Explore This Treatment Program
Leg Veins and Broken Blood Vessels
Spider veins are extremely common and can develop at any age. They are small superficial veins and can be red, blue, or flesh tone and they have a web-like appearance. Spider and varicose veins are damaged veins.
Varicose veins are larger veins that may appear twisted or bulging on top of the skin. Varicose veins can put you at risk for complications like a blood clot or open sores on the leg. If you have varicose veins, you should see a vascular surgeon. Learn more about vein care at Mass General.
If you can answer yes to these questions, you may want to consider non-surgical treatments to fade your veins:
- Are you bothered by the appearance of leg veins?
- Do you have broken blood vessels at the surface of your skin?
Treatment Options
Sclerotherapy
The most commonly used treatment by our doctors is sclerotherapy. One of our highly skilled doctors injects a chemical into the damaged spider or varicose vein. These injections irritate the wall of the vein and prevent the
blood flow in the damaged vein. This improves circulation to the treated leg and reduces swelling.
All treatments are performed in our office. You may need more than one treatment. Spider veins usually disappear in 3-6 weeks, and varicose veins take longer, about 3-4 months.
Laser Treatments
Lasers can be used for spider veins and small broken blood vessels. During the laser treatment, you doctor will direct the laser light directly at the vein. Lasers
have the ability to destroy the vein without damaging your skin.
Most patients can return to work or normal activities the next day. Smaller veins may disappear after treatment, while larger veins turn dark and fade over 1-3 months. You may need more than one treatment.
Why Do I Need a Consultation?
One of our cosmetic dermatologists (a skin doctor who helps improve a person's physical appearance) will evaluate your condition and all of your information to determine the best course of treatment. If your varicose veins put you at risk for complications, you may be referred to a vascular surgeon. During your consult the doctor will:
- Address your concerns and develop a personalized treatment plan
- Review your overall health
- Evaluate your skin conditions
- Discuss the risk and benefits of the treatment
- Discuss the number and costs of treatment
A consultation is required and there is a fee for the consultation.
Is Treatment Covered by Insurance?
No, in most cases treatments for spider veins or superficial broken blood vessels are not covered by health insurance.
If you have bulging varicose veins, you should see a vascular surgeon to find out if it's medically necessary to treat them. Always check with your individual health insurance provider to find out if you have coverage.
The primary lasers used for bright-red, small (0.5 mm or smaller) leg veins are the pulsed visible light lasers or intense pulsed light (IPL) sources. Lasers tried on 0.5-mm or larger leg veins are near-infrared pulsed lasers. Lasers that have been reported to be effective include green (potassium titanyl phosphate [KTP] 532 nm), yellow pulsed dye (585-605 nm), alexandrite (infrared, 755 nm), diode (infrared, 810 nm), Nd:YAG (infrared to 1064 nm), and the IPL broadband light source (515-1200 nm). [7] Most recently, 940-nm diode lasers have been shown to have efficacy in the treatment of leg veins. [8] These lasers have all been designed with large spot sizes, typically 3-8 mm in diameter, and with pulse durations of 2-100 milliseconds to match the thermal relaxation time of larger telangiectasias. Most incorporate a mechanism to cool the skin to allow higher fluence to be delivered with less chance of inadvertent injury to the epidermis.
The pulsed KTP 532-nm laser is used for bright-red vessels. The 532-nm light is well absorbed by oxygenated hemoglobin and the penetration depth of no more than 0.75 mm is ideal for superficial capillaries. With the pulsed KTP laser, the most positive results have been achieved by using larger spot sizes (3-5 mm) and longer pulse durations of 10-50 milliseconds at fluences of 14-20 J/cm2.
PDL (585 nm, 450-millisecond pulse duration) is highly effective in treating a variety of cutaneous vascular lesions, especially facial telangiectasias and port wine stains. PDL is less effective for leg veins. Although 595-nm light can penetrate 1.2 mm to reach the typical depth of leg telangiectasias, the pulse duration is inadequate to effectively damage all but superficial fine vessels approximately 0.1 mm or smaller in diameter. Immediate purpura is also a consequence of treatment, which results in prolonged hyperpigmentation, more so than when treated with sclerotherapy.
Long-PDLs (ie, 585 nm, 590 nm, 595 nm, 600 nm) are capable of deeper penetration into the skin, and pulse durations from 1.5-40 milliseconds allow for thermal destruction of vessels corresponding to the size of the leg telangiectasias.
Long-pulse alexandrite lasers (755 nm) have been modified to allow pulse durations of up to 20 milliseconds or longer. This wavelength theoretically penetrates to a depth of 2-3 mm. Optimal treatment parameters for long-pulse alexandrite lasers appear to be 20 J/cm2, double pulsed at a repetition rate of 1 Hz. In one study, medium-diameter vessels (0.4-1 mm) responded best and small-diameter vessels responded poorly.
