What are facial telangiectasia?
Facial telangiectasia presents the image of 'broken' blood vessels and constitutes an aesthetic issue. However, their contribution to the pathology of rosacea is crucial, as it often coexists with inflammation and a sensation of heat. Sometimes patients may not notice them but observe redness, flushing, and swelling. These symptoms are caused by the dilation of blood vessels, while examination with a lens or a dermatoscope reveals the presence of telangiectasia on the face leading to this redness.
Telangiectasia essentially refers to dilated vessels, and the use of specialized vascular lasers is necessary for their treatment.
What causes them and how do they form?
The causes of facial telangiectasia vary. Sun exposure to ultraviolet radiation is crucial, leading to collagen and elastin fiber degeneration. These components are the fundamental substances of the skin and blood vessels. Consequently, this results in a more lax, aged skin with more lax vessel walls, making their dilation more likely. Smoking and natural aging also have a similar effect on collagen and elastin quality.
Other factors that may lead to the formation of telangiectasia include disruption during the healing process after inflammation. The release of growth factors that lead to angiogenesis is part of the healing process, but more vessels than necessary may be produced, or they may have imperfections in their formation, which, in combination with possible skin atrophy, can lead to their dilation or make them more apparent.
Telangiectasia formation is also crucial for the pathogenesis of rosacea. The initial stage of this condition may only have a strong vascular component without the presence of pimples and pustules as in more advanced stages. Dilated walls may make the vessels more permeable to immune cells, thus creating a vicious cycle where inflammation leads to telangiectasia, and telangiectasia increases inflammation.
Most of the time in our clinic, we are called upon to address facial telangiectasia as part of rosacea treatment. It is crucial to treat the entire face as we have found through original published work abroad that the entire face is affected, even if the symptoms are not present throughout its extent.
What is the appropriate treatment method?
The only effective treatment for telangiectasia is through the use of specialized targeted lasers. The appropriate machine emits energy at a wavelength selectively absorbed by the chromophore hemoglobin, which has a red color due to the iron it contains. Hemoglobin is the protein found inside blood vessels. This means that the vessel heats much more than the surrounding skin, and in this targeted way, we destroy the vessel from within, without causing damage to the overlying skin. The vessel must be damaged enough to lead the body to degrade and absorb it in the following days, but not too much to avoid necrosis and unnecessary inflammation.
For this reason, after examination, we need to evaluate the size, number, and location of telangiectasia on the face and choose the appropriate handpiece, on the appropriate machine, and set the appropriate intensity and pulse duration. In some cases, we choose, after consulting with the patient, to treat some telangiectasia individually, while in other cases, we cover the entire facial area. Similarly, we can also treat the décolleté and neck area, where telangiectasia may also appear.
Improvement is always seen after just one session, although sometimes 2-3 sessions are required for the desired result. The patient's response allows us to adjust the settings in each subsequent session and to proceed more aggressively if possible. There is a sensation of heat during application only and redness for a few days afterward. It is advisable not to undergo these treatments during periods of intense sun exposure.
The results of lasers on the cherry angiomas that we all have and increase with age are impressive. These are primarily cherry angiomas, and 1-2 sessions are enough to make them disappear without a trace. Similarly, we use these lasers for angiomas that may exist from birth or childhood.
Treatment cost
The cost of treatment depends on the individual case and can be estimated after a detailed evaluation of the patient and discussion regarding post-therapy.
