Treating couperose, rosacea and thread veins with light and laser
Couperose, rosacea, red thread veins on the nose and cheeks, thread veins on the legs and cherry angiomas have one thing in common: they all involve dilated blood vessels in the skin. This page explains how light and laser close a vessel via the red blood pigment haemoglobin, which wavelengths are suitable for this and where the limits lie.
It also covers numbers of sessions, pain perception, healing, triggers, skincare and the question of when a doctor should take a look first. The matching SIACSKIN devices are the DERMAFORCE BBL PRO for couperose and diffuse redness and the SIACSKIN x Velaslift, a diode laser for vascular lesions and thread veins.
What is couperose and how does it differ from rosacea?
Couperose refers to permanently dilated, visible thread veins and redness on the cheeks and nose, whereas rosacea is a chronic inflammatory skin disease of which these vessels can be a part. In couperose, the fine vessels of the facial skin are dilated and no longer contract, usually owing to predisposition and aggravated by sun exposure. It is often regarded as a precursor or mild form of rosacea. In rosacea there are additionally episodes of flushing, burning, inflammatory papules and pustules, and sometimes the eyes are involved. The diagnosis is made by a dermatologist.
In both cases the visible vessels and the redness can be addressed with light. The DERMAFORCE BBL PRO from SIACSKIN lists vessels, couperose and redness as applications.
Which stages of rosacea respond to light and laser treatment?
The early, predominantly vascular form responds best, that is, persistent redness and visible thread veins without marked inflammation. Here the target is clear: dilated vessels, which the light targets via haemoglobin. In the form with papules and pustules, medical treatment of the inflammation takes priority, and light can then reduce the remaining redness. Bulbous thickening of the skin, for example on the nose, is not a matter for vascular treatment but for ablative procedures in medical hands. No treatment is carried out during an acute flare.
The DERMAFORCE BBL PRO is used for redness and vessels, including in rosacea. For individual vascular lesions there is the SIACSKIN x Velaslift.
What helps against persistent facial redness and flushing?
A course of pulsed light helps against persistent facial redness, while flushing itself is helped above all by avoiding the triggers. The background redness is caused by a dense network of dilated capillaries that are barely visible individually. Broadband light reaches this network across the whole area and allows it to fade session by session. Flushing, the sudden reddening with a sensation of heat, is an overreaction of the vessels to stimuli such as heat, alcohol or stress. With fewer vessels it usually becomes weaker but does not disappear completely.
For larger areas, the DERMAFORCE BBL PRO is suitable with its spot sizes of 45 × 15 mm and 30 × 12 mm. The Skin Analyzer Pro assesses redness and shows in a before-and-after comparison what has changed.
Light or laser: which works better on individual thread veins on and around the nose?
For individual, clearly visible thread veins the laser is usually the better choice; for diffuse redness with many fine vessels, pulsed light. A laser focuses the energy on the individual vessel and can be guided along its course. Light treats a whole area at once and has the advantage when the cheeks and nose are red overall. Vessels on the sides of the nose are thicker and have a stronger blood flow than those on the cheeks; they often need more sessions and are more likely to return.
The SIACSKIN x Velaslift is a multi-wavelength diode laser that lists vascular lesions and redness as applications. The DERMAFORCE BBL PRO takes care of larger areas. The two combine well.
Can thread veins on the legs (spider veins) be removed by laser, and what are the limits?
Yes, fine red and violet thread veins up to about 1 mm in diameter can be closed with the laser; for larger and bluish veins, sclerotherapy is usually superior. Leg vessels lie deeper than facial vessels, have thicker walls and are under higher pressure. They therefore respond more slowly: 2 to 4 sessions at intervals of 6 to 8 weeks are usual, and fading takes weeks. If a deeper vein feeds the thread veins, they will return. In the case of varicose veins or heavy or swollen legs, a vein examination comes first.
The SIACSKIN x Velaslift explicitly lists thread veins and vascular lesions as applications. The diode laser weighs around 12 kg and can be used on a mobile basis.
Can ruby spots (cherry angiomas) be removed with laser or light?
Yes, cherry angiomas can usually be removed with laser or pulsed light in 1 to 2 sessions. They are benign clusters of fine blood vessels, ranging from the size of a pinhead to that of a lentil, which increase over the years, mainly on the trunk. Because they are engorged with blood, they absorb the light energy very well. After the pulse the lesion turns dark to grey, forms a crust and falls off after 1 to 2 weeks. New cherry angiomas can develop elsewhere. If a lesion bleeds, grows quickly or is dark and irregular, a dermatologist should look at it first.
The SIACSKIN x Velaslift, which lists vascular lesions as an application, is suitable. For many small lesions on fair skin, the DERMAFORCE BBL PRO is an option.
How do light and laser close a thread vein without injuring the skin above it?
The light is absorbed by the red blood pigment haemoglobin and converted into heat, which closes the vessel from the inside. The blood heats up within milliseconds, the vessel wall coagulates and seals, and the body breaks down the closed-off thread vein over the following weeks. The technical term is selective photothermolysis: the wavelength is chosen so that haemoglobin absorbs it strongly and the surrounding skin only slightly, and the pulse is so short that the heat stays within the vessel. Cooling additionally protects the epidermis.
The DERMAFORCE BBL PRO implements this with filtered light, adjustable pulse width up to 800 ms and sapphire contact cooling. The SIACSKIN x Velaslift works as a diode laser with individual wavelengths.
Which wavelengths reach blood vessels in the skin?
