24 Yr Old White Female with Red Telangiectases Veins on Chest- Options? (photo)

Question

I am a 24 yr old female with red Telangiectases superficial spider veins on my chest (a few on bridge of nose). I tanned regularly in university, burning a few times. I was on 100mg spironolactone for 2 mths, then went on accutane (20mg/day 120 lb) 5 mths (this worked for my acne), but the veins seem to be getting worse daily. I am very concerned given I am only 24. I am considering laser in a few months but want to understand the cause. I feel ugly, any suggestions or advice would be great.

Anil R. Shah, MD · Answer

Redness on the chest is usually best treated by a good IPL system, although some lasers such as Nd:YAG or Excel V can be helpful.  Other modalities to treat the chest include:Ablative laser resurfacing- Fractionated C02 resurfacing or erbium at a lighter setting can help build up collagen
Fractora- RF needling can help improve the texture and collagen creation in the skin here
IPL- can help improve the brown spots and discoloration of the area
Melanage or Cosmelan- Peels can help improve the appearance of the discoloration
Sculptra- Dilute Sculptra can help improve the texture of the skin and crepy appearance of the skin.

Michael M. Omidi, MD, FACS · Answer

Thank you for the question! In my practice, I offer sclerotherapy, endovenous laser ablation, Clariven treatment, and microphlebectomy to treat varicose and spider veins. It's not a matter of one treatment being better than the other. Rather, the choice of treatment will depend on a size and location of your veins.  
In recent years, endovenous laser ablation (EVLA) has replaced traditional surgical method of treating varicose veins. This procedure uses laser to heat the veins instead of surgically removing them. The heat produces a steam bubble inside the vein, which destroys the vein walls, causing the affected vein to collapse. The body, in turn, naturally absorbs the dead tissue. 
Sclerotherapy tends to be one of the most popular and widely-used treatments these days. It uses a sclerosing solution that causes the vein to shrink. Usually, sclerotherapy takes only 1 to 2 sessions to achieve fading of the undesirable veins.  
Microphlebectomy is ideally suited to treat superficial bulging veins that are too large for sclerotherapy.  In the course of this treatment, I will make tiny incisions as small as 1mm to remove an undesirable vein.  He will then insert a small phlebectomy hook to extract the vein through the puncture.  Only a small section of the vein needs to be eliminated because the remaining portion of the vein will clot off and gradually fade from view. 
Clarivein is a minimally-invasive procedure that utilizes a thin infusion catheter clinically proven to deliver faster results and guarantee up to 74% less pain than most other peripheral vascular treatments. 
An in-person exam with a board-certified plastic surgeon would be the best way to assess your needs and obtain expert medical advice. Best of luck!

Hratch Karamanoukian, MD, FACS · Answer

Thank you for your question and for providing pictures. This is a very common problem that we see in our offices due to the location of our practice with a huge # of patients of Northern European and Irish descent. A combintion of freckles and telangiectasias worsened at a young age from excessive sun exposure in areas of the face, neck and chest. IPL is great for this and a series of 3 treatments should take care of it. Protect your skin with high SPF lotions to avoid early recurrence.

Channing R. Barnett, MD · Answer

Based on the photos which are somewhat blurry, it appears that you have a combination of redness (mostly related to the broken blood vessels) and brown discoloration. These are both likely secondary to sun damage, and are more common in fair-skinned individuals. A series of intense pulse light (IPL) treatments can help improve this with minimal downtime. Also very effective but requiring more healing would be a combination of the erbium laser to the brown spots and light electrodessication (superficial burning) to the broken blood vessels. The most important thing you can do at this point is to protect the areas from future sun damage by practicing sun safe habits.

Stephen Mandy, MD · Answer

Freckles and blotchy dilated capillaries on the declote area in the center of the chest is nearly alway caused by sun damage in relatively fair skin. For most patients, especially young patients, IPL, (intense pulsed light) is very helpful with minimal to no down time. It usually requires 2 to 3 treatment sessions about one month apart and you must not be suntanned at the time. It is also essential to protect the area after from further sun damage afterwards.

Richard Ort, MD · Answer

Usually pulsed dye laser or intense pulsed light would be used for redness on the chest. These treatments are effective but multiple sessions are necessary for best results. It is very important to wear sunscreen to prevent any more sun damage to the area. Most doctors will wait 6-12 months after a patient stops taking Accutane before performing laser treatments.

Stacey Tull, MD · Answer

The photos look more suggestive of photodamage rather than distinct vascular lesions. Photodamage tends to have both a vascular and pigment component. For this reason, I would recommend a series of IPL or BBL treatments.

Adam J. Mamelak, MD · Answer

While there are multiple causes of broken blood vessels in the skin, sun damage and excessive UV exposure is one of the major culprits. Poikiloderma is a specific type of sun damage where the skin in chronically sun exposed areas (particularly the sides of the neck and upper chest of women) changes color and the blood vessels under the skin become dilated.

	Covering the area with a high SPF sunscreen on a daily basis can help prevent this condition from worsening and can help reverse the skin changes in some individuals. Lasers that specifically target the discoloration and red color of the blood vessels, such as Pulse Dye and Intense Pulse Light, can resolve this completely. More than one treatment is often required with both of these devices.

Michelle Copeland, MD, DMD · Answer

For problems such a broken capillaries, lasers like the Pulsed Dye or Nd: YAG work best by using light energy to home in on ruddy pigment and erasing red areas on the face and body. 

	When using a laser, a doctor does one pass, or several, over sections with persistent redness. The wavelength recognizes only high concentrations of pigment in the visible capillaries. Once heated, those vessels shrivel and disappear. In most cases, one to two laser sessions spaced over four to six weeks are necessary to reach complete clearance. Postprocedure, skin may be slightly irritated for a few days.

24 Yr Old White Female with Red Telangiectases Veins on Chest- Options? (photo)

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