What to Do About Spider Veins on Your Face

Electrodessication and lasers could help. Here are some solutions.

This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.

When people say “Aging is a privilege,” I guess they mean how lucky we are to do it. But like the phrase “aging gracefully,” I find its flavor slightly off. There’s a righteousness to it, a whiff of If you’re not careful, you’ll do it wrong.

I’ve been thinking of that aphorism a lot in the past couple of weeks, because my neighbor, a young woman of remarkable beauty and strength and compassion, recently died after a protracted battle with cancer. She left two little daughters. A psychotherapist, she wore her spiritual and emotional generosity openly, always inviting your presence. After her death, her family posted a video she’d made to say good-bye, an eloquent and loving memorial. In it, she never said aging is a privilege, but that notion — expressed in her courage, her regret, her gratitude, her adoration of her beloved family, and her reluctance to leave them — flooded every frame. She was a gift.

And now for a question from one of the privileged.

Q: I have some tiny, noticeable broken capillaries on the sides of my nose. To minimize them, I’ve tried treatments with intense pulsed light (IPL), Vbeam (pulsed dye) laser, and cauterization. No results seem to stick. The capillaries may disappear briefly or look like they’re fading, but ultimately there isn’t much improvement. Both the medical aesthetician I see and my dermatologist seem more than happy to try different approaches. But I’m tired of shelling out money only to be disappointed. Should I give up and use concealer? Honestly, I hate concealer.

A: I’m not sure why you hate concealer, Dear Reader, but I don’t like using it, either. If I took the time to figure out which concealer might work for me and how to use it to my best advantage, I might have more affection for it. But my attitude — what you see is what you get — pervades my makeup routine, such as it is.

As for your capillaries, HNTFUYF DermDiva Heidi Waldorf, M.D., has a few suggestions. Those tiny, superficial dilated veins frequently appearing as red, threadlike squiggles on either side of the nostrils are formally called telangiectasia. They’re commonly seen with rosacea, photo damage, or after a rhinoplasty, she said. It’s possible they may also be the result of chronic nose-blowing and rubbing, exposure to extreme temperatures, and genetics.

Treatment to minimize them can be frustrating for both patients and doctors, said Waldorf. Have I told you about the time — many years ago, when I first became a beauty editor — I saw a dermatologist to eliminate the annoying little veins on my cheeks and chin? I thought they’d be easy to erase, and if there were downtime after the laser treatment, it would be insignificant. I remember the doctor passing me a (cracked) hand mirror after the procedure so I could have a look. As my husband said when he saw me that evening, I appeared to have walked face-first into a glass door. “You won’t be able to cover the marks with makeup,” the doctor told me belatedly. It was a lesson in … something, as I made note of who asked me what was going on with my face and who didn’t mention it. Back at the office, Gayle King exclaimed, “My God, Val, what happened to you?” It took around a week for the marks to disappear, and the veins went with them. Waldorf guesses the treatment was with an old/original pulsed dye laser with only one fixed pulse duration and no cooling, so there was maximal bruising. That option is still available for resistant veins, but personally? I wouldn’t recommend it.

Delicate electrodessication — using an electrical current to seal the blood vessel — can work, though there’s a risk of scarring, said Waldorf. Lasers and IPL work by using a light wavelength or a group of wavelengths absorbed by hemoglobin in the blood cells in those superficial vessels (while sparing surrounding structures). The technology has advanced over the past four decades, said Waldorf, but there are still resistant vessels because of their size, depth, color (red or blue), and/or where they’re located.

If you’ve tried electrodessication and it didn’t diminish your squiggles, they’re likely to be more resistant to other treatments, too. It may be an issue of changing the parameters used on one device or switching to another with a different wavelength, energy, and/or pulse duration. So seeing a physician with specific expertise in devices could be helpful. I’d avoid seeing an aesthetician and, instead, look for a doctor who’s well informed about lasers.

Waldorf had some thoughts about your recurrences. You mention seeing the telangiectasia disappear for some period and then return. After some types of treatment, the vessels spasm for a short time, seeming to disappear. Then, after a few hours or a day, they become visible again. It’s important to remember that the mechanism by which the treatment works takes four to six weeks for visible results. But if the veins return after several months or a year, that could be because of an underlying predisposition — rosacea, for example — which may need different management.

Waldorf advises patients that two to three treatments with a Vbeam laser are generally successful to reduce the appearance of fine vessels to the point that concealer isn’t needed. But larger veins may take more or adjunct treatment with a different laser (like the long pulse Nd:YAG). She recommends an annual visit for patients with more resistant vessels or rosacea to maintain improvement.

Gosh, that’s a lot to consider. I wouldn’t blame you if you thought, The hell with it. But I might take my telangiectasia to a dermatologist one last time for an honest, bottom-line consultation about what treatment might offer the most lasting results. If the doctor cannot ensure a better outcome than you’ve had previously, then I’d table the issue. Ignore the offending veins or pop for a highly recommended concealer and use it only when a cover-up feels absolutely necessary (like for your kid’s wedding … or your mayoral inauguration).

Originally published on July 6th.