Unlike leg veins, which are induced and aggravated by gravity, facial telangiectasia are usually capillaries or small arteries (arterioles) in the papillary dermis, with weakened elastic fibers in their walls which allow them to dilate and become visible, and despite their common name, they are not true "veins". They can be classified according to their appearance as linear, arborizing (branching), spider, or punctate telangiectasia. The linear and arborizing type occur most commonly around the nose, and the spider type are most common on the cheeks.
Background: Before medical lasers were developed, facial telangiectasia were usually treated with pinpoint electrocauterization ("electric needle"). Besides being uncomfortable, cauterization often caused pinpoint scarring and discoloration, especially in the thicke, oily facial skin areas where telangiectasia commonly occur. In the late 1970's and early 1980's, the continous wave (CW) CO2 laser was used, although results were little better than with electrocautery. The Argon Laser's blue-green light is effective for superficial vessels, but its shallow penetration and non-specific thermal effect limits its use on deeper vessels and dark skinned patients. In the late 1980's the Pulsed Dye Laser, emitting short pulses of yellow light was developed, and although it's effective, its short pulse duration (less than 1 millisecond) ruptures the telangiectasia, causing purpura, or black and blue marks, which can take up to 2 weeks to resolve. In the 90's the Copper Vapor Laser , Copper Bromide, and Krypton lasers were also used to treat facial telangeictasia. Later, the Frequency Doubled Q-Switched Nd.YAG laser, which is usually used to treat certain tattoo colors, was noted to be effective, but the short Q-Switched pulse also caused vessel rupture with purpura.
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