Side Effects of Laser Spider Vein Treatment?

Question

I am anxious to get my spider veins zapped, and although it seems pretty safe I am concerned about the hyperpigmentation risk. The med spa I am considering keeps asking about my tanning history, which is making me a little concerned. I have light skin leaning just a tad toward olive, and aside from wearing shorts in the summer do not spend time sunning or tanning. Am I flirting with disaster?

Steven H. Williams, MD · Answer

Thank you for your question.

	It is true that is that not all lasers are safe for all skin types and misuse can result in permanent darkening (hyperpigmentation) or lightening (hypopigmentation) of the treated skin. These changes tend to affect darker skin to a greater degree, however there are lasers that are successful for darker skin types. In our San Francisco Bay Area practice we use an Nd:YAG laser that has been shown to be safe and effective on most skin types.

	The fact that you are being asked about your tanning history is a good thing. Knowing how one&rsquo;s skin typically responds to UV exposure and last exposure is part of a thorough pre-laser treatment assessment and useful in determining the appropriate laser treatments and settings.

	I hope this helps.

Christopher Balgobin, MD · Answer

Hello,
Lasering the veins is an excellent procedure. Just be careful as this can cause hypo or hyperpigmentation if performed by poorly trained clinician.

Vivek Bansal, MD · Answer

If the veins are on the face, no worries. But if they are on the legs, pigmentation can be a risk for the first year, and if pigmentation occurs, then you will have to wait months to a year for that to fade, or treat with a tattoo laser and this will help reduce the color.

Harold J. Kaplan, MD · Answer

Hi AAmom.  It's likely that the facility considering this procedure for you is asking about your skin type and tanning habits because they are not using the correct technology.  In the legs, the best laser for small spider veins (less than 1mm) is the long pulsed Nd:Yg laser (1064).  

	Using this laser, even if you are olive skin toned, is not a problem.  We use it for African Americans with spider veins and it is perfectly safe.  It is likely this facility is trying to use an IPL or pulsed dye laser, which is an inferior technology for the legs.  We would recommend finding a facility that uses the proper laser technology or as others have suggested consider sclerotherapy.  Good luck.

John Landi, MD · Answer

Although topical lasers can be used for leg spider veins, the gold standard for leg spider vein therapy is sclerotherapy.  I would recommend that you see a vein specialist for an evaluation before commencing spider vein treatment in a spa setting.

Deborah Manjoney, MD, RPVI, FACS · Answer

When you have a laser treatment for spider veins, the laser is attracted to pigmentation, so it is best that you avoid the sun both prior to and after treatment.  Spider veins can also be treated with injections and many facilities utilize both methods during a single treatment.   Patients generally do not have an issue with hyperpigmentation if they have been conscious of their sun exposure, but there are other treatments like IPL that can help should a spot arise.  Spider vein treatments are pretty straightforward, and if you have a well-trained doctor, PA, or nurse, you can have excellent results and can enjoy having the beautiful legs you’ve always wanted.

Dennis Gross, MD · Answer

With lasers, there might be some swelling that will disappear within a few days, you might experience some discolored skin in the areas that have been treated, but this fades in 10-14 days. It’s extremely important that you see a highly trained dermatologist—to have these procedures done. In inexperienced hands, lasers, in particular, can cause burns and scars on the skin.

Hratch Karamanoukian, MD, FACS · Answer

You should be happy that they are asking you about your tanning history and that they will assess your skin type before they use the proper device, energy source, laser type and energy settings.Lasers deliver energy at different wavelengths, some targeting water molecules, others primarily hemoglobin in capillaries and veins, others to melanin. They want to choose a laser that targets the blood vessels and not melanin, esp if you are dark skinned (olive or Black). The appropriate wavelength laser for 'veins' ALSO depends on their depth. For example, the 532 nm wavelength can reach the superficial dermis for treatment of facial vessels, but it is not suitable for deeper vessels.Consult a physician who has expertise with more than one laser system.Avoid the sun altogether for 3 months following laser vein or cosmetic sclerotherapy and wear stockings as recommended by your physician.

Joel Gotvald, MD, FACS · Answer

Thank you for your question.  

	The most common side effect from spider vein treatment is hyperpigmentation or hypopigmentation of the skin at the treatment sites (spots that look lighter or darker than the adjacent non-treated skin).  This is usually the result of the heat energy from the laser damaging or burning the skin.  With sclerotherapy injections it is either the result of hemosiderin pigment from blood cells getting trapped in the skin or under the skin, or from inflammation of the skin as a result of the chemical reaction that results from the sclerotherapy medication.  These are unfortunate and often unavoidable side effects . . . the skin is intimately associated with the veins.  When heat or chemical is applied to the veins, the skin is at risk for a reaction as well.  The skin side effects that occur from sclerotherapy will usually resolve and fade over time.  But the thermal skin side effects from laser are usually permanent.  For that reason, I recommend sclerotherapy over laser therapy whenever possible.  But there definitely are circumstances in which thermal treatment with heat is preferred (for example, on the face and on the ankles).  For spider veins that are better served with thermal energy (over sclerotherapy) due to their location, I actually prefer the use of Ohmic thermolysis with the VeinGogh or Veinwave device rather than laser whenever possible.  I have found this technology to have less risk of permanent skin damage or thermal burns that leave scars. In addition, the VeinGogh / Veinwave devices are FDA approved for spider vein treatments, as they have been shown to be safe and effective with low risk. I have found Ohmic thermolysis / thermocoagulation to be very effective on the face, legs, and ankles and have also found it to be of lower risk than the laser treatments.  I see patients on a weekly basis that were unhappy with their results with laser for spider veins.

	 

	My recommendation to you would be that you go see a board certified vein specialist who is a MD, rather than going to the local med spa.  The level of training of the individual performing the procedure is of utmost importance in terms of you getting the results you are looking for.  Vein specialists can usually offer all of the various treatments and recommend the one that is best for your individual skin type and circumstances.

	 

	I hope that this information was useful to you.

Grant Stevens, MD · Answer

Laser vein removal is common for treating unsightly spider veins on legs.  Hyperpigmentation is a  common side effect of all laser treatments whether it is on your legs, face, arms, etc.  The med spa you are thinking of going to sounds like they just want you to be aware of the risks and to be cautious about tanning before or after the treatments.  This is a reasonable precaution.  Always make sure the provider whom is treating you has experience with the machine. 

	Hope this helps.

	Dr. Grant Stevens

Side Effects of Laser Spider Vein Treatment?

Answers (14)

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