Facial telangiectases

Treatment of facial telangiectases by any laser treatment gives very satisfying results. The lasers most commonly used are the continuous wave 532nm KTP laser, the 595nm PDL laser, and the intensed pulse light or IPL system which is now giving outstanding performance.

Facial telangiectases has traditionally been treated by PDL causing purpura, much discomfort and scarring for more than a week. The latest lasers, using longer pulses and subpurpuric treatment give excellent results, increasing the popularity of PDL lasers.

The KTP lasers are also very effective in facial telangiectases. But absorption of green light by melanin in darkly tanned or chronically bronzed skins limit its use. In one instance of treating 40 patients with facial telangiectases, clearing of the vessels was seen in 75% patients.

Recently, IPL treatment has given excellent results. But, since, broad spectrum delivery is used in IPL, epidermal cooling needs to be carefully monitored and great caution exercised when it is used in dark skins. In dark or tanned skins, ‘postage stamping’ or track marks are left behind, causing spot-sized hypopigmented patches at the treatment site, due to melanin absorption and destruction. Post inflammatory hyperpigmentation and blistering can also occur when IPL is used in dark skins. To ensure safety, filters may be used to select long wave lengths which are less absorbed by the melanin in dark skins. Longer pulse durations gently heat the skin and are safer in dark skins. To reduce the chances of post inflammatory hyperpigmentation in dark skins by IPL treatment, the skin may be prepared by treating it with retinoids and suitable sunscreens.

The larger reticular facial veins are better treated by deeper penetrating wave lengths. But extreme care must be taken to prevent scarring or other thermal damage.

Leg telangiectases

Leg telangiectases treatment is in most cases a cosmetic treatment. In more than half the cases the condition may become a diseased one. Pregnancy and hormonal influences have been cited as causes for the condition. In 70% cases, it was found to run in the family.

Traditionally sclerotherapy has been the standard treatment for leg telangiectases. It continues to thrive and evolve. But, lately, laser therapy is being seen as acquiring an increasing role in the treatment of leg telangiectases. This is true, especially, in the case of patients suffering from needle phobia or in case of those having side effects from sclerotherapy treatment. Laser therapy may also be effective in treating small vessels that cannot be treated by sclerotherapy. An advantage of laser treatment is that, subsequent compression therapy is not required.

The vascular net work in the legs is complex, consisting of numerous vessels with varying diameters, located at various depths. Vessel diameter, depth and oxygenation determine the treatment type and the outcome of leg telangiectases treatment.

For treating superficial leg telangiectases, visible laser devices, such as, KTP laser, the PDL, the long pulsed alexandrite laser and IPL with filters, which emit wave lengths absorbed by the hemoglobin, may be used. However, their penetration is shallow and may cause pigmentary problems.

Long pulsed tunable dye laser or LPTDL is particularly effective in treating thin leg telangiectases measuring up to 1mm in diameter. Vessels with diameters up to 1mm respond very well to this treatment. But vessels with diameters more than 1mm respond poorly, with only 2% patients showing any improvement. The skin surface in LPTDL is protected by spray cooling. The alexandrite laser in one case showed more than 75% improvement in 65% patients and more than 50% improvement in 86% patients. Here also spray cooling was used to protect the skin.

To target deeper vessels, long wave length lasers from the near infra-red region of the electro-magnetic spectrum may be more effective. Oxyhemoglobin has a higher absorption for these wave lengths. Also, these long wave lengths heat uniformly. The Nd: YAG laser with its variable spot sizes and higher fluence can reduce the chances of unwanted tissue damages. Thicker vessels respond well to Nd: YAG laser therapy. As these vessels have a longer cooling time than thinner vessels, even short pulse durations are sufficient to bring about the desired results. Pulsed beams, where the pulse duration can be varied are most effective in treating leg telangiectases.

The most common side effects of laser treatment of leg telangiectases is post-inflammatory hyperpigmentation. The common reasons of hyperpigmentation are dark skins, sun exposure, short – less than 20 milliseconds - duration, ruptured vessels and vessels with thrombosis formation. Hyperpigmentation gradually clears in due course, which may be a year or in some cases more than a year. Inappropriate fluences or pulse duration can cause ulceration, leading subsequently to scarring.