Haemoglobin absorbs light mainly in the blue, green and yellow range, with peaks around 420, 540 and 577 nm, and again more weakly in the near infrared. What matters is the interplay with penetration depth. Blue light barely penetrates, while green and yellow light between about 500 and 600 nm reaches fine, superficial red thread veins on the face. For deeper, thicker and bluish vessels, longer-wavelength light is used: it is absorbed more weakly but penetrates deeper and places less strain on the melanin in the epidermis.
With 400 to 800 nm and 9 filters, the DERMAFORCE BBL PRO covers the visible range. The SIACSKIN x Velaslift offers the four wavelengths 450, 635, 980 and 1470 nm and lists vascular lesions, leg thread veins and redness as applications.
How many sessions are needed for couperose and leg thread veins (spider veins), and at what intervals?
For couperose and diffuse redness, 3 to 5 sessions at intervals of 3 to 4 weeks are usual; for leg thread veins, 2 to 4 sessions at intervals of 6 to 8 weeks. Individual facial thread veins and cherry angiomas have often disappeared after 1 to 2 sessions. The intervals are determined by the breakdown process: the body needs weeks to clear a closed vessel, longer on the legs than on the face. Only then does it become apparent what is left. How many sessions are needed depends on the number, thickness and depth of the vessels.
With the DERMAFORCE BBL PRO a session takes 15 to 30 minutes. The SIACSKIN x Velaslift is intended for leg thread veins and individual vascular lesions.
What does the skin look like after vascular treatment with light or laser?
Immediately afterwards the skin is red, warm and slightly swollen, similar to mild sunburn. Treated thread veins have either disappeared straight away or initially look darker and greyer. Occasionally small bluish marks resembling a bruise or fine crusts develop, which subside after 1 to 2 weeks. On the legs it takes longer, and brownish discolouration along the vessel can remain visible there for months. For the first few days the rule is: cool the skin, no sauna, no hot showers, no strenuous exercise, no scratching, and sun protection factor 50 daily.
After a session with the DERMAFORCE BBL PRO, the redness usually subsides within hours. The individual skincare steps are set out in the SIACSKIN aftercare guide.
What makes couperose and rosacea worse, and which skincare is suitable between sessions?
The most important triggers are UV light, heat, sauna, sharp changes in temperature, alcohol, spicy food, hot drinks and stress. They dilate the vessels again and again and promote new thread veins. Skincare can also irritate: alcohol, fragrances, menthol, coarse exfoliants and hot water are unfavourable. Gentle cleansing with lukewarm water, a low-irritant moisturiser and sun protection factor 50 every day are better. A short diary helps you identify your own triggers, as they differ from person to person.
Between sessions with the DERMAFORCE BBL PRO, the Sensitive Cream and the Suncream Sensitiv SPF50 from the SIACSKIN skincare range are suitable; both form part of the aftercare following laser treatments.
Is the result of couperose treatment permanent, or do the thread veins come back?
The body breaks down a completely closed thread vein, and it generally does not return. Vessels that are only partially closed can reopen. However, the tendency to develop new vessels remains: couperose and rosacea are a matter of predisposition and continue to be driven by sun, heat and other triggers, so that new thread veins and redness can form over months and years. Maintenance is therefore part of the course: usually 1 to 2 top-up sessions per year, together with daily sun protection and avoidance of known triggers. Those who take this to heart benefit from the result for considerably longer.
With sessions of 15 to 30 minutes, the DERMAFORCE BBL PRO is well suited to such top-up sessions. The Skin Analyzer Pro records the redness in a before-and-after comparison.
Can couperose and red thread veins also be treated on dark skin?
On dark skin, vascular treatment is possible only to a limited extent, because the melanin in the epidermis absorbs the same wavelengths as the haemoglobin in the vessel. Green and yellow light, which targets fine red thread veins best, also heats the epidermis in skin types V and VI. The result can be burns and light or dark pigment spots. Longer wavelengths tend to spare the melanin but require experience, cautious parameters, strong cooling and always a test patch. This also applies to tanned skin.
The DERMAFORCE BBL PRO is intended for skin types I to IV. Whether the SIACSKIN x Velaslift, as a diode laser, is an option for a darker skin type is best clarified in a consultation.
Does treatment of couperose and thread veins (spider veins) with light or laser hurt?
The treatment can be felt but is well tolerated by most people: each pulse feels like a brief, hot snap from a rubber band. The sides of the nose and the upper lip are the most sensitive. On the legs the sensation is usually stronger because the thread veins there need more energy. Skin with rosacea reacts more readily to heat, so treatment starts with low energy there. A numbing cream is rarely necessary and tends to be counterproductive when treating vessels, because it can constrict the thread veins and the light then finds less of a target. Afterwards a feeling of warmth like that after mild sunburn remains for a few hours.
For comfort, cooling matters most. The DERMAFORCE BBL PRO cools via a sapphire directly at the light outlet. In addition, the KYROMASTER can be used, which cools with cold air down to minus 50 °C before, during and after treatment.
When should redness and thread veins first be checked by a doctor?
Anything that is new, one-sided, inflamed or painful, or that changes quickly, should be seen by a doctor. This includes redness with papules, pustules or burning eyes, because this points to rosacea, butterfly-shaped redness across the cheeks and nose, vascular lesions that bleed or grow, and many newly appearing star-shaped thread veins. In the case of leg thread veins accompanied by heavy, swollen legs or varicose veins, a vein examination comes first. Pregnancy, photosensitising medication and blood thinners are also clarified beforehand.
Once the cause has been established, couperose and redness can be treated with the DERMAFORCE BBL PRO and individual vascular lesions with the SIACSKIN x Velaslift. Who is permitted to perform which treatment is regulated differently from country to country.
