Patients with unsightly facial vein problems are common to aesthetic medicine practitioners. Spider veins are an example (broken capillaries) beneath the surface of the skin. Problem veins on the face range from very superficial ‘capillaries’ to large bulging subdermal veins (blue veins under the skin). In our practice we have found that, to provide a full service to these patients, we need a combination of traditional aesthetic approaches along with a little more invasive surgical approach. In addition, it is also important to be able to recognize facial veins that might be a sign of a more complex problem that should be handled by the specialists like vascular surgeons. For some people, alcohol consumption presents a problem as can sun exposure.
Some causes of broken blood vessels on the face include:
- Genes: People whose family members experience spider veins are more likely to have them, too.
- Sun exposure: Sun damage can enlarge the blood vessels and draw them closer to the skin.
- Changes in weather: Drastic changes in the weather may affect the circulation in the body, causing the skin in the face to flush. The blood vessels may burst, resulting in a spider vein.
- Changes in pressure: Sudden, extreme changes in pressure may cause small broken blood vessels to appear. An exceptionally hard sneeze or vomiting can cause this change in pressure.
- Pregnancy: Hormonal changes during pregnancy may also cause broken blood vessels. Pregnancy-related spider veins usually disappear after giving birth.
- Environmental irritants: Exposure to certain chemicals or environmental pollutants may damage the skin and make blood vessels more visible.
- Rosacea: This is a common condition that causes the skin to become flushed and red due to enlarged veins. People with rosacea often experience spider veins.
- Alcohol consumption: Alcohol can dilate the blood vessels temporarily. Frequent alcohol consumption may lead to longer-lasting broken blood vessels and redness on the face.
- Injuries: Head injuries that cause bruising may also cause broken blood vessels. In this case, the blood vessels will often heal as the bruise does.
Because of the combination of aesthetic or surgical treatments that might be needed, some patients are offered a joint consultation between aesthetic practitioner and doctor (vascular surgeon). However, we have found that a few simple screening questions asked at the time of first inquiry, often backed up with a picture sent by the potential patient by email, can normally determine right course of action.
We classify facial veins in terms of how big and how deep they are, and where they are found – i.e. the size of the vein, the depth of vein – either within or under the dermis, and the anatomical area of the face affected. Fortunately, there is a good correlation between the anatomical location and what sort of vein is found in each location. Therefore, when we describe veins by the anatomical area on the face, it usually indicates what sort of vein is likely to be found.
Telangiectasia (‘spider’ or ‘thread’ veins)
Spider veins are broken blood vessels. Telangiectasia are classically very fine veins that are very superficial. If bright red, the blood is usually in small arterioles that lie before the capillaries, whereas if the blood is blue or purple, it normally lies in veins after the capillary network.
When veins are both big enough and deep enough, they can make the skin bulge above them, giving the appearance of a ‘varicose vein’. Of course, a ‘varicose vein’ of the face is not really a varicose vein as we would understand it in the legs as such veins occur because the valves fail and blood accumulates in the vein due to gravity. In veins in the face, blood flows with gravity back towards the heart. However, in some people, these veins can still dilate, resulting in cosmetically unsightly bulges, particularly when certain provoking maneuvers are performed such as smiling, talking, straining or leaning forwards.
Intense pulsed light (IPL)
IPL machines produce very concentrated and well-controlled bursts of white light in pulses. It also includes some infrared and ultraviolet wavelengths, ranging from about 400nm through to 1200nm. A variable number of pulses can be chosen, each of the defined length, with a defined length of rest in between each pulse. The white light is at an intensity that it will heat tissue. Different hand pieces then put variations of filters in the way of this beam before it hits the skin. As the absorption peaks for oxyhemoglobin (predominantly found in red veins) and deoxygenated hemoglobin (predominantly found in blue veins) are 418nm and 542nm respectively, this is ideal for spider veins. IPL handpieces often have a wide ‘footprint’ meaning that quite large areas can be treated with each shot fired. Thus, IPL is ideal for large areas such as for diffuse spider veins or rosacea.
