Facial Thread Veins, Rosacea & Leg veins.

We treat the redness and broken veins of Rosacea with Intense Pulse Light or Pulse Dye Laser. We use either the Lumenis Quantum SR machine or the Cynosure Cynergy laser.

These deliver a pulse of red light to the broken vessels causing them to heal up and fade away. People with Rosacea flush easily and develop redness, pimples, and thread veins on their cheeks nose and forehead. It often starts in the second or third decade of life, and women are more often affected than men.

It is common, affecting perhaps 10% of adults. Because rosacea affects the face it can cause significant psychological problems. The unpredictable flushes can be mistaken for too much drinking.

Many people with Rosacea find the rash on their face causes them embarrassment and anxiety. Some people stay well by avoiding triggers of flushing such as certain foods and beverages, sunlight and certain cosmetics. The active flare ups when spots break out are best treated with antibiotic lotions to rub on or as tablets to swallow.

The better active flare ups are controlled the fewer thread veins are left behind. Lasers and IPL machines are used to help the remaining redness and broken veins.

IPL stands for intense pulsed light.

The machine contains a flash lamp, this is an extremely bright light source. The shorter dangerous wavelengths are filtered out. A computer is used to set the length of the flash and calibrate the machine. IPLs and lasers are used to treat a wide variety of conditions apart from Rosacea such as red birthmarks, pigmented skin lesions, thread veins and unwanted hair. Here are several different manufacturers of IPL machines, all with different names. We use a Quantum machine manufactured by Lumenis.

This is an improvement on their earlier Photoderm machine. The pulse dye lasers make a wavelength of light specifically tuned to the red colour of rosacea.

You will be asked to keep your face as pale as possible by avoiding sun exposure before and during your course of treatment. At your first visit you can discuss the pros and cons of treatment and a patch test can be performed to check the reaction of your skin.

A week later the first full, treatment is carried out. The whole of the affected are will be treated, except in men where the beard area is avoided. There is a feeling of heat during the treatment and your face will be redder for a short while afterwards. Cooling packs can be applied afterwards.

You will need to wear goggles to protect your eyes from the intense light. A course of 4 – 6 treatments at 3-4 week intervals produces the best benefit.

Improvement may continue for many weeks after the course has finished. Rosacea is a relapsing condition and this treatment improves the appearance but does not cure the Rosacea. If you have active inflammatory Rosacea then this will need to be controlled with medication before you can have IPL or laser treatment.

It is believed that the light from IPL and pulse dye lasers has two actions that help in Rosacea.

Firstly red thread veins absorb the light energy, this makes them hot. This damage encourages the body to reabsorb them, improving the appearance.

Secondly the light energy warms the collagen fibres in the skin this stimulates new collagen and collagen remodelling, this improves the support of the small blood vessels which helps to delay the development of more thread veins.

The bright light is not though to be cancer forming as it utilises visible and infra red light that is outside the ultraviolet range that causes sunburn, skin cancer, and aging of the skin.

The flashes of bright light that are produced may damage the eyes so goggles have to be worn during the treatment. The treatment is generally well tolerated but some patients find it unpleasant. Exposure is limited to an extremely short flash that feels like the snap of a rubber band. A mild burning sensation can be felt for a while afterwards.

Occasionally there is some swelling that will subside in a day or two. The beard area is avoided in men as the treatment may cause some hair loss. Bruising is unlikely but if it occurs will settle in a few days. There is a chance that pigment changes may occur in the skin, either dark marks, hyperpigmentation, or pale marks, hypopigmentation.

These are temporary and fade in 1 – 6 months. To help reduce the risk of this it is very important that sun exposure is avoided for 4 weeks before your treatment and throughout the course of treatment. Crusting and blistering may occur after the treatment, this is best left to heal undisturbed so as to reduce the risk of scarring.

It is important that you follow any aftercare instructions carefully.

Patients with light sensitivity should not have these light treatment. Its effects during pregnancy are unknown and it is safer to avoid the treatment when pregnant.

You should not have IPL/laser treatment if you have any suntan, however mild. You should not have IPL/laser treatment whilst taking Roaccutane (Isotretinoin) or for 12 months afterwards.

The inflammatory part of rosacea causes spots, these should be treated with antibiotics, either by rubbing them on as a lotion or taking them by mouth as tablets.

If the inflammatory type of rosacea is left untreated it will cause more thread veins.

Other lasers can be used for treating the thread veins and these are an alternative to IPL. The KTP laser can be used but there is a slightly increased risk of scarring.

The laser flashes feel like being zapped by an elastic band. If necessary a numbing cream can be used one hour before. Spider veins may only need a few flashes, but Port Wine Stains will need many.

Immediately afterwards the skin will be bruised with some surrounding redness and swelling. The bruises go a deep purple colour. The treated area will feel warm for a while afterwards. It is unusual for blisters to form, but some crusts or scabs may form. These appearances last a week to ten days.

A small patch of thread veins in the centre of this picture were treated 8 weeks earlier. Circular areas of clearance can be seen surrounded by untreated thread veins.

Now the whole cheek has been treated except for the previously treated test patch. This dramatic bruising lasts about a week.

Usually a few test shots will be done first. This is to assess the correct power level. If the results are good then at your next visit larger areas can be treated. Broken veins generally need two or three treatments, with eight weeks between them. Port Wine Stains need more treatments, usually over a couple of years.

For many people there is also a considerable emotional burden from looking different. We are all sensitive to what other people think of us and sometimes learning how to cope with this can be more useful than the laser treatment. Please ask the doctor for more details.

