Lasers Not Working for Broken Nostril and Chin Capillaries - What Next?

I would attempt the pulse dye laser for these fine capillaries. Multi modality laser therapy sometimes works as well.  I have used the pulse dye laser with enormous success.

It is commonly observed that repeat laser therapy is needed for telangiectasias on the chin and nares. The face is a very vascular area and laser therapy must be repeated regularly until they are eliminated. 

I agree with the comments below.  Various lasers may be required to give you a good result; however, some veins tend to be very stubborn and can recur after treatment or never totally disappear.  Maintenance treatments may be required.

Greetings in Colorado~

There are a number of effective treatments for the small vessels around the nose but two very important things to keep in mind- 1) a treatment and the laser or device being used is only as good as the person performing the procedure.  Experience counts. 2) these are treatments and unfortunately not cures....there will always be maintenance involved.  Telangiectasias on the nose and cheeks can be resilient.  In addition to Nd:YAG laser, there are PDL (Pulsed Dye Lasers), IPL (Intense Pulsed Light), Radiofrequency, KTP, Electrocautery, Veinwave.... many options.  Don't be discouraged but do look for someone with good experience in treating facial vessels.

Good luck~

Dr. Grant Stevens

I agree with Dr. Mandy, find a laser treatment specialist using ALL the available lasers. This give you and the doctor options. for a great result.
From MIAMI Dr. B

There are many different lasers for this problem - V beam, Pulse Dye, KTP diode and others. Most doctors do not have them all so the one that was used on you may not have been the ideal one for your problem.. I would seak a laser specialist in your area or elsewhere who has all of the options you may need.

It is important to be appropriately classified so both the patient and the physician know what to expect.  I would suggest that you go back to your physician or vascular surgeon and review what is causing these small veins to appear.  The most common problem is the presence of "the feeder vein."  Small nose and face veins are what doctors call telangiectasias (the doctor word for small veins).  They are often "fed" by other veins that might not be under the surface.  Surgeons must always go for the feeder vein first.  There are three signs of a feeder vein.  The decompression test (rapid refill when one presses on it).  Another is visualization (seeing it).  This is aided (helped) with transillumination (a bright light and now the VeinViewer).  The last test to suggest a feeder vein is treatment failure which you are now experiencing. 
Cryo Laser and Cryo Sclerotherpy (CLaCS) is a specific method and technique designed and taught by Clinica Miyake to deal not only with leg veins but also veins elsewhere on th body including the face.  There is a specific classification scale (9 to 1) used to help clinicians and patients not only manage expectations but to guide treatment for lower extremity veins (veins on the legs).  For the face no such scale exists although the principle three tests mentioned above still apply. 
There are many accepted methods of dealing with facial telangiectasias and they range from using intense pulsed light (IPL) laser, radiofrequency and chemical ablation (sclerotherapy). 
It is important to realize that telangiectasias are classified as Clinical Class 1 of chronic venous disease.  Chronic Venous Disease is just that, a chronic condition.  If you do have some "feeder veins" that are causing the problem to recur even with CLaCS a series of staged treatments generally about two weeks apart are recommended.  In order to get rid of the veins in "one shot" more aggressive treatments are necessary which also increases the risk of adverse (bad) effects to the patient. 

If the nd:YAG laser does not seem to be working you might ask the dermatologist to use a pulsed dye laser. If he does not own one, then a referral to a colleague to use another laser would be in order. The KTP and 910 diode laser are also good choices.
Finally, electro-dessication, in the right hands, can be quite effective and is much less expensive.