P MA DERMATOLOGY

Gerald N. Goldberg, MD Duane C. Whitaker, MD Kathleen A. Strickland, NP-C Jennifer A. Allison, MPA-C

5150 East Glenn Street Tucson, Arizona 85712

520.795.7729
FAX 520.795.4177

www.pimaderm.com Laser Treatment for Facial Blood Vessels / Spider Vein Telangiectasia
Many myths exist about spider veins. Many people call dilated blood vessels present on the face or leg broken blood vessels. In reality, these often unsightly red blood vessels are the result of dilated blood vesselstelangiectasia (from telos = end, angio = vessel, ectasia = stretched). 1. What are the main types of dilated vessels? a) A true spider vein has a central feeder vessel with radiating fine vessels from a central dot or punctum. This classic spider vein is often the result of trauma. b) The second type of vessels are those that are either disconnected or spread like branches of a tree, socalled arborizing vessels, typical of essential telangiectasia. This dilated vessel is caused from heredity (especially with white, fair Anglo-Saxons), sun-damaged skin, hormonal changes or changes associated with adult acne and the skin condition called rosacea. c) The third type of vessels, also associated with rosacea are diffuse and form a blush-like pattern of redness on the nose and cheeks. D) The fourth type of vessel are reticular veins which are large, deep, blue veins typically on the cheeks or around the eyes. 2. Where do dilated vessels occur? Most commonly dilated vessels occur on the face, especially the cheeks and nose or as clustered vessels of various sizes and patterns on the lower legs. 3. Are these facial dilated vessels dangerous or do they signal other problems? Usually these dilated vessels are not medically significant and are only of cosmetic importance. 4. What are my treatment options for dilated facial blood vessels? Since 1984 Dr. Goldberg has been using Lasers such as the Argon Laser, Copper Vapor Laser, and Argonpumped Tunable Dye Laser. However the newer generation yellow and green Light lasers are a considerable improvement to these original Lasers and offer more selective and efficient vessel removal with less discomfort than was available previously. Dr Goldberg typically uses the green light Versapulse Laser for discrete branching vessels and the fifth generation Candela Pulsed Dye Laser for blush-like facial redness. He will often use a combination of both lasers when both types of vessels are present. The Infrared Gentle:YAG Laser is used for larger or deeper blue facial vessels. These devices give the most effective and efficient treatment to optimize results. We also offer the newest Palomar Starlux Intense Pulse Light treatment. These treatments involve little downtime and are done under Dr. Goldberg's supervision, typically utilizing more aggressive protocols and delivering more cost-effective results than one can receive at a typical medical spa.

5. Can blue vessels around the eyes be treated? We utilize one of our Infrared Lasers such as the Gentle:YAG to remove enlarged blue vessels around the eyes. Injections can also be done, but we get excellent results with one or two well-tolerated Laser sessions. 6. How do our Lasers and Light sources differ from the medical spa Photo-facial Intense Pulse Light devices? Our Lasers represent the best and most cost-effective technologies available. The Laser results are clearly superior to the typical spa delivered Intense Pulse Light treatments. Dr. Goldberg does the vast majority of Laser treatments and usually we are able to significantly improve facial redness and vessels with 1-3 treatments. 7. How do our Lasers work? The various Lasers available all emit a powerful yellow or green light beam. As it is visible light, the Laser light is not a harmful light source when targeting the unwanted vessels. The VBeam and the Versapulse Lasers are selectively aimed at and absorbed by the targeted red blood cells present in the vessels. The target absorbs the energy and transfers heat to the vessel, which becomes inflamed, slowly collapses and disappears or diminishes over time. There is little risk of harming the overlying skin and/or leaving scar or texture change on the skin. The Vbeam Laser delivers short millisecond pulses of yellow light, which impact the skin and occasionally temporarily leave a purple bruise-like area on the skin. It feels like a skin prick or rubber band snap on impact. The unwanted vessels are treated by a train of small circular pulses (3-10 mm in size) depending on the vessel size. The Versapulse Laser emits a green Laser light, which is of a fixed wavelength, but the duration of the pulse and energy of each pulse can be varied extensively to precisely target vessels of different sizes and depths. 8. What can you expect after treatment? After the treatment, the skin usually appears red and there can be mild to moderate swelling for several days. Larger vessels (i.e. on the nose) can turn slightly purple but this rarely lasts more than a few days. On occasion, a slight whitish discoloration, bruising, or a small crust can occur over the treated vessel for several days. This enables a quick return to work with very little downtime. Makeup may be used several days following the procedure. Several treatments commonly are used to obtain optimal improvement, and the treatments are usually very well tolerated. 9. Is Laser treatment painful? The Vbeam is equipped with an effective dynamic cooling device to cool and protect the skin surface during treatment. The cooling spray is synchronized with each pulse, which decreases any discomfort with treatment and protects the skin surface from injury as higher powers are delivered to underlying vessels. The Versapulse has a contact chill tip which cools the skin as the laser is working to make treatments quite tolerable. No anesthesia is usually necessary. Ice is used to enhance your comfort both during and after treatment. In addition we often encourage people to use a topical anesthetic cream such as LMX, 1-2 hours prior to the procedure to reduce discomfort during the procedure. We can dispense a tube in the office for home application or you can come by the office 1-2 hours prior to the procedure and our medical assistants will apply the medication for you. Various medications, such as Valium or Tylenol #3, may also be prescribed and are taken 30-60 minutes prior to the procedure for additional comfort.

10. Can injection treatments be done on facial veins as with leg veins? Injection therapy is almost always the treatment of choice for unwanted leg veins. Laser therapy is not the treatment of choice for leg veins because it is expensive, more painful and may lead to long-lasting discoloration at treatment sites on the lower legs. On rare occasion large caliber vessels on the face can be injected with a solution, which irritates the inner vessel lining and slowly closes off the vessels. Repeated injections are usually necessary and this is done in office and is quick and very cost-effective. There is risk of temporary pigmentation change and a rare possibility of scarring. 11. What are the risks of the procedure? The most common side effects involve bruising and temporary swelling of the skin for a number of days after treatment. Some temporary skin discoloration or pigmentation can occur several weeks after the treatment, but usually this clears with skin bleaching creams and time. Infection following the procedure is rare, as is the risk of scarring which occurs in less than 1% of treated patients. 13. What is the cost of the treatment and does my insurance pay for it? The cost of the treatment varies as to the number and location of the vessels treated, the complexity of the problem, as well as the time spent in treatment. A typical treatment session, involving a modest sized area on the nose or a cheek may cost $295-$475. A large area involving much of the face may cost $550 or more. Unfortunately, insurance companies will not reimburse you for the cost of these treatments and will usually consider them cosmetic or not medically necessary. Payment for the procedure is discussed prior to the procedure and payment is expected prior to the time of service unless specific arrangements are made with the Office Manager prior to the treatment date. Dr. Goldberg has unique and extensive Laser experience in the treatment of unwanted red vessels since becoming certified on the Argon Laser in 1984. Dr. Goldberg and one of our experienced staff, will discuss various options for your care and develop a treatment plan to meet your needs and exceed your expectations. A consultation is required prior to scheduling any Laser or treatment. If desired, or if traveling a long distance we, can make arrangements for your consultation and treatment on the same day.

Please contact our office for an appointment to learn more about the treatment options. Laser scheduling is done by Monica, Carla, or Lynne in our back office.