since 1990. A more advanced technology is now available.Benign vascular lesions are made up of clusters of surface blood vessels. They vary in size and colour depending on the density, extent and depth of these dilated blood vessels. Common variations include spider naevi, thread veins, and capillary malformations (port wine stains).
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Thread veins on nose
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Thread veins on cheek
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Spider naevus child
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Spider naevus adlult
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Birth mark (port wine stain)
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Port wine mark neck
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Thread veins, medically known as telangectasia, are the most common vascular lesions and vary a great deal in their density and extent. In the majority of cases there is no obvious underlying cause. However, facial thread veins are seen more frequently in individuals who have had excessive sun exposure, prolonged use of topical steroids or alcohol abuse. They can be a manifestation of certain types of birth marks or the product of certain disease processes such as rosacea, (autoimmune diseases, chronic liver disease or poikiloderma). Most vascular lesions responding to laser therapy are cosmetic in nature and pose no medical threat if not treated. They can become darker, enlarge or spread with time if not treated.
Laser
A Pulsed dye laser (585nm) emits pulses of intense yellow light that penetrate the most superficial layer of the skin targeting the unwanted dilated red blood vessels. Laser light selectively destroys the dilated vessels without significantly affecting the normal skin (This is in contrast to ablative lasers used for facial resurfacing)
Pulse dye laser
The dye laser emits pulses of yellow light that selectively target and destroy dilated red blood vessels
Some vascular lesions disappear following one treatment. Others require a series of treatments to reach the desired level of improvement. These may range from 2-6 depending on the type and extent of the condition. The treatments may be repeated as long as there is evidence of continuing improvement and no side effects. Some conditions may not clear completely whilst a few may not respond at all. Some vascular lesions may recur or new ones can emerge.
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Cheek threadveins
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After first treatment
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After 2nd treatment
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A series of treatments may be necessary to reach the desired level of improvement
Sessions
The treatments are usually scheduled at 6-8 weekly intervals.
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Red scar on cheek
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Response after one treatment
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Red scar
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Thread veins face
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Response after 2 sessions
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Cheek threadveins
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Response after 3 sessions
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Cheek thread veins
Result after 3 sessions
Side effects
Common (expected) side effects including the following: Pain – The impact of the laser pulsates like a snap of a rubber band. The majority of patients find this sensation mildly uncomfortable and do not need anaesthetic. Some individuals with larger marks or who are more sensitive may require a topical anaesthetic cream. Bruising – A blue-purple bruise appears immediately at the treatment site. This discolouration usually fades within 7-10 days.
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Spider naevus
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Temporary bruising after treatment
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Complete resolution after one treatment
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Note fine thread veins (not the larger blue veins)
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Bruising few days after laser treatment for the thread veins
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Resolution of bruising with only slight improvement in thread veins (see microsclerotherapy
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Blistering/ Scabbing – The skin at the treatment site may become fragile. Rarely blisters and scabs can develop and can take 1-2 weeks to resolve.
Swelling – There may be temporary swelling which subsides in 2-3 days. Swelling may follow larger treatments especially those involving eyelid skin.
Skin colour changes – Skin darkening (hyper pigmentation) occasionally follows laser treatment taking 2-4 months to fade. Individuals with olive or darker skin tone are more susceptible. Premature exposure to the sun is a factor. Pigmentation is a real possibility following laser to leg thread veins.
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Temporary pigmentation after laser
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Temporary pigmentation after laser
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Temporary pigmentation is not uncommon following laser treatment for leg thread veins
Skin lightening (hypo pigmentation) can occur in certain sites (the neck-upper chest) after several treatments. It may resolve spontaneously but is rarely permanent.Uneven skin colour patterns may develop half way through a series of treatments, particularly in cases of dense thread veins giving a honeycomb appearance. This pattern fades with further treatments.Scarring – is extremely rare after Pulsed Dye Laser.The risk of accidental exposure of the eye to laser is minimised by a number of safe guards including the use of safety eyewear during laser treatment.
Postoperative instructions
You have been treated with the Pulsed Dye Laser. The treated area is now bruised. This may last 1-2 weeks. The treated skin is delicate and should be treated with care. Apply simple moisturising cream to the treated area. Aloe Vera gel and cool packs may be applied during the first 24-hours.Any discomfort you may have can usually be relieved with simple painkillers. Showers are permitted but gently pat the area dry. Do not rub with a towel because the treated skin can be fragile.Avoid antiseptic lotions which can cause unnecessary irritation.
PRECAUTIONS:
Avoid direct exposure to the sun for several weeks. Use sunscreen (SPF30-lotions)
Do not rub, scratch or pick at the treated area. Dressings are occasionally provided if the area is irritated by clothing or jewellery
Avoid make-up for the first few days
Avoid contact sports and swimming until the bruising has subsided
In the rare event of blisters or scabs developing you may contact the laser nurse for advice
The opinions and images presented are those of Mr Awf Quaba and are based on his own experience and review of the medical literature.