What to do about spider veins on your face

This column first appeared in Valerie Monroe’s newsletter, How not to argue your facewhich you can subscribe to in Substack.

When people say “Aging is a privilege,” I guess they mean how lucky we are to do so. But like the phrase “aging gracefully,” I find it slightly off-putting. There is a justice to it, a smell If you’re not careful, you’ll get it wrong.

I have been thinking a lot about this aphorism over the past two weeks because my neighbor, a young woman of remarkable beauty, strength, and compassion, recently passed away after a long battle with cancer. He left two young daughters. A psychotherapist, she openly wore her spiritual and emotional generosity, always inviting your presence. After her death, her family released a video they had made to say goodbye, an eloquent and loving memorial. In it, she never said that aging is a privilege, but this perception—expressed in her courage, her sorrow, her gratitude, her adoration for her beloved family, and her reluctance to abandon them—infused every frame. It was a gift.

And now a question from one of the privileged few.

Q: I have some tiny, noticeable broken capillaries on the sides of my nose. To minimize them, I have tried intense pulsed light (IPL), Vbeam laser (pulsed dye) and cautery treatments. No effect seems to be left. Capillaries may disappear for a while or look like they are fading, but ultimately there is not much improvement. Both the medical esthetician I see and my dermatologist seem very happy to try different approaches. But I’m tired of spending money only to be disappointed. Should I give up and use concealer? Honestly, I hate concealer.

A: I’m not sure why you hate concealer, Dear Reader, but I don’t like using it either. If I had taken the time to figure out which concealer could work for me and how to use it to my advantage, I might have loved it more. But my attitude—what you see is what you get—permeates my makeup routine, as it is.

As for your capillaries, HNTFUYF DermDiva Heidi Waldorf, MD., has a few suggestions. These tiny, superficial dilated veins that often appear as red, threadlike striations on either side of the nostrils are officially called telangiectasia. They’re usually seen with rosacea, photo damage or after rhinoplasty, she said. It is also likely to be a result of chronic blowing and rubbing of the nose, exposure to extreme temperatures and genetics.

Treatment to minimize them can be frustrating for both patients and doctors, Waldorf said. Have I told you about the time – many years ago, when I first became a beauty editor – that I saw a dermatologist to get rid of those pesky little veins on my cheeks and chin? I thought they would be easy to erase, and if there was downtime after the laser treatment, it would be insignificant. I remember the doctor passing me a (cracked) hand mirror after the procedure so I could take a look. As my husband said when he saw me that night, it looked like I walked face first into a glass door. “You won’t be able to cover the scars with makeup,” the doctor belatedly told me. It was a lesson in… something, as I noted who asked me what was going on with my face and who didn’t mention it. Back in the office, Gale King exclaimed, “Oh my God, Val, what’s wrong with you?” It took about a week for the scars to disappear and the veins went with them. Waldorf speculates that the treatment was done with an old/prototype pulsed dye laser with a single fixed pulse duration and no cooling, so there was maximum bruising. This option is still available for resistant veins, but personally? I wouldn’t recommend it.

Fine electrolysis — using an electric current to seal the blood vessel — can work, although there is a risk of scarring, Waldorf said. Lasers and IPL work by using a wavelength or group of wavelengths of light that is absorbed by the hemoglobin in the blood cells in these superficial vessels (while not being restricted by the surrounding structures). Technology has advanced over the past four decades, Waldorf said, but there are still ships that are resistant because of their size, depth, color (red or blue) and/or where they are.

If you’ve tried electrolysis and it didn’t reduce your breakouts, it’s likely that they’re more resistant to other treatments. It may be a matter of changing the parameters used in one device or switching to another with a different wavelength, energy and/or pulse duration. So seeing a doctor with special expertise in devices could be helpful. I would avoid seeing an esthetician and instead seek out a doctor who is knowledgeable about lasers.

Waldorf had some thoughts about your relapses. You mention that you see the telangiectasia go away for a while and then come back. After certain types of treatment, the vessels break for a short time, appearing to disappear. Then, after a few hours or a day, they become visible again. It is important to remember that the mechanism by which the treatment works takes four to six weeks for visible results. But if the veins return after several months or a year, it could be due to an underlying predisposition—rosacea, for example—that may need different treatment.

Waldorf advises patients that two to three Vbeam laser treatments are generally successful in reducing the appearance of fine veins to the point where concealer is not needed. But larger veins may need more or additional treatment with a different laser (such as long pulse Nd:YAG). He recommends an annual visit for patients with more resistant vessels or rosacea to maintain improvement.

God, it’s a lot to take in. I wouldn’t blame you if you thought, The hell with it. But I might take my telangiectasia to a dermatologist one last time for an honest, meaningful consultation about what treatment might provide the most lasting results. If the doctor cannot ensure a better result than you have had in the past, then I will file the case. Ignore offending veins or pop for a concealer is highly recommended and only use it when coverage is absolutely necessary (like for your child’s wedding… or the mayor’s swearing-in).

Originally published on July 6.