At some point, many people will look in the mirror and see that dreaded tiny red line or a cluster of red lines that resemble a spider web somewhere on their face or body. Broken capillaries, or telangiectasia, are typically found in places where skin is exposed to daily environmental stressors. They can appear anywhere on the body but are most likely found on the face, neck, and chest. Broken capillaries are not a cause for concern but can be frustrating for an individual, as they will not go away on their own and are generally hard to camouflage with makeup.
{mprestriction ids=”3,4,26,18,6,7,8,9,14,18″}
UNDERSTANDING CAPILLARIES
Broken capillaries occur when the walls of veins weaken. This can be caused by various factors. When the walls deteriorate and become dilated, the vein becomes visible at the surface of skin. Capillaries are thin vessels that only allow red blood cells to flow through them in a single file formation, thus making them fragile.
Types of Capillaries
First and most common, are the red veins seen largely on the face, sitting in the superficial dermis. They can appear as a single, bright red line, arborizing configurations (multiple branching lines), or spider angiomas which have a red papule in the center with the spider web appearance around it. When pressure is applied and the vein blanches, meaning it turns pale and almost disappears, this plays a crucial role in a successful treatment outcome.2
Secondly, blue or green veins are venous capillaries that sit much deeper in skin. They are more commonly associated with the lower body such as the legs. If these veins are visible on the face, they are much harder to treat, and it is often better to refer clients to a vein specialist.
Lastly, cherry angiomas are red circular growths that can develop anywhere on the body. These are a collection of broken vessels that can be smooth, flat or raised, and are noncancerous lesions.
CAUSES OF BROKEN CAPILLARIES
There are various reasons as to why red vascular vessels appear. Understanding the main causes is beneficial for both professionals and their clients. The most common causes of broken capillaries include many triggers.
Skin care professionals should consider several factors, such as their clients using at-home devices. This list includes microdermabrasion devices, extractor tools, suction cleansing devices, microneedling devices, and more. When these devices are placed in untrained hands, they can often become harsh and aggressive, causing many problems like broken capillaries.
It is also important for professionals in the spa to select the right candidates for treatments. Always evaluate the health of clients’ skin prior to a treatment. For example, if their skin is on the thinner side, choose a more conservative depth for microneedling. If their barrier is dry and sensitized, avoid microdermabrasion all together. If skin is vascular or thin, lower the power of the suction when performing a hydrodermabrasion treatment. If extractions are being done, never force or push too hard to achieve an extraction. Always do what is right for the client, not what they are asking to be done. Customer service is important but not at the expense of skin health.
Although steam treatments can feel nice and soften sebum for easier extractions, not all clients are candidates because steam can dilate blood vessels. If the client’s skin has more of a red vascular appearance or has several broken capillaries in the cheek or chin area, avoid using steam. Educate clients on minimizing the use of hot saunas, hot tubs, hot yoga, hot water, and harsh scrubs as well.
Additional Causes & Triggers
Rosacea: Most clients with rosacea typically have hotter skin to the touch due to enlarged veins and an overactive vascular system. This constant state of heat may lead to broken capillaries.
Diet: Certain foods that may cause the swelling of blood vessels include spicy foods, alcohol, and caffeine, causing broken capillaries to appear more prominently.
Genetics: Individuals who have a family history of easily developed broken capillaries will most likely inherit the same trait.
Alcoholism: Alcohol can create a temporary dilatation of capillary walls. If alcohol consumption is used frequently, this can lead to a more permanent appearance.
Sun Exposure: Sun damage can enlarge the blood vessels, leading them to draw visibly closer to the surface of skin.
Trauma: Aggressive or improperly performed extractions as well as pressure and constant adjusting of glasses on the bridge of the nose can lead to broken capillaries.
Allergies: The sudden pressure changes of sneezing, blowing the nose, and rubbing the area with tissues can lead to telangiectasia.
Pregnancy: Pregnancy puts pressure on blood vessels, and it is not uncommon to experience an increase in broken capillaries and varicose veins.
Medical Conditions: Long-term steroid use, some autoimmune diseases, radiation, and chemotherapy can lead to broken capillaries.
Weather Changes: Quick changes in the weather can cause skin to rapidly flush, resulting in weakened and bursting capillaries.
TREATMENT OPTIONS
There are several different treatment options available when looking to minimize broken capillaries. Currently, intense pulse light (IPL), electrical cauterization, and sclerotherapy are the most effective. It is important to do a consultation with every client and make sure proper expectations are set for how many treatments may be needed, along with future maintenance. Not all treatment options work for everyone; some individuals may need several treatments of the selected modality, and for some, it may only minimize their capillaries instead of eliminating them all together. It is not uncommon for broken capillaries to make an appearance again, especially in the same areas.
Intense Pulse Light
IPL is a wavelength of light that is attracted to different chromophores. The chromophores, or targets for IPL, include melanin (browns) and oxyhemoglobin (reds). When treating red broken capillaries, IPL locates the oxyhemoglobin. The action of IPL creates energy that is converted into heat, which then allows the blood vessel to be damaged. As a result, the vessel closes, and the blood flows back and is absorbed by the body. This method can take multiple treatments especially on the nose area. Vessels on the ala, or the sides of the nose, can be resistant to laser treatments; therefore, this area may require more aggressive settings and multiple appointments. Poikiloderma is a mottled discoloration of skin and consists of erythema, hyperpigmentation, and telangiectasia. Presenting on the upper sides of the neck and below the ears, it is a common complaint among many women. IPL is an excellent choice in treating this condition as well. Shorter wavelengths target more superficial veins and pigment, while longer wavelengths reach deeper into skin.2
The chromophore in red vascular lesions has an absorption of 500 nanometers to 1,200 nanometers with IPL. Melanin is a competing chromophore; therefore, IPL utilizes a cooling method to protect the epidermis from thermal injury during treatment.2 Some providers may choose to disengage the use of cooling when working on telangiectasia, as overcooling may blanch the vessels and suppress blood flow, reducing the efficacy of the treatment. When dealing with vascularity, it may be more beneficial to avoid numbing cream as this can create suppression of the vascular system or false erythema, making treatment less effective.
