Veins return a week after treatment. What's my next option?

Question

I have had two thermavein treatments for facial red veins and on both occasions after a week they return

Raffy Karamanoukian, MD, FACS · Answer

Under eye veins can vary in caliber and length, ranging from bluish varicose veins to light red spider veins. The treatment of larger varicose veins is very specialized and I have demonstrated my technique on the Doctors television show which can be found online. Treatment includes surgical removal with initiation of a skin brightening regimen to optimize skin thickness and collagen content. 
Associated dark pigmentation on the lower eyelid skin can be due to melasma, bluish veins, hemosiderin deposits, and hyperpigmentation.  
Topical regimens include: 
	1.MelaClenz
	2.Melarase AM
	3.Melarase PM
	4.Melapads
	5.Replenish Retinoid Cream
Additional therapies for undereye rejuvenation include fractional laser, fractional RF, Covalent peels, and LED microneedling with Replenish serum. The video demonstrates an analysis of varicose veins.
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hi Claire.  Not sure what "Thermavein" is, but when it comes to lasers, there are two types (not brands) of lasers that do well with facial veins.  The first is a long pulsed Yag laser (1064 nanometers) and we use the Laserscope Lyra and Sciton Profile.  But what's more important than the technology is how good the person using it is.  Consumer's tend to get hung up on the name of the machine without realizing the skill involved with using it to get the desired result so find a practice that is skilled with getting rid of facial veins with lasers and then ask them what type of technology they are using and how long they have been doing it.  Also ask for before and after photos like the ones at the link below.The second type of laser is the long pulsed KTP laser (532 nanometers) and we have used the Laserscope Aura in the past.  Good luck.

John Landi, MD · Answer

There are may options for the treatment of facial veins but all of them usually require multiple treatment spaced at intervals of 3 to 4 weeks.  These options include laser, IPL, sclerotherapy, VeinWave, VeinGogh and microneedle radiofrequency.  The response to the treatment also depends on many factors including  genetics, sun exposure and occasionally an underlying reason for the facial veins.  It may be impossible to eradicate all of the veins and maintenance treatments are usually necessary.

Hratch Karamanoukian, MD, FACS · Answer

There are different types of lasers for facial veins/broken capillaries. Once I do a session, I bring patients back a month later for a follow-up appointment. Even with the best lasers that we have in our offices, I tell patients up front, when they pay for the procedure, that we expect them back 3 or 4 times to get the final results - where the veins are gone. Talk to the treating physician about expectations and his/her recommendations. The face is very vascular and these broken capillaries are very 'stubborn' to treat, even in the best of hands and with the best lasers.

Veins return a week after treatment. What's my next option?

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