Treatment of Telangiectasia
Telangiectasia is the permanent widening of small blood vessels, 0.1–1.0 mm in diameter, in the papillary and upper dermis. It shows up as red, purple or blue spidery, branching or net-like vessels, most often on the sides of the nose, the cheeks, the chin and the lower legs. Causes vary widely and include genetics, UV damage, rosacea, photoaging and complications of long-term topical corticosteroid overuse.
At Haute-Derma, treating telangiectasia is about more than erasing red lines on the skin. We first assess the depth, diameter and blood flow of the vessels precisely, then set the laser parameters (wavelength, pulse duration, energy density) to destroy the target vessels while leaving the surrounding healthy tissue intact.
How It Works: Selective Photothermolysis
Laser treatment of telangiectasia is based on the principle of selective photothermolysis:
- Target chromophore: oxyhemoglobin (in bright red arterial blood) has absorption peaks at 418 nm, 542 nm and 577 nm, with a secondary band at 940–1064 nm. Deoxyhemoglobin (in darker red to bluish-purple venous blood) absorbs well at longer wavelengths, from 800 nm to 1064 nm.
- Thermal relaxation time (TRT): the smaller the vessel, the shorter its TRT (1–10 milliseconds). The laser's pulse duration must be set equal to or shorter than the vessel's TRT so the heat stays inside the vessel and does not spread to burn the surrounding skin.
- Heat conversion and vessel closure: hemoglobin absorbs the laser energy and turns it into heat, instantly boiling and coagulating the blood inside the vessel (photothermal coagulation). The heat injures the endothelial cells, causing the vessel to constrict and its walls to seal together. The vessel then scars down and is completely cleared by macrophages over 2–6 weeks.
Laser and Light Technologies for Telangiectasia
| Technology / Device | Chromophore and Depth | Preferred Uses at Haute-Derma |
|---|---|---|
| Pulsed dye laser (PDL) 595 nm | Oxyhemoglobin / superficial (0.5–1.0 mm) | Red facial telangiectasia, rosacea redness, hemangiomas |
| KTP / LBO laser 532 nm | Oxyhemoglobin / superficial (0.5 mm) | Fine vessels on the sides of the nose and cheeks in fair skin types |
| Long-pulsed Nd:YAG laser 1064 nm | Hemoglobin and water / deep (up to 3.0 mm) | Deep blue/purple vessels, leg veins, feeder vessels |
| Intense pulsed light (IPL) 515–1200 nm | Melanin and hemoglobin / multiple depths | Diffuse redness and widespread superficial telangiectasia, combined with rejuvenation |
| Diode laser 940 nm / 980 nm | Oxyhemoglobin and deoxyhemoglobin / medium | Red-purple vessels on the face and body, with consistent results |
Clinical Workflow and Personalized Treatment at Haute-Derma
- Classifying the Vessels and Assessing the Skin: the doctor examines the vessels with a dermatoscope to determine their color and depth:
- Red vessels (under 0.2 mm across, superficial): PDL 595 nm, KTP 532 nm or IPL is preferred.
- Blue-violet or purple vessels (0.2–1.0 mm across, deeper): long-pulsed Nd:YAG 1064 nm or diode 940 nm is preferred.
- Multipass Laser Technique
- Long-pulsed Nd:YAG 1064 nm with a small spot size (1.5–3.0 mm) is used to destroy the deeper source and feeder vessels.
- PDL 595 nm or IPL is then passed over the whole area to treat the superficial capillary network and reduce diffuse redness.
- Protecting the Epidermis and Aftercare
- We always use cryogen spray cooling (−30°C) or a built-in sapphire cooling tip to cool the epidermis, reduce stinging and prevent burns.
- After treatment, the skin is cooled and a repair cream containing panthenol and Centella asiatica is applied, followed by a broad-spectrum mineral sunscreen.
Managing Side Effects and Complications
- Bruising (purpura): a typical reaction to short-pulsed PDL, caused by minor vessel rupture. It clears completely within 7–10 days without scarring.
- Post-inflammatory hyperpigmentation (PIH): more common in darker skin (Fitzpatrick IV–V) because epidermal melanin also absorbs some of the heat. It is prevented with good cooling and longer pulse durations, and patients apply tranexamic acid or niacinamide after the procedure.
- Blistering: caused by excessive energy (fluence) or poor cooling contact. It is treated like a superficial burn: keep it clean with saline, apply an antibiotic ointment, and never pick off the crusts.
- Vessel reopening (recanalization): a treated vessel can reopen if its feeder vessel was not fully destroyed. We schedule a follow-up visit after 4–6 weeks for touch-up treatment.
