Facial Spider Veins or Telangiectasia Treatment by 532nm KTP Laser

These are one of the most common facial skin conditions for which patients seek treatment. These unsightly dilated blood vessels are seen almost exclusively in patients with fair skin, and are often associated with chronic sun exposure, rosacea, overuse of cortisone creams and certain autoimmune diseases, and occasionally they may be hereditary. In many cases, the exact cause is unknown.

Contrary to popular opinion, facial telangiectasia are not associated with alcohol abuse. Unlike leg veins, which are induced and aggravated by gravity, facial telangiectasia are usually capillaries or small arteries (arterioles) in the papillary dermis with weakened elastic fibers in their walls which allow them to dilate and become visible, and despite their common name, they are not true "veins".

They can be classified according to their appearance as linear, arborizing (branching), spider, or punctate telangiectasia. The linear and arborizing type occur most commonly around the nose, and the spider type are most common on the cheeks.

Like most other lasers, the KTP laser makes use of the principle of selective photothermolysis to coagulate abnormal blood vessels while sparing the surrounding tissue. The KTP laser emits a brilliant green light at 532nm, close to a major absorption peak of hemoglobin in blood. The blood absorbs the laser energy more than the surrounding tissue, and by selecting a pulse width less than the thermal relaxation time of the blood vessel, the blood vessel can be selectively coagulated without causing purpura or damaging the skin. No anesthesia is needed for treatment of facial telangiectasia-the laser pulses feel like little "snaps", and can be easily tolerated by most patients. In most cases a transparent cooling gel is applied to the skin to increase comfort and decrease superficial blistering. After the proper laser setting are made, the individual vessels are "traced" with individual laser pulses. If vessels are too small or to numerous to trace, a scanner can be used to treat entire areas. In some cases, the skin may be cooled with ice packs prior to treatment. In some cases, especially in larger, high flow telangiectasia around the nose, there may be an improvement instead of complete resolution. Occasionally, the telangiectasia may at first appear worse than before treatment, and then disappear within a few weeks or months. 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 best results. Because melanin in skin also absorbs green 532nm light, darker skin can absorb some laser energy, and in some cases, cause mild superficial blistering and crusting ("chicken scratches"), which usually resolves in a few days. Temporary redness and lightening of the skin can occur, especially with higher fluences in darker skinned patients. Scarring is extremely rare with the energy settings used on the face.