What is facial sclerotherapy? How blue blood vessels on the face are closed, and when to use it versus laser treatment

Facial sclerotherapy is a treatment in which a sclerosing agent (hardening medication) is injected through a fine needle into protruding blue blood vessels on the face, damaging the inner wall of the vessel to close it and make it less noticeable.[1]It is suited for relatively thick blood vessels; for vessels thinner than 1 mm, laser treatment may be chosen instead.[2]However, most research has focused on blood vessels in the legs, and studies examining the face alone are limited.

Which blood vessels are it suited for?

It is suited for relatively thick blood vessels. According to treatment guidelines for blood vessels, sclerotherapy is considered more effective for thicker vessels.[2]

For vessels thinner than 1 mm, people with medication allergies, those who dislike needles, or those for whom sclerotherapy was ineffective, laser treatment applied over the skin is proposed instead.[2]There are reports of improved appearance when laser is used on fine blood vessels on the face.[3]

How well established is the effectiveness?

For sclerotherapy of fine blood vessels, effectiveness superior to placebo injection is shown with moderate certainty.[2]Polidocanol, a commonly used medication, showed similar effectiveness to other agents, with less pain.[2]

However, these results are for leg blood vessels. Because facial skin is thinner and blood vessels differ in diameter and depth, the same results cannot be guaranteed.

Which is better—sclerotherapy or laser?

No clear difference has been found regarding whether fine blood vessels disappear with one approach versus the other.[2]However, laser may result in less post-treatment hyperpigmentation (dark spots).[2]

There are reports that combining laser with polidocanol resulted in greater improvement than polidocanol alone (with low certainty).[2]Conversely, it has been noted that laser alone may fail to completely close blood vessels.[1]

How often does post-treatment hyperpigmentation occur?

Post-treatment hyperpigmentation is a relatively common side effect. For treatment of fine blood vessels, it occurred in 2–25% of patients using 0.25% polidocanol, with higher concentration associated with increased incidence.[4]

Most fade within 6–12 months, but in 1–2% of patients it persists.[5]Some reports indicate that with foam-form medication, hyperpigmentation persisted beyond 1 year in up to 17.5% of cases.[6]

What other side effects should I be aware of?

New fine red blood vessels appearing near the treated area (matting) has been reported in 15–20% of cases.[5]Foam-form medication tends to cause this more frequently than liquid medication.[2]

Vessel inflammation (thrombophlebitis) occurs in 4–7.5%, and nerve injury is possible depending on location.[5]Rarely, a complication (Nicolau syndrome) has been reported in which the medication stops blood flow and causes skin necrosis.[6]

Once you understand these side effects, it is reassuring to ask beforehand about the medication concentration, whether foam or liquid will be used, and what post-treatment care entails.

What should be confirmed during consultation to determine if it is right for you?

It is important to confirm the thickness and depth of the blood vessels of concern, and whether laser treatment might be more suitable. For widespread or large vessels, treatment may need to be divided into multiple sessions.[7]

Whether your skin is prone to post-treatment hyperpigmentation is also an important factor. Have the blood vessels examined, and confirm the anticipated number of sessions and how to manage hyperpigmentation if it occurs.