The advent of lasers and intense pulsed light (IPL) platforms has significantly improved the safety and efficacy of treating facial vessels, but the ability to address both telangiectasias and facial reticular veins requires the use of different lasers and appropriate settings, says Mitchel P. Goldman, M.D. His tools of choice are IPL for treating facial telangiectasias and a long-pulsed, dynamically cooled 1,064 nm Nd:YAG laser for periocular veins.
"Facial telangiectasias can also be treated with a pulsed dye laser, but many studies have shown the treatment needs to induce some purpura for it to be effective. Although the purpura only needs to be minimal, it lasts from three to seven days, which is a drawback for a cosmetic procedure," he explains.HOW IT'S DONE When using an IPL system for treating facial telangiectasias, the settings vary by instrument. For his preferred platform (M22, Lumenis), Dr. Goldman uses a 560 nm cutoff filter, a double pulse of 4 milliseconds, energies ranging from 18 to 20 J/cm2, and a delay between pulses that depends on skin type.
For example, a 10 millisecond delay is used when treating patients with Fitzpatrick type I skin, while the device is programmed for a 30 millisecond delay between pulses when treating someone with Fitzpatrick type IV skin.
"With these settings and not including vessels around the nose, we can usually achieve 99 percent efficacy in permanently eliminating facial telangiectasias," Dr. Goldman says.
Telangiectasias appearing around the nose, which are usually fed by the nasolabial artery, are an exception, as they tend to recur after six months. Patients with these vessels are advised about the temporary benefit and the need to come back for repeat treatment every few months, Dr. Goldman says.