Diode lasers generate coherent monochromatic light through excitation of small diodes. A group of 810-nm diode lasers (5-250 millisecond pulse duration) have been used with encouraging results in the treatment of superficial and deep small- to medium-sized leg telangiectasias. The concept behind using near-infrared wavelengths lies not only in the deeper penetration of this wavelength and in the decreased melanin absorption but also, and most importantly, in the tertiary hemoglobin absorption peak that occurs at 915 nm, for which deoxygenated hemoglobin is the target. By choosing these longer wavelengths, even deeper vessels up to 3 mm below the surface (eg, feeder, reticular veins) can theoretically be treated, and, by varying the pulse width from a few milliseconds to several hundred milliseconds, a variety of different-sized vessels can also be targeted.
Results of leg vein treatment using a 930-nm pulsed diode laser that is closer to the 915-nm hemoglobin absorption peak have also been encouraging. The single significant adverse effect of pain may limit use of this wavelength, and this characteristic of pain is shared by many of the near-infrared lasers. The 940-nm diode laser shows a decreased incidence of pain and a better response in vessels between 0.8-1.4 mm.
Combined use of radiofrequency with a diode laser to treat leg veins has shown no better long-term results than lasers alone. Trelles et al treated 40 patients with skin types II-IV with a maximum of 3 treatments on 1- to 4-mm leg veins at 2-week intervals with a 900-nm diode laser (250 millisecond exposure time, average fluence 60 J/cm2) and radiofrequency (energy 100 J/cm3). [9] The 6-month assessment showed greater than 80% clearance of treated vessels, based on clinician assessment. Reproducibility of this study has been difficult, and the combined use of radiofrequency ablation has not been independently evaluated.
Long-pulsed Nd:YAG 1064-nm lasers target deep, relatively large-caliber, dermal and subdermal vessels. The primary benefit of this wavelength is its deep penetration and the relatively low absorption by melanin. Treatment of vessels in skin of color is therefore theoretically possible. However, high energies must be used for adequate penetration. Only with sufficient fluence and facilitation of heat dissipation can the posterior wall of a larger diameter (1-2 mm) vessel filled with deoxygenated hemoglobin be reached and heated. [10]
In general, treatment with long-pulsed 1064-nm laser light is relatively painful and requires cooling and topical anesthesia. Large-caliber vessels, more than 0.5 mm in diameter, respond best. Vessels up to 2 mm (rarely up to 3 mm) can be treated with long-pulsed Nd:YAG lasers. Some of the effects of hydrostatic pressure may be addressed by treating these larger vessels, although the pain experienced by patients significantly increases beyond a vessel that is 2 mm in diameter. Data suggest that by using smaller spots and even higher fluences, even small vessels respond. In the authors' initial studies, optimal settings were fluences of 80-120 J/cm2 and single pulse durations of 10-30 milliseconds. For patient comfort and epidermal sparing, some type of cooling must be used, whether in the form of contact cooling, cryogen cooling, or cold gel.
The IPL laser was developed as a device to treat ectatic blood vessels. By using noncoherent light emanating from a filtered flashlamp, pulse durations can be manipulated to match thermal relaxation times of vessels larger than 0.2 mm in diameter, and filters can be used to remove lower wavelengths of visible light. Fluences can be very high, with the unit delivering as much as 90 J/cm2. Sequential pulsing of 1- to 12-millisecond duration separated and synchronized with 1- to 100-millisecond rest intervals delivers wavelengths of 515-1000 nm. It is most commonly used with the 550- and 570-nm filters to deliver primarily yellow and red wavelengths with some infrared. [11]
The therapeutic potential of IPL is explained by the optical properties of hemoglobin as the size and the depth of its container (blood vessel) and the state of oxygenation are changed. As the size of the vessel increases to 1 mm in diameter, it absorbs more than 67% of light, even at wavelengths longer than 600 nm. This absorption band is even more significant for blood vessels that are 2 mm in diameter. Thus, a light source higher than 600 nm should result in deeper penetration of thermal energy, thereby allowing much absorption by deoxyhemoglobin. The reason for this effect is that the absorption coefficient in blood is higher than that of the surrounding tissue for wavelengths from 600-1000 nm.
A device that produces noncoherent light as a continuous spectrum longer than 550 nm is thought to have multiple advantages over a single wavelength laser system. These advantages include absorption by both oxygenated hemoglobin and deoxygenated hemoglobin and by larger blood vessels located deeper in the dermis being affected. Additional advantages have been a larger spot size and a relatively low incidence of purpura, but disadvantages are risks of pigment changes when these devices are not operated by expert users.