Facial Spider Veins

Spider veins of the face, like the spider veins of the legs, are called telangiectasias. They may occur in any person with or without other vein problems. They tend to occur as we age, usually first occurring in the 30’s and 40’s, and are quite common in people past 50. Rarely these veins may be seen in children, usually girls because of female hormones, or in any child with an injury to the face, such as may occur with a fall. While spider veins may be seen anywhere on the face, common locations include the junctions of the nose and the cheek and the upper lip near the nostrils, the cheeks themselves, and the chin.

The cause of facial spider veins is not known. Suffice it to say that they occur with aging and probably have a genetic link.  In some men facial spider veins tend to be worse with alcohol intake. In women estrogen has been thought to play a role. Chronic sun exposure may also be a factor. Some patients report the development of localized spider veins at the site of trauma such as over zealous extraction during a facial. Rosacea, a chronic inflammatory facial skin condition, causes redness and flushing and the appearance of small red spider veins. Any inflammatory skin condition affecting the face may predispose an individual to develop these facial veins. Chronic use of strong topical steroid agents may cause dilation of the skin vessels, and this has been suggested as a causative agent in some.

Treatment of facial spider veins is done for cosmetic reasons only. Treatments that have been advocated include sclerotherapy (injection of chemical into the spider veins), intense pulsed light (short burst of high intensity light exposure to the skin), skin laser, and pinpoint delivery of radiofrequency energy (VeinGogh). I will discuss each of these and my experience with patients who have received these treatments.

Sclerotherapy involves injection of a chemical compound that causes irreversible injury to the vein inner wall. The injections are done with a fine needle that enters the tiny vein. The discomfort is minimal, if at all. This is usually followed by clotting of the vein and its removal by the body’s own inflammatory process over ensuing weeks. While sclerotherapy is extremely effective and commonly used for spider veins of the legs, it is the most infrequently used treatment for facial spider veins. First of all it is not usually possible to introduce a needle into the veins, because these facial spider veins are much smaller than ones usually seen on the legs. These facial spider veins are so fragile that any pressure from an attempt to inject them would result in rupture of the tiny structure. In addition most vein specialists do not like to inject vein-damaging chemicals near the eyes. Therefore I do not employ sclerotherapy for facial spider veins at Dallas Vein Specialists.

Intense Pulsed Light (IPL) has been used for facial spider veins with limited success. Small and faint spider veins may sometime respond to IPL, but it works poorly on dense clusters and ones that are more prominent. Usually several treatments are necessary, and the cost can be substantial. Patients report some discomfort from the treatments.

Lasers have been used with success for facial spider veins. The potential for skin damage and the discomfort of treatments are drawbacks however. Scarring from skin damage and loss of normal skin pigmentation are concerning considerations.

VeinGogh treatment, a promising and effective new approach, is the delivery of a burst of radiofrequency energy to the spider vein via a hair-like metal probe that is placed directly on the spider vein. This causes thermocoagulation of the spider vein, which immediately disappears from the skin. The mild discomfort is usually easily tolerated. At Dallas Vein Specialist I have used the VeinGogh device with good success. There have been no significant problems such as scarring. Some patients have required more than one treatment to completely eliminate the spider veins.

Other treatments using creams or dietary supplements or vitamins have not been shown to be of any real benefit. Commercial claims of curing or removing spider veins of the face or legs should be viewed with great skepticism.

In summary spider veins of the face are cosmetic concerns and occur in many people as a consequence of aging. Various treatments have been proposed. Sclerotherapy or injection treatment is fraught with problems. IPL is of limited benefit, often providing improvement but not complete removal. Laser is effective but scarring, expense, and discomfort are limiting factors. VeinGogh using radiofrequency energy is effective, safe, and cost friendly.