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Millions of people suffer from unwanted vascular lesions
on the face and body. These lesions may be referred to as "broken
blood vessels,""spider veins," or "spider or
cherry angiomas." Some children suffer from specific vascular
birthmarks known as "port wine stains" and "hemangiomas."
Prior to the mid-1980's, we did not have effective and safe treatment
for vascular lesions. Fortunately, several good lasers are now available.
What causes these lesions?
The most common causes in adults are sun, rosacea, and estrogen.
Genetic factors also play a significant role – e.g. patients
of Western European ancestry develop these lesions more easily.
What types of lasers are available to treat undesired
vascular lesions?
We currently use the Versapulse and the pulsed dye (Candela) lasers.
The Versapulse is the most advanced laser available and is thus
used for most patients. One of its great advantages is the lack
of significant downtime following treatment in the majority of patients.
The Candela laser is associated with postoperative
bruising (purple spots), which typically takes 5 - 14 days to resolve.
This makes it less desirable for adults who must quickly return
to their social and occupational schedules. However, the Candela
laser is associated with deeper penetration than the Versapulse,
which makes it useful in children with vascular birthmarks and in
rare adults who do not achieve the desired response with the Versapulse.
How do vascular lasers
work?
Medical lasers operate on the principle of "selective photothermolysis."
This refers to the ability of a laser to selectively damage a specific
target while basically ignoring the remainder of the skin. To treat
vascular lesions, the laser's wavelength is tuned to precisely match
red blood cells. Since red blood cells are confined to blood vessels,
the laser deposits its energy into the unwanted vascular lesions
without damaging the surrounding skin. This is quite different than
older methods of treatment, such as electrocautery, which cause
nonspecific damage.
Isn't laser therapy
also the latest treatment for unwanted veins on the legs?
Actually, sclerotherapy (leg vein injections) remains the most effective
treatment for spider and varicose veins of the legs. Simply put,
lasers often fail to cause enough damage to unwanted leg vessels
to effectively remove them. The diminished effectiveness of lasers
on leg veins is due to the higher degree of blood flow through these
veins, coupled with their deeper location. Occasionally, lasers
are effectively used following sclerotherapy to treat tiny blood
vessels that are either too small for sclerotherapy or that have
failed to respond to previous injections.
How many treatment sessions
are required?
Most patients need two to three sessions to achieve significant
clearing. While some patients achieve their results with one treatment,
this is not typical. This is due to the body's remarkable ability
to heal damage. Your health and safety are important to us, and
we cannot speed up the process by "over-treating" areas.
Treatment sessions are scheduled every 4 weeks, so that the body
has adequate time between sessions to eliminate damaged vessels.
Vascular birthmarks in children often require numerous
treatment sessions. Some adults with particularly severe or widespread
involvement may benefit from additional treatment sessions as well.
We regret that we cannot give you a guarantee as to the total number
of sessions needed. However, we can promise you that we will do
our best to achieve your goals safely in the fewest sessions possible.
Does treatment hurt?
Most patients complain of moderate stinging or burning during the
procedure. Unfortunately, local anesthetics are impractical because
they cause blanching of the skin. This blanching removes the target
of therapy and makes treatment less effective. The vast majority
of patients tolerate the discomfort well and are pleasantly surprised
by the lack of pain immediately following the procedure. If desired,
we can prescribe a pain medication to be taken two hours prior to
treatment. In this case, you will need to be accompanied by a companion
who will drive you to and from your appointment.
What are the possible
complications of vascular laser therapy?
Laser therapy is very safe, with almost no risk of serious complications.
Most patients return to their usual social and occupational schedules
within several hours following treatment, or by the next day. With
the Versapulse laser, almost all patients experience facial flushing
that lasts a few hours. Treatment of the cheeks or neck often results
in small, mosquito-bite-like red bumps, due to histamine release.
These bumps typically last only 24-36 hours, but can persist for
several days in rare cases. Some patients find it helpful to take
an antihistamine (such as Claritin, Allegra, or Zyrtec) before and/or
after the treatment to minimize the flushing and red bumps. Approximately
2% of patients, typically those with sensitive skin (e.g. rosacea),
may also notice mild-to-moderate "puffiness" or swelling
of the lower eyelids and/or cheeks. Although this swelling is not
dangerous, it can take a few days to resolve.
In a minority of patients, focal areas of treated
skin may develop small crusts similar to scratches. However, scarring
occurs in less than 0.1% of cases. Pigmentary changes are also rare
but can occur in patients with a strong tan or naturally dark skin.
With the Candela laser, the only additional inconvenience is the
aforementioned purple spots. Purple spots are very rare with the
Versapulse laser but do occur in 0.1% of patients – usually
those with unusually large broken blood vessels of the face or legs.
Please inform us if you are prone to fever blisters or cold sores,
since these may be precipitated by laser treatment. We will prescribe
an antiviral medication for you.
Will my insurance cover
the procedure?
Laser treatment of vascular lesions is considered cosmetic and is
not covered by insurance companies. Prices vary from $200 to $600
per treatment session, depending on the size of the area to be treated.
Payment is due at the time of scheduling.
Will my lesions ever
return?
Rarely, treated areas may fail to clear completely or may even recur
following successful therapy. Of course, new lesions may develop
with time; the risk factors (rosacea, sun, estrogen, genetics) are
difficult to avoid. Fortunately, new vessels can be effectively
treated with touch-up procedures if necessary. No reputable surgeon
can guarantee the elimination of every unwanted blood vessel, but
most patients achieve a 70 - 100% improvement and are very satisfied
with their treatment.
Thank you for choosing Dermatology Associates
of Kentucky for your skin care needs. Established in 1951, we are
one of the oldest, largest, and most comprehensive dermatologic
practices in the United States. We look forward to caring for you.
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