Is There a Treatment to Get Rid of Facial Telangiectasias Due to Systemic Scleroderma?

Question

Several years ago I tried 2 different lasers and did not have luck getting rid of the red dots. Maybe there are better lasers for this now. I have had Drs tell me that I will never be able to get rid of the dots.... Thank you.

Sonia Badreshia-Bansal, MD · Answer

Thank you for your question. Facial telangiectasias are a symptom of sun damage, rosacea, and other factors and is associated with some forms of scleroderma. Lasers have evolved over time and I would seek the advice and supervision of your Board Certified Dermatologist to determine if you are a candidate for laser therapy. I hope this helps.

Larry S. Nichter, MD, MS, FACS · Answer

Several different lasers are great for angiomas - " red dots", and telangiectasias "broken capillaries" including KTP, pulse dye and others.We use both the Diolite KTP and Sciton lasers to take care of this problem.

Richard H. Tholen, MD, FACS · Answer

Any plastic surgeon or dermatologist experienced with many lasers (not just the one or two other doctors may have) can successfully eliminate most of these facial telangiectasias with a single treatment session with a KTP laser. (I always offer a free touch-up session no sooner than one month after the initial treatment session to ensure maximum improvement.)

	As a general rule, you should probably avoid any doctor who has a "one-laser-fits-all" attitude, as most lasers have specific uses based on wavelength, power, and shutter duration. It should NOT be "Well, I have a hammer, so everything must be a nail!" Even, if as in your case, you have had two different "hammers" used. You need the laser best tailored for the problem at hand!

	Treatment with a KTP laser may cause superficial blistering and/or crusting for a few days, but this wavelength laser (532nm) is very well absorbed by blood and skin pigment, making this a workhorse laser for tiny blood vessels and superficial pigment spots. Scarring is rare with proper treatment, and once the vessels are gone, they remain gone.

	KTP stands for Potassium (K) Titanyl (T) Phosphate (P), which is the frequency-doubling (wavelength-halving) crystal used in the beam path of a 1064nm near-infrared Neodymium:YAG (Yttrium Aluminum Garnet) laser. This was the first of many lasers I purchased over 20 years ago, and I still use it weekly for problems exactly like yours.

	The V-beam is a 585nm yellow light laser that is also well-absorbed by blood, but this laser is a flashlamp-pumped pulsed dye laser with long(er) shutter durations than "standard" 585nm pulsed dye lasers, which also emit laser energy at 585nm, but in very high-energy, short shutter duration (450 microseconds, about half a millisecond) pulses. Pulsed dye lasers were designed to treat the extremely small surface capillaries in port wine stains (capillary malformations), and this type of laser has too short a shutter time for the thermal relaxation time of larger diameter vessels (which are your [small] facial telangiectasias). The V-beam laser would be used in the 10 millisecond pulse duration range, which may still be a bit too short of shutter duration (inadequate energy) to eliminate vessels the size of your facial telangiectasias.

	A V-beam laser is not a "bad" choice, but is probably not be the "best" choice. Other less-than-ideal options that can (but don't always) work include IPL (non-laser Intense Pulsed Light machines), argon laser (ancient blue-green laser with too long pulse duration and too little energy = non-specific for blood vessels), or other lasers that are NOT recommended.

	There are probably several physicians in your area that routinely use a KTP laser; seek one out and make sure the operator is experienced in its use. Best wishes!

Ron Shelton, MD · Answer

I have had great success treating capillaries on the face with the V-beam laser in a few individuals. Successive treatments may be needed at which time the settings are changed based on the prior results. I start out cautiously and adjust slowly, with each month's treatment. Bruising may occur but this is temporary and can be covered with makeup.

Kris M. Reddy, MD, FACS · Answer

Ipl and vascular lasers can be used to treat telangiectasias due to systemic scleroderma. Not every ipl or vascular laser is appropriate so you should consult with 2 - 3 experienced and expert practitioners to explore your options.

Mark Taylor, MD · Answer

Both IPL and Pulsed Dye lasers are excellent in treating the vessels caused by scleroderma. Not all IPL or PDL treatments are the same. You need an experience laser doctor who knows how to use short high energy pulses to treat the fine, medium and larger vessels. An inexperience technician at a medispa will likely not know how to do this treatment safely. the best IPL's to do this treatment are the VascuLight, SmoothCool and the new MaxG IPL hand piece from Palomar. Fine vessels usually need a pulse duration of 1ms or less with a high peak power to be effective. It can be done if you are seeing the right doctor who know how to do it.

Elizabeth F. Rostan, MD · Answer

Your red spots should respond to any vascular laser. My favorite for these is the Vbeam pulsed dye laser. For the angiomas - red spots - associated with scleroderma, more aggressive settings with the laser are required for best removal. These more intense settings can cause temporary bruising.

Is There a Treatment to Get Rid of Facial Telangiectasias Due to Systemic Scleroderma?

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