Facial and Leg Spider Vein Treatment – Lasers Vs Sclerotherapy

Spider vein treatment. The spider veins of this patient were treated with sclerotherapy injections at Nu Vela Esthetica, Los Angeles.
Spider vein treatment. The spider veins of this patient were treated with sclerotherapy injections at Nu Vela Esthetica, Los Angeles. | Source
The spider veins on the nose of the patient were treated with a laser at Nu Vela Esthetica, Los Angeles.
The spider veins on the nose of the patient were treated with a laser at Nu Vela Esthetica, Los Angeles. | Source
Spider vein treatment. The spider veins of this patient were treated Dr. R. Dishakjian, Los Angeles.
Spider vein treatment. The spider veins of this patient were treated Dr. R. Dishakjian, Los Angeles. | Source
Before and after sclerotherapy. The spider veins of the patient had almost disappeared after 3 months following the treatment.
Before and after sclerotherapy. The spider veins of the patient had almost disappeared after 3 months following the treatment. | Source

Which Treatment is the Best for the Face? Which One for the Legs?

Though it is possible to prevent the occurrence of the unsightly, twisted, blue or dark purple spider veins that appear on the face or legs through the use of topical creams, oral remedies, and by making some lifestyle changes; the only effective spider vein treatment is through medical intervention.

Most documented causes for developing facial spider veins are largely speculative; however, heredity, hormonal fluctuations, and rosacea (a chronic condition characterized by facial redness) are known to be contributors, and exposure to the damaging Sun rays is surely the single most important cause. Despite the fact that legs have thicker skin than the face, and as a consequence leg capillaries are less susceptible to Sun damage, leg spider veins are usually larger and more bothersome than facial veins; often causing pain, restless legs, burning, cramps, and heaviness in the legs. Leg spider veins develop as we age, when one-way vein valves deteriorate and blood starts to leak and pool, causing veins to expand; a condition known as venous reflux. Because of the position of the head relative to the heart, the role of venous reflux is insignificant; if any, in facial veins.

Among the many available spider vein treatment modalities, light-based therapies and sclerotherapy are by far the two widely administered spider vein treatment procedures. Light based therapies use either laser beams or intense pulse light (IPL) to target the hemoglobin in the blood vessels. Intense pulsed light (IPL) therapy is similar to laser therapy, except that it is gentler and uses broadband light instead of focused monochromatic (single wavelength) light. Both IPL and laser therapy destroy the vessels by generating heat. Sclerotherapy; on the other hand, uses a fine needle to inject a potent fluid (a sclerosant) directly into a diseased vessel. The sclerosant damages the vein and causes it to collapse. Both procedures, light-based and sclerotherapy, are minimally invasive and yield excellent cosmetic outcome, provided of course, your doctor knows which to apply where; because spider veins come in different sizes, develop at different depths, occur in different parts of the body, and most importantly, they originate from different causes.

An expert Los Angeles phlebologist, Dr. R. Dishakjian says "facial and nose spider veins have all the characteristics that determine the safe and effective dosage setting for lasers." Unlike leg veins, facial spider veins are usually very similar in size, depth, color, and therefore a single laser setting can be repeated for all the veins. The smaller wavelength lasers work well on superficial spider veins; whereas, the longer wavelength lasers penetrate deeper, and therefore are good for reticular veins (dilated bluish vein, usually from 1 mm to less than 3 mm in diameter).

Facial vein treatment with light-based therapies may require several sessions and can take up to 3 months before the full effect of the treatment is realized. Larger vessels may require more repeat treatment sessions; however, once complete clearance is achieved, the veins remain closed. The side effects of lasers can include pain (similar to a rubber band snap) and temporary purpura (purple pigmentation of the skin similar to bruising). Fortunately, compared to other areas of the body, the healing process of the facial skin is much faster; the perpura resolves in a matter of days, and the occasional pigmentation or scars heal in a short time. IPL spider vein treatment is gentler than laser treatment, and accordingly the side effects mentioned above are less common.

According to the Los Angeles phlebologist, for a sclerosant to work on facial veins, its concentration has to be higher than that required for leg spider vein treatment. As a result, skin scarring is a common side effect of sclerotherapy when applied to facial veins. Moreover, the use of highly concentrated sclerosants for reticular veins around the eye carries a risk of causing retinal changes, or even blindness, especially when the sclerosant backflows into the ophthalmic artery. For laser treatment; on the other hand, the doctor says "lasers therapy is safe as long as the laser beam is not within 1 cm of the orbital rim where there would be a risk of light being transmitted to the eye."

Although the newer longer-wavelength lasers can be useful for leg spider veins up to 2 mm in diameter, leg spider veins vary in all the characteristics that determine the safe and effective dosage setting for lasers. The deeper reticular and perforator veins, which serve as "feeders" for spider veins are often not accessible by topical lasers; and if these are not treated, spider vein treatment alone is doomed to fail. On the other hand, because of venous reflux, laser treatment of leg spider veins requires longer pulses, higher energy settings, and more treatment sessions. These make the procedure painful, costly, and increase the risk of scarring.

Currently, sclerotherapy is the procedure of choice for leg spider vein treatment. Sclerotherapy is a safe, time-proven, almost painless spider vein treatment modality with excellent cosmetic outcome. Unlike laser therapy, sclerotherapy can treat spider veins and the larger veins that "feed" them during the same session. Except for the occasional allergy to the sclerosant or discoloration and blotchiness in the treated area, which usually fades over a period of time, the complications of sclerotherapy are rare when used for leg spider vein treatment, provided of course, there is no serious illness.

The expert Los Angeles phlebologist, Dr. Dishakjian, says: "some leg spider veins that are either too small or too resilient to be adequately treated by sclerotherapy can be treated with lasers." According to the Los Angeles phlebologist, the greatest utility of lasers is in a "clean-up" role following sclerotherapy to ablate veins that are smaller than the diameter of a 30-gauge needle used in sclerotherapy. Combination treatment allows sclerotherapy to treat the larger, feeding venous system, while lasers or IPL effectively seal the superficial thin vessels.

As a final note, neither lasers, nor sclerotherapy prevent future vein development. If you’re prone to spider veins, and do not make some lifestyle changes, spider vein treatment could be a very costly ongoing struggle, but at least there’s help.

The following link is a very informative source of information on spider vein treatment. For information on various other minimally invasive vein treatment procedures, you may visit the website of the renowned Los Angeles phebologist, Dr. R. Dishakjian.

The under eye reticular vein of this patient were ablated using an Nd:YAG laser. The procedure was performed by Dr. R. Dishakjian of Nu Vela Esthetica, Los Angeles.
The under eye reticular vein of this patient were ablated using an Nd:YAG laser. The procedure was performed by Dr. R. Dishakjian of Nu Vela Esthetica, Los Angeles. | Source
The facial veins of this patient were treated with laser therapy by Dr. R. Dishakjian of Nu Vela Esthetica, Los Angeles.
The facial veins of this patient were treated with laser therapy by Dr. R. Dishakjian of Nu Vela Esthetica, Los Angeles. | Source

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