Spider veins of the eyelids can be difficult to treat,. Agree with topical laser therapy as described. Our practice has experience with combination laser and micro electtrocautery therapy. Electrocautery or micro cautery is very helpful to coagulate very small facial veins. [See Veinwave as a brand of micro electrocautery]. The technique involves very small electric currents transmitted to the vessel by fine wire cautery tips--the kind used to complete electrolysis for hair reduction. The fine wires are pressed to the surface of the skin. Electric currents are applied. Sometimes the vessel will coagulate as the electric current will travel down the flow of blood by the path of least resistance. Other times, the fine wire tip will actually puncture the skin to allow the tip contact with the vessel and blood flowing in the vessel. Here is where the problems occur with darker skin types. Collateral damage. The electrocautery seals the vessel by coagulation, the surrounding skin also sustains coagulation--tissue damage. Pigmentation changes can occur. Patients with dark skin colorations can have hypopigmentation [white spots] or hyperpigmentation [dark brown/black spots] at each of the skin electrocautery contact points. Multiple treatment sessions maybe needed for best cosmetic effect.. Eye shields are a MUST during treatment..
Most cosmetic surgeons who deal with facial veins would recommend a few test spots with a 2-3 month time interval to see how your skin would react to micro coagulation. Formal consultation is needed to determine your specific skin type and for skin testing.