LASER is an acronym for light amplification by the stimulated emission of radiation. Although some lasers do produce light, others produce microwaves which are invisible to the naked eye. Unlike IPL, which uses white light and then selects bands of wavelengths using filters, laser produces a beam of a single wavelength only.
As a laser produces a precise wavelength, the appropriate laser can be chosen to target any particular pigment such as oxyhemoglobin or hemoglobin. When such a pigment or chemical is targeted by laser, it is called a ‘chromophore’. Chromophores absorb or reflect various wavelengths of light. When it absorbs sufficient energy, it can be disrupted or can heat up. Therefore, for vascular lesions such as thread veins on the face, a wavelength is used that is readily absorbed by oxyhemoglobin or deoxygenated hemoglobin. Such lasers include the KTP (532nm – green light) and the ND:YAG (1064nm – microwave) lasers although other lasers can also be used. The KTP does not penetrate very deeply and so is used for very superficial veins that are bright red or bright blue. It heats the hemoglobin, causing the heat to be passed into the vein wall and destroying the vein. The ND:YAG, which has a wavelength exactly twice that of the KTP, also interacts with hemoglobin causing it to heat. However, this longer wavelength penetrates deeper into the skin, allowing larger green veins to be treated that lie deeper under the skin. It is effective to at least 1.5mm deep to the skin.
Lasers allow many different factors to be changed. The area to be treated for the ‘spot size’ can be varied, allowing for individual veins to be targeted with a very small spot size or areas with a larger spot size. Various powers can be used and when a power is selected, this is divided by the area of the spot, giving the ‘fluence’ (power per square centimeter of skin). In addition, the pulse length can be varied. Pulses are normally in the range of milliseconds. This variability makes laser a very flexible tool to use, although it needs considerable experience to master.
Therefore, with access to lasers of different wavelengths and varying spot sizes and powers, spider veins and reticular veins can be treated in the majority of cases.
The use of sclerotherapy in facial veins is controversial. Sclerotherapy is used to treat small veins on the legs and body and when made into a foam, has been used to treat larger veins. Sclerotherapy for face veins is off label and should be performed only by the practitioners who have medical experience performing the treatment. The medical experts in the field have pointed out that sclerotherapy “can be used on larger blue spider veins but may be complicated from inadvertent injection into arterioles”. This can lead to skin damage (necrosis) or, very rarely, blindness in one eye. The sclerosing agent once injected into the blood vessels will eventually close the veins and they will disappear in few weeks. The odds are high that one might need more than one session to treat the veins effectively and safely. The higher the volume of sclerosant injected, higher the chance it can cause complications so the amount of sclerosing agent injected should be limited to small dose.
Phlebectomy of facial veins is technically difficult and requires considerable practice. Incisions are made using the smallest possible blade and in line with where skin creases will develop if there are none present. Of course, if there are skin creases already, incisions should be made within these. Phlebectomy hooks can be used but it should be noted that these veins are very small and difficult to remove. They are often adhered to the skin and access with the hook is difficult due to the muscles of facial expression (frontalis muscle on forehead) inserting into the skin around the vein. With experience, good results can be obtained but we have found it is a long learning curve to get good at this and so we recommend this procedure be done by someone who has lot of experience.
Face vein treatment at VIVAA:
At VIVAA, depending on the size and location of the veins on your face we can offer all of the above treatments including laser treatments. The first step is to come in for a consultation where we will discuss the areas of concern and then develop a plan that best suites your needs. All treatments will be discussed so you are well informed and can make an educated decision.
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We Use Nitrox for Pain Releif
Nitronox is a proven safe and effective treatment for managing any pain and anxiety you might feel during treatments. The Nitronox system delivers a mix of nitrous oxide (laughing gas) and oxygen directly to you on an as-needed basis to provide comfort. This treatment enhancement is ideal for short, minimally-invasive treatments such as tattoo removal when pain is a concern.
You won't need this extra comfort for most of the services at VIVAA, but we want you to have it available for you should it be helpful.