What is the best way to permanently, safely treat telangiectasia (red blood vessels) around the creases of the nose area?

Hi Bestrest.  The best treatment we have for this issue is a long pulsed yag laser.  In contrast to what Dr. Emer has stated, the only time you get "divots or holes" would be if the treatment were not done well.  A yag laser is a very safe laser and easily produces the results shown at the link below for nose veins.We actually prefer it to hyfrecation because in cauterization (hyfrecation) you will cause scabbing and potentially indented scarring if the treatment is too aggressive.  Just as with lasers, user experience is key to proper outcomes but lasers, because they do not ablate (materially change) the surface of the skin offer a safer solution for the removal of spider veins.One issue of concern is that you are looking for "permanent" results.  Permanent removal of these small veins is not possible.  They always come back, but the question is how long in between treatments.  We hope they stay away for a prolonged period, but every patient is different and with vascular lesions like these, you can expect them to return at some point.  To view before and after photos for facial spider vein removal in Los Angeles and Orange County, visit the link below.

There are many treatment options for this, I would avoid long pulsed YAGs as the heat can cause divits or holes.  The best treatment is pulsed dye laser or excel V laser.  Some treatments such as hyfrecation or dessication needle work well.  The most important thing is that you see a physician with experience for treatment and who is well trained in lasers.  Best, Dr. Emer.

You used the word 'permanently' and there is no such treatment.It is likely that you will develop similar veins elsewhere on your face or recurrence of such telangiectasias in the future. Treatment does not guarantee that you will not develop new telangiectasias in the future. The pictures you provide are very helpful. What you have are called telangiectasias (< 1 mm in size) on the nares. They can be treated with thermocoagulation, topical lasers. They are too small to be injected with sclerotherapy.These are cosmetic and not covered by insurance.You may well need more than 1 session of treatment as these areas of the nose are highly vascularized and these veins are quite stubborn to treat, 

The most safe and effective way to treat nasal telangiectasias is with a pulsed-dye laser. Depending on the size of the vessels and the degree of bruising you are OK with having, you may require 1-3 or 4 treatments, each spaced about 2 months apart. Nasal telangiectasias do tend to re-grow, however, so most individuals require a "touch-up" laser treatment every 2-5 years, to maintain the skin telangiectasia-free.

These thin red blood vessels appearing on the alae of the nose in the
photos are dilated capillaries.Normal capillaries are too small to be seen
but become visible when they dilate.There are many factors associated with capillaries remaining permanently
dilated; it is more common in those with fair complexions compared to those who
have darker complexions.The medical
term to describe a small blood vessel that is dilated is telangiectasia. Therefore, dilated
capillaries are also known as capillary
telangiectases.Capillaries are the
smallest blood vessels in the body.The
other types of blood vessels found in the body – that range from small to large
- are veins and arteries.In the skin,
veins may also appear dilated – dilated arteries are rarely observed in the
skin.Small dilated veins are known as venous telangiectases; these appear as blue or purple blood
vessels, usually on the legs and thighs but sometimes on the face.Large
dilated veins are known as venous
varicosities or varicose veins.The terms spider
veins or broken blood vessels are
often used to refer to both capillary
telangiectasesandvenous
telangiectases; as such these terms are not specific.However, it is important to distinguish capillary telangiectases from venous telangiectases because they
respond to different treatments.Capillary telangiectases (as in this
case) respond best to 532nm (Nd:YAG) laser or 585nm (pulsed dye) laser; they
don’t respond as well to 1064nm (Nd:YAG) laser.Laser is the optimal method of treatment because the light should be
absorbed by the red blood vessel without damaging the overlying skin as it
passes through it.Electrodessication
(‘hyfrecation’), electrocoagulation and other non-selective treatments
invariably heat the skin directly overlying the telangiectasia; scarring –
linear or divets – are common.These techniques
were used prior to the advent of lasers.Venous telangiectases respond
much more favorably to a procedure known as Sclerotherapy than to laser.

There is no best or permanent way to treat facial and nasal veins.  Options include topical laser, IPL, sclerotherapy, fine needle radio frequency and ohmic thermolysis. All options work.  The cost varies with the physician, locale of service, amount of veins treated and frequency of treatments.

We treat facial spider veins with laser.  This is the best treatment on the face. We can achieve great resolution with 1-2 treatments depending on the severity.  Cool the skin is very important before and after treatment to avoid any blistering especially with darker skin tones.