Transcutaneous laser and intense-pulsed-light (IPL) therapy has proven effective for the tiniest surface vessels (eg, those found on the face), but this modality is not generally useful as primary therapy for treatment of spider veins of the lower extremity. This is true for several reasons.
Because of the physics of light absorption, delivering an ablative dose of thermal energy to the vessel without damaging the overlying skin is difficult.
The degree of patient-to-patient variability of light absorption in the skin is high.
Even an experienced practitioner may inadvertently cause painful skin burns that can lead to permanent hyper-pigmentation or hypo-pigmentation.
For most patients, the laser pulses are significantly more painful than the 30-gauge needles used for microsclerotherapy.
Most spider veins have associated feeding vessels that must be treated by some other means before the tiny surface vessels are amenable to laser or IPL treatment.
After treatment the areas treated become reddened and there is a feeling of sunburn for a couple of hours. On occasion it is possible to produce a bruise if one of the smaller veins ruptures but parameters can be altered to stop this recurring. This will fade as with normal bruising. There is a slight possibility of a blister forming but it is very superficial and will heal with no scarring. Local swelling of the face is a possibility but this subsides spontaneously within a few days. Ice packs can be applied to reduce swelling and soothe the thermal affect. Make-up can be applied immediately post treatment.
PL (Intensive Pulsed Light) is a very successful way of eradicating facial veins and reducing redness. Three or four sessions are usually required at three-week intervals. If a good moisturizer and strong sun block are applied whenever exposed to sunshine (including day to day activities, not only when sunbathing) then the likelihood of recurrence is greatly reduced.