For Fitzpatrick types I to III, IPL has been proven to create great results. For larger vessels or darker Fitzpatrick types, a 1,064-nanometer laser may be used in treatment. Generally, with Fitzpatrick types IV to VI, it is less common to experience broken capillaries. When performing IPL, the clinical endpoint to look for during a successful reduction is the darkening of the vessel to an almost blue or black color or the constriction of the vessel that makes the vein almost completely invisible.4
Electrical Cauterization
Electrical cauterization uses a pinpoint needle to deliver a frequency to capillaries which then coagulate the dilated capillary. It is important to not overdo the energy of the device as this can lead to scarring of the area. During healing, the area will look like a scratch and can take five to seven days to heal. It is advised to not pick or scratch the treated skin. Clients should be provided with a healing ointment to accelerate healing. For stubborn, unresponsive veins, the combination of IPL followed immediately by electrical cauterization will knock the vein out. This is accomplished by softly tapping along the entire length of the capillary, and it will most likely disappear.
Sclerotherapy
Sclerotherapy is most commonly used for spider and thrombosed veins in the legs. Some medical providers may choose to use the procedure on stubborn deeper veins on the face, neck, or chest, but it is uncommon. Sclerotherapy refers to the injection of a solution into a vein to shrink it.
There are typically three different solutions used. Hypertonic saline is the most affordable and widely used solution. The saline concentrate irritates veins, resulting in the veins closing and becoming no longer visible. This option comes with quite a bit of discomfort. Burning in the injection site and bruising post-treatment is normal. Sodium tetradecyl and polidocanol are similar in nature. They are more expensive options but create much less discomfort for the client. These are detergents that foam in the vein to create clotting, leading to the blood rerouting to healthier veins. Individuals could experience bruising post-treatment and are generally required to wear compression stockings for a few days if the treatment occurred on the lower body. As always, if veins are not responding and are deeper than what a professional can achieve with their devices, it is best to refer the client to a vein specialist.1
Cryotherapy
Cryotherapy can be used as an alternative treatment if cherry angiomas are not responding to IPL or an electrical cauterization device but should not be used on generalized broken capillaries. Cryotherapy involves applying liquid nitrogen to the cherry angioma lesion to freeze it using a swab, spray, or pen device. Always refer to the directions of the specific device being used, but the typical time of application to the cherry angioma can range from five to seven seconds for effective treatment.
PREVENTING CAPILLARIES
Ingredients and products that may reduce the onset of capillaries include sunscreen, vitamin C, and horse chestnut seed extract. Sunscreen is the number one factor in antiaging and prevention of sun damage. It is also the number one choice for telangiectasia prevention. The topical use of vitamin C increases the strength of capillaries, fights daily oxidative stress, and is another glorious layer of defense against the harmful effects of the sun. Internal vitamin C supplements can also be taken to strengthen the capillary walls. However, prescribing supplements is not in the scope of practice for some skin care professionals. Always recommend clients to speak with their doctor before adding supplements to their regimen. Horse chestnut seed extract is an anti-inflammatory and antioxidant that has a substance known as aescin. Applied topically, it strengthens veins; taken orally, it has been shown to strengthen venous insufficiency.3 Cold rollers are also a great way to calm inflamed skin to soothe and reduce the chances of broken capillaries.
In conclusion, noticeable results are evident after a single treatment for properly selected candidates. As with most skin care treatments, a series of three to five treatments may be needed. With that, IPL, electrical cauterization, and sclerotherapy are not cures for broken capillaries; maintenance treatments may be scheduled as needed.
References
- Aquino, MD , Melinda L. “San Francisco Vein Center.” San Francisco Vein Doctor | Varicose & Spider Vein Treatment, March 19, 2021. https://www.sfveincenter.com/.
- Small, Rebecca, and Dalano Hoang. A Practical Guide to Laser Procedures. Philadelphia: Wolters Kluwer, 2016.
- Healthy, The Editors of The. “Horse Chestnut: How It Can Help Varicose Veins and More.” The Healthy. The Healthy, September 16, 2020. http://www.thehealthy.com/nutrition/horse-chestnut-benefits/.
- Obagi, Zein E. The Art of Skin Health Restoration and Rejuvenation: The Science of Clinical Practice. Boca Raton: CRC Press, Taylor & Francis Group, 2015.
{/mprestriction}
Holly Sheppard has been involved with the medical field for over 13 years – five of those years as a licensed aesthetician and laser technician. She also holds certifications in oncology aesthetics and eyelash lift services. She enjoys continuously expanding her knowledge and skills with advanced training. Sheppard takes pride in creating unique customized treatments with the latest technology that are both corrective and relaxing. She sees beauty in every individual and believes that taking the time to invest in skin is a decision that lasts a lifetime. Sheppard performs various aesthetic treatments; some popular treatments include IPL, laser resurfacing, peels and facials, microneedling, Emsculpt Body Toning, Hydrafacial, and more.
