Chapter 17: Facial Veins

INTRODUCTION

Many patients who present for treatment of leg veins are also concerned about appearance of vascular lesions on the face. We estimate that approximately 50 percent of patients seen for evaluation of leg veins have some form of vascular cosmetic blemish on the face. These blemishes commonly include telangiectasias that are both individual and relatively isolated or large groups of matted telangiectasias on the cheeks. Cherry hemangiomas are also seen, which are small, round, red to purple, dome-shaped vascular ectasias scattered anywhere on the face or body. In addition, some patients develop enlargement of venulectases that appear as purplish vessels on the cheeks, periorbital region, vermillion, and nasal alae. A standard terminology has been proposed that divides vascular lesions into hemangiomas, malformations, and ectasias.^1–4

The first group, childhood hemangiomas, consists of proliferative lesions with endothelial hyperplasia. The second group, vascular malformations, results from anomalies of embryologic development, and in some of them, the abnormalities of the involved vessels are more functional than anatomic. The largest category is the ectasias; it is the most common type of lesion on the face for which adults request treatment (Table 17-1). Ectasias have normal endothelial turnover but have enlarged vascular spaces. Spider angioma, capillary aneurysm-venous lake, and telangiectases are examples not of vascular proliferation but dilatations of preexisting vessels. Our goal in treatment is to obliterate these vascular spaces or at least reduce their size so that they are no longer clinically apparent. For patients with rosacea, treatment can improve facial erythema and flushing as well.⁵

Special Consent for the Face

Although the face typically heals well, patients should receive instruction as to the risks of purpura, edema, potential pigmentation changes, and scarring before such vessels are treated. Special care should be taken to ensure that the patient’s expectations are appropriate and informed consent documented in the medical record. Patients should fully understand that facial vessels will need to be treated a series of times. They should understand that these veins may recur and that they will periodically need treatments to maintain their results. Angiogenic factors may play an important role particularly in patients who have a genetic predisposition to facial vessels. The patient needs to understand that further sun exposure or flushing episodes may lead to recurrence. Patients should sign a specific consent form or a note written in the chart acknowledging this discussion before beginning treatment of any form. Appendix 17-A shows a sample consent form.

Considerations: Face versus Legs