Laser Treatment



Those seeking cosmetic treatment for their legs often request laser, as they believe it to be more effective, less painful and less invasive vs. sclerotherapy. With the advent of newer, advanced technology lasers, physicians debate heatedly over which laser is best to treat veins.

It must be understood that for leg spider veins telangiectasias, sclerotherapy remains the gold standard of treatment. The newest technological improvements of lasers have improved the rate of success and are slowly beginning to challenge these perceptions. Combination treatment of lasers and sclerotherapy may be the best solution for some patients.

A complicating factor for laser treatment of leg veins is that most telangiectasias are associated with high reverse pressure from associated reticular veins. Most lasers or IPL (except possibly the 1064 nm lasers) will not treat associated high-pressure reticular veins.

In general:

  • Laser is more painful
  • Sclerotherapy can cover a larger treatment area
  • Laser has a higher risk of injuring your skin
  • You can treat tanned legs with sclerotherapy (and possibly 1064nm lasers)
  • Laser is more expensive and requires more treatments


The pulsed dye laser is considered the laser of choice for most vascular lesions because of its superior clinical efficacy and a low-risk profile. The V-beam laser (595 nm) features ultra-long pulse duration so greater energy is directed at the target blood vessels over a longer period of time, resulting in more uniform blood vessel damage. This reduces the bruising seen with the earlier pulse dye lasers. The addition of dynamic cooling (DCD) increases comfort during treatment enabling higher fluencies (energy) to be delivered safely and effectively, so fewer treatments are required.


The treatment of facial telangiectasias is generally more predictable than that of the legs. The skin heals quickly and is much less likely to scar. Treatment results are often seen much more quickly as healing is much faster on the well-oxygenated skin of the face. Facial vessels have a more uniform depth than the legs. The walls themselves are much thinner and uniform and hydrostatic pressure plays no major role. Whereas the cause of telangiectasias on the legs is predominately hydrostatic pressure, facial vessels appear to result from damage to the collagen of the vessel wall by sunlight. Sun exposure damages and weakens collagen. We typically would treat facial vessels and rosacea with BBL and/or the V-Beam laser.

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