Pigment changes are the commonest unwanted effect.

A light brown stain may remain after the bruising has cleared. This takes months to fade. Darker skin types contain pigment that blocks the laser light. This makes the treatment less effective, and the laser can make the skin darker.

The laser can also remove the brown pigment from the skin and leave a white mark. It is important to never have treatment when you have a tan. Scarring is a potential problem but is very rare. If it does occur it is usually in the form of some change in texture of the skin, which may return to normal in time. In some individuals a thick (keloid) scar can develop.

Laser light can bring out cold sores. If you are taking anticoagulant tablets such as Warfarin extra care is needed, make sure the Doctor knows.

A sun tan blocks the laser light so avoid the sun, or use a strong sun block (SPF 20 or more) before and during the course of treatment. Keep the area to be treated as pale as possible.

Avoid prolonged wetting of the treated area. A quick shower will not cause problems, but do not let the area get soggy.

Try to wait 2 or 3 days before applying any makeup. Apply gently by dabbing, avoid rubbing, and once applied leave the makeup on rather than remove it.

Be gentle with the treated area until it has settled down so as to minimise the risk of scars. It should not need a dressing as long as you can resist picking and scratching.

If redness increases around the bruises, especially if accompanied by crusting or weeping contact the clinic, or your own doctor, as it may be infected.

These are unsightly red or blues veins close to the surface and less than 3mm across. They typically occur in clusters on the thighs or lower legs. You cannot feel them with your fingers. Varicose veins are lumpy and can be felt when you are standing up.

There are two systems of veins in your legs. A deep system that works under high pressure, and a surface system that works under low pressure. The two systems connect and there are valves in these connections to hold the pressure back. If these valves are not working well you will be more likely to get varicose veins and it will be difficult to clear up your thread veins. A Doppler test will help us check the condition of the main valve in your groin.

Micro-sclerotherapy is still the gold standard for the cosmetic treatment of thread veins on legs. Lasers, intense pulse light, and microwave cautery can also be tried but are generally less effective. If your leg veins cause symptoms then graduated compression stockings may provide relief. Varicose veins that you can feel through the skin are best treated surgically. We offer micro-sclerotherapy, long pulsed Nd:YAG laser and pulse dye laser treatments.

Do not shave or apply cream or moisturiser to your legs on the day of treatment. Wear loose shorts or big knickers, we will need to examine your groin. Avoid anti-inflammatory medication including aspirin and alcohol for a few days to reduce bruising .

First you need to book a consultation for an assessment, consultation and Doppler test. Some treatment can be started at this visit if you are suitable, or can be arranged at a later date if preferred. Photographs may be taken for the medical records. You will lie on a couch for treatment, a series of small gentle injections will be performed on the selected areas. The injection sites will be taped over with cotton balls to compress them. You will be encouraged to have a brisk 15 minute walk after your treatment. The treatments can be repeated after 3 months if necessary. Benefit is gradual. There is a 1 in 10 chance we cannot improve the thread veins.

Budget for up to 4 treatments in the first year and hope for 75% clearance. Thereafter expect an occasional maintenance treatment every 2-3 years. Milder cases will need less treatment than this.

The discomfort experienced varies from person to person. The needles are tiny, like acupuncture needles. Some patients cannot feel the treatment, others describe it as a little prick. In the days after the treatment while the damaged vein is being broken down the treated area will be tender and itchy. The treated areas will look worse before they get better, the bruising and tenderness will last a week or two.

Staining and matting are the commonest unwanted effect of treatment. Staining is caused by leakage of damaged blood from the veins and is a rusty brown colour. It gradually fades over many months. It will worsen in the sun. Matting is a break out of fine capillaries at the injection site. If you have high back pressure in your veins because of weak valves in the deep veins then the surface veins will continue to get worse, and injecting one area may cause them to break out somewhere else. Surgical treatment is advised first to correct the high back pressure.

Ulcers are rare. They occur when the solution leaks and causes a blister, the blister may separate early, especially if scratched or rubbed, and leave a small ulcer that will heal with a small scar. Staining matting and ulcers can also occur with laser treatment.

Deep vein thrombosis, DVT, is extremely rare after thread vein treatment. Please advise us if you have a family history of thrombosis or pulmonary embolism.

Serious allergic reactions to the injection solution are extremely rare. The solution we use is called Fibrovein.

Expect to see redness and welts like insect bites in the first 24 hours. The veins darken and look bruised and will look worse for a week or two. Improvement is not noticed for a month or two.

You should walk for at least 15 minutes after your treatment, and remain active. When sitting perform ankle exercises to improve the circulation. Sitting or standing still for long periods should be avoided. Walking is encouraged. When resting raise your legs. Expect some itching and discomfort, especially in the first week.

Wear your graduated compression stocking continuously for 24 hours. Then wear them all day for a week, only taking them off at night. The veins will look worse at this stage. Consider wearing graduated compression stockings long term to reduce recurrence.

For 4 weeks avoid extremes of temperature, such as hot baths and sun beds, contact sports including horse riding.

For 6 weeks do not take a long haul flight or wax your legs, or any sun exposure.

Contact the clinic if worried.

We hope to improve the appearance of 75% of your thread veins. Some patients will get good clearance after just one or two treatments, but we recommend that you plan for 4 in the first year. Remember the thread veins look worse for a few weeks and improvement is gradual over many months. Micro-sclerotherapy is not a quick fix for a special event. Neither will it stop new thread veins developing.