Telangiectasias: How to eliminate small veins on the face?

The term "telangiectasia" refers to the permanent dilation of small capillary blood vessels, typically located on the skin's surface. These present themselves as small red or blue lines, often in a spider web or branch-like pattern, and can appear on various parts of the body, including the face, legs, and chest. The emergence of telangiectasias is often associated with a skin condition, particularly rosacea. Indeed, they are characteristic of the vascular rosacea, or couperose, the primary form of rosacea.

Several factors have been identified as the cause of telangiectasias, among which are a primary abnormality in the circulation of the facial vein, exposure to the sun's UV rays, stress, intense physical effort, temperature variations, consumption of spicy foods, and even genetics. Although benign from a medical standpoint, telangiectasias can be a source of discomfort due to their visibility, particularly when they are located on the face, and treatments to make them disappear are often sought.

There are several methods of dermatological surgery to eliminate telangiectasias. It should be noted that before performing an operation on the veins, their examination by duplex ultrasonography is essential. Indeed, there is a great anatomical variability in the superficial veins. Their meticulous observation and pre-operative marking are essential to ensure the success of the treatment. The examination by duplex ultrasonography is quite simple and does not require any preparation for the patient: after spreading a gel to improve conduction on the skin, high-frequency sound waves are sent and reflected by the body's organs, allowing them to be visualised. This examination is painless and poses no health risks.

Sclerotherapy.

Sclerotherapy is often the first treatment suggested for telangiectasias. A substance, known as a sclerosing agent, is injected into the dilated vein, which causes the fibrosis of the vein and its gradual disappearance. Among the most commonly used sclerosing agents are polidocanol and sodium tetradecyl sulfate, which are surfactants. Complications such as hyperpigmentation and phlebitis are rare. Several sessions spaced a month apart are generally necessary to completely eliminate the telangiectasias. The results obtained with this method are often very satisfactory, however, it happens that the telangiectasias return.

Laser treatment.

Skin lasers are highly effective in treating facial telangiectasias, although the results are often superior with sclerotherapy. Lasers with short wavelengths, such as KTP 532 nm or pulsed dye 585-600 nm, are used to eliminate red telangiectasias , and lasers with longer wavelengths, such as alexandrite 755 nm or diode 800 nm, are preferred for treating blue telangiectasias, which are generally deeper in the dermis. Flash lamps (intense pulse light), whose wavelength can vary between 500 and 1200 nm, are sometimes used and have an efficacy comparable to that of lasers. The aim of lasers and flash lamps is to burn the small vein in order to eliminate its colouration.

External Radiofrequency

A less popular technique, external radiofrequency relies on the use of high-frequency electromagnetic waves to generate heat at the level of dilated blood vessels and make them disappear. The principle is similar to that of laser treatment and the risks of complications are also low.

Surgery.

When telangiectasias are very widespread, surgery may be considered. A tumescent anaesthesia is performed, meaning a highly diluted local anaesthetic is injected into the subcutaneous tissue. This solution is very slowly absorbed into the bloodstream, providing effective and very safe anaesthesia. The removal of the dilated veins is then carried out, while the healthy superficial veins are preserved. After the operation, a prevention of venous thrombosis through subcutaneous injection may be recommended for a few days to reduce the risks of residual pigmentation and recurrence.

• GOLDMAN M. P. & BENNETT R. G. Treatment of telangiectasia: A review. Journal of the American Academy of Dermatology (1987).

• NOËL B. Treatment of Varicose Veins and Telangiectasias. Swiss Medical Review (2007).

• CRIBIER B. Pathophysiology of Rosacea: Redness, Telangiectasia, and Rosacea. Annals of Dermatology and Venereology (2011).

• SAURAT J.H., LIPSKER D., THOMAS L., BORRADORI L., LACHAPELLE J.M. Dermatology and Sexually Transmitted Infections. Elsevier Masson (2017).