Facial blood vessels: Which is right for you, sclerotherapy or laser? How to choose based on vessel diameter

In summaries of research comparing sclerotherapy and laser for fine blood vessel treatment, no clear difference has been observed in improvement rates[1]. Differences tend to appear in vessel diameter and side effects; very fine vessels are said to suit laser treatment, while thicker vessels are better suited to sclerotherapy, and pigmentation tends to be less with laser[1][2]. However, most of these comparisons are studies of leg blood vessels, and within the scope of our review, we found no research directly comparing the two on the face.

What is the difference in mechanism between sclerotherapy and laser?

Sclerotherapy is a method in which medication is injected into the blood vessel to seal it by adhering the vessel walls together[3]. Laser is a method that hardens blood vessels by directing light from above the skin, and does not use a needle[1].

For small blood vessels, polidocanol is a commonly used medication. It has similar efficacy to other drugs and is reported to cause less pain.[1].

Does the appropriate treatment change depending on blood vessel diameter?

Yes, it does. Research on leg vessels showed that lasers are effective for very fine vessels under 1 mm in diameter, while sclerotherapy becomes more effective as vessels become larger.[2].

According to guidelines for leg blood vessels from the American vascular medicine society, laser is recommended for patients with allergies to medications, those who are uncomfortable with needles, those for whom sclerotherapy was ineffective, and those with newly appearing fine vessels under 1 mm in diameter.[1]For fine facial blood vessels, there are reports that many disappear with Nd:YAG laser treatment, but long-term results are still limited at present.[4].

Which has fewer side effects?

A notable difference is post-inflammatory hyperpigmentation (darkening that remains after treatment). According to research summaries, laser treatment tended to show less hyperpigmentation.[1]On the other hand, some studies reported that laser treatment caused stronger pain.[1].

Pigmentation from sclerotherapy tends to increase as the drug concentration becomes stronger.[5]Treatment of fine blood vessels using polidocanol 0.25% has been reported to occur in 2–25% of people.[5].

Another concern is "matting," where new fine blood vessels appear to increase after treatment.[6]While these may fade within about 12 months, they persist in up to approximately 10% of people according to reports.[6]Foam-based medication is reported to cause this more readily than liquid formulation.[1].

What rare but important complications should I know about?

Sclerotherapy can cause changes in vision such as blurred vision or headaches, and most cases resolve naturally.[7]Rarely, serious complications have been reported, including deep vein thrombosis, severe allergic reactions, and cerebral circulation disorders.[7].

Sclerotherapy is contraindicated in people with medication allergies or those with existing thrombosis.[3]Always disclose any pre-existing conditions, medications you are taking, and past allergies beforehand.

What are the guidelines for choosing based on facial blood vessels?

First, confirm the thickness and location of the blood vessel of concern. The options differ depending on whether it is very fine red blood vessels or blue blood vessels visible beneath the eyes.

Most of the figures presented here are from leg blood vessels. Because facial blood vessels follow different pathways than leg blood vessels, the results may not be identical.

Based on the article alone, you cannot determine which treatment is right for your facial blood vessels. During your consultation, convey the thickness and location of your blood vessels, susceptibility to pigmentation, allergies, and pre-existing conditions, and confirm the rationale for the chosen treatment and precautions when treating around the eyes.