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I am considering a chemical peel but have a scattering of tiny red dots on my skin. ...

Q:

I am considering a chemical peel but have a scattering of tiny red dots on my skin. They look like small pin prick marks. I believe they are probably burst blood vessels. Will a chemical peel highlight these even more and leave my skin smooth, but covered with red dots? Do they need to be treated separately or will they also disappear during the procedure?

A:

Many situations can cause the "tiny red dots." If they are broken blood vessels, in some cases laser treatment(s) may be helpful. On the other hand, the redness that you refer to could be rosacea which may need to be treated with topical agents. The key element is to first obtain an accurate diagnosis by consulting with a plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery. A qualified plastic surgeon can help you pick the appropriate treatment.

A:

 

Many people, especially fair-skinned people in sunny climates (like North Carolina), will develop areas of the face as they age where superficial veins and capillaries in the skin become enlarged and highly visible. Because of their typically irregular and spidery appearance, these superficial cutaneous vessels are commonly referred to as 'spider veins'.

The medical term for this phenomenon is 'telangiectasia', which is essentially Greek for 'the stretching out of the very end of a blood vessel'. And that's essentially what 'spider veins' are. They occur most frequently in the central face, particularly on the anterior cheeks and at the base of the nose. Some people develop very prominent spider veins on the dorsum and tip of the nose, where they are difficult to conceal.

The red spots you describe could be cherry angiomas. They are similar to spider veins.

 

 

The cause of spider veins and rosacea is not completely understood, and appears to be multi-factorial. Contributing factors may be a genetic predisposition, the chronic use of topical steroid agents, and solar damage to the facial skin that gradually builds up over many years. Rosacea occurs most commonly in warm climates where people get a great deal of year-round sun exposure.

These conditions can perhaps be prevented (in part) by the avoidance of excessive exposure to ultraviolet radiation (the sun, that tanning bed), the avoidance of chronic topical steroid use, and by the daily use of a high-SPF facial sunblock. In some cases, telangiectasias are associated with a systemic autoimmune disorder, such as scleroderma. Once a person develops facial telangiectasias and/or rosacea, these conditions in general do not spontaneously disappear.

So how do I get rid of rosacea, or my facial spider veins, or both?

The ideal treatment for 'spider veins' and rosacea should be easily administered, safe for the patient, reliably effective, should not require an excessive number of treatments, should be non-invasive, and should not have a prolonged recovery period.

Here's the good news: such a vein treatment does exist. The V-Beam Laser, a pulsed-dye laser developed specifically for the treatment of cutaneous vascular disorders, can completely eliminate most facial 'spider veins', usually in two to three treatments (large areas of long-standing spider veins may require more treatments), and can reverse the cutaneous manifestations of rosacea as well. In addition, the laser energy pulse delivered by the V-beam has been modified to limit the development of post-treatment bruising (purpura), a problem associated with older pulsed-dye lasers.

The V-Beam laser uses light energy of a wavelength that is specifically absorbed by structures which are reddish or purple in color, i.e. capillaries and small arteries and veins. The V-beam incorporates a Dynamic Cooling Device which sprays the skin with a cooling agent immediately before every laser pulse. This advanced technology both protects the skin from thermal energy and reduces the discomfort previously associated with pulsed-dye laser treatment. The laser pulses are generally described by patients as feeling like 'a rubber band snapping against the skin'. No anesthesia (topical or otherwise) is required.

 

While pulsed-dye laser technology has been available for decades, pulsed-dye laser treatment of rosacea and facial telangiectasia was not frequently performed as the laser energy tended to explode superficial blood vessels, producing facial bruising that may persist for several weeks. The V-Beam Laser modulates both the peak energy and the duration of the laser pulse in order to coagulate rather than explode dermal blood vessels, which allows treatments to be performed that produce little or no bruising. This advanced technology makes it possible to achieve significant clearance and even complete elimination of facial redness and spider veins with no 'downtime'.

 

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