The following is an excerpt from the Glow Journal podcast. To listen to the full interview, subscribe now on iTunes or Spotify
In this instalment of our Ask An Expert series with our friends at Candela Medical, we’re taking YOUR questions to Dr Deshan Sebaratnam. A Fellow of the Australasian College of Dermatologists, Dr Deshan holds an academic appointment as Conjoint Senior Lecturer with the University of New South Wales, has presented his research internationally and has had his research published in both local and international medical journals. With experience and an interest in all facets of dermatology including medical, surgical, cosmetic and paediatric, I felt that Dr Deshan was the ideal doctor to objectively answer YOUR questions on visible and dilated capillaries and spider veins.
Away from our regular brand founder conversations, I am frequently asked so many highly specific questions about the skin. Given that I am an educated consumer and by no means an expert, it would be extremely unethical for me to even attempt to address your skin concerns- which is why I have long insisted on taking those questions to a medical doctor. That’s why I sincerely love producing this Ask An Expert series with Candela. Although the series itself is sponsored, doctors legally and ethically have to remain completely objective in interviews like this. For this reason, this series is the single most authentic way for me to integrate branded content into the podcast because it’s giving you, the listeners, completely unbiased expert answers to your most specific skin questions.
GLOW JOURNAL: Let’s begin with visible facial capillaries. Firstly, is it true that there’s technically no such thing as “broken” capillaries, and instead they’re actually just dilated capillaries?
DR DESHAN SEBARATNAM: That’s exactly right. So the name broken capillaries, or burst blood vessels, is kind of a misnomer. The blood vessels aren’t broken. If your blood vessels break, then you end up with a bruise.
It’s exactly the way you you described it. The vessels aren’t broken, they’re just a bit bigger than they are naturally. And so as they increase in size, you can then see them. They become visible to the naked eye and that’s what’s commonly known as a “broken” or “burst” blood vessel.
So what is the difference between a dilated capillary, a spider vein and telangiectasia?
Excellent question. Telangiectasia is just the scientific name for most kinds of blood vessels- more so the smaller vessels. There’s lots of different blood vessels in your body. You’ve got your heart, and then the heart sends out blood through the arteries. The arteries then get smaller and smaller and smaller, they turn into capillaries, and that’s where oxygen and nutrient exchange takes place. And then the vessels go back to the heart via the veins. So when most people talk about telangiectasia, they’re talking about the small vessels, the capillaries, but it can capture some of the small arteries and some veins as well, depending on the context.
In terms of the “broken” blood vessels, normally they’re small arterials- those are the names of the tiny arteries or veins.
And the last one, spider veins. There’s actually two things which have the name “spider” in them. One is a spider nevus. With the spider nevus, you’ve got a central, big blood vessel that kind of comes up and then from it, it’s got these… if you think about it in 3D, it’s kind of like an umbrella. You’ve got the central vein and then the spokes coming out of it. But if you look at it from the top, it looks like one big red blob with little legs coming out. That’s a spider nevus.
Then the other thing is a spider vein. I think that name comes from the fact that it looks a little bit like a spider web because you get lots of these tiny little blue veins, which all kind of form a network.
I received a bunch of questions along the same line, which was “Why are visible capillaries so common around the nose area?”
I don’t actually have a really good evidence-based answer for that! You are 100% right, though. I see them all the time around the nose. I have them on my nose! I get them zapped because I hate the look of them. I don’t have a good evidence-based answer, but the nose is right in the middle of the face so you can imagine there’s lots of blood vessels coming from lots of different angles. So I imagine it might have a little bit to do with the way the blood flow takes place in the face. It might just be a watershed area, but that’s just me speculating.
I’ve had a listener ask “Do genetics come into play at all with broken capillaries? Are some people predisposed to them?”
Genetics kind of refers to a few different things. Specifically, when we’re talking about medical phenomena, it’s the genes that you pass down from one generation to another- but it’s not just the actual DNA that gets passed down from one generation to another. Money gets passed down from one generation to another, lifestyles get passed down from one generation to another. So, generally speaking, if your parents were fair skinned, you’re probably going to have fair skin, which means you’re going to be a bit more susceptible to sun damage. But the other thing is if your family grew up on the beach and spend a lot of time outdoors with lots of sun exposure, you’re going to get some of those habits as well. And on the flip side, if your parents are really good with sunscreen, in theory, you might be a little bit better with your sunscreen. So genetics do play a little bit of a role in that regard. But I guess the other thing that’s also really important to mention is that there’s lots of genetic conditions which can present with broken blood vessels. I’m a paediatric dermatologist and an adult dermatologist as well, so when I see a patient who comes in at 24, it’s a very different conversation when I see a patient coming in at 4 with broken blood vessels because there are some genetic conditions that can present with broken blood vessels.
Is there anything that we can do to prevent broken capillaries or dilated capillaries?
Yes, so I was speaking a little bit about sun protective habits, and that’s definitely something that can help slow down that process.
In terms of why people get broken capillaries, there’s a few different components to it. One is that you can get increased flow. Your blood vessels are like little pipes and they pump your blood around, and if you’re getting lots and lots of increased flow, what happens is eventually that pressure makes the vessels get a bit bigger and to the point that you can see them with the eye. The other thing that can contribute is inflammation which, again, kind of feeds into the flow. If your body’s sending out chemicals and signals, that (in the setting of inflammation) can also contribute to more blood going to a particular area. Sun damage is the other component. In your blood vessels, or in your skin rather, you’ve got your blood vessels and they’re surrounded by your collagen fibres. Now, with lots and lots of sun damage, and also the passage of time, things like smoking, your collagen gets a bit shonky. And that means that the vessels, which are normally wrapped around with insulation, if the insulation degrades, then the blood vessels can get a bit bigger as well. And then the other component is genetics as well. So if you are good with your sun protection, you can at least help with keeping your collagen in good nick. And then the other thing is picking things up early. Often people will start off with just a little bit of flushing or a little bit of redness, and then as time goes by, if you let that run its natural course, eventually that kind of background and redness can lead to the start of actual, visible blood vessels that you can see with your eye.
One listener says “I feel like whenever I use a physical exfoliant, no matter how gentle it is or I am, I get burst capillaries.” What would your advice be for her?
I’m not a giant fan of physical exfoliators. With a physical exfoliant, what you should be trying to do is to perhaps get rid of the stratum corneum- that’s the very, very top layer of the skin. Underneath that you’ve got the rest of your epidermis, and then you’ve got your dermis, and that’s where all your blood vessels are. So you don’t want to be stripping off lots and lots of layers of the epidermis. It’s meant to be there, for a reason. It’s meant to be there as a mechanical barrier and also sun protection. So if you’re getting to the stage where you’re actually causing damage a few layers below in the dermis, I suspect that perhaps the physical exfoliant is maybe not as gentle as it’s purported to be.
A number of people have written in to tell me that they’ve either read or heard that laser is a really effective way to reduce the appearance of facial capillaries, but they aren’t quite ready to go down that path yet for whatever reason. One listener asks “Is it possible to fade the appearance of burst capillaries topically?”
The first thing, or the simplest thing, you can do is to use makeup with a bit of a green base. That’s a good way of camouflaging any flushing or any background redness. But, if that’s not working, there are creams available. They’re prescription strength creams, so you need to see a doctor for them. But what these do is they actually shrink down the blood vessels, but shrink them down temporarily. So with the creams, they last about 12 hours or so, and different people like to use it in different ways. Some people use it every single morning, it’s just part of their routine, and that 12 hour window gets them through their workday and they just use it every single day. It’s just part of their regime. Other people just save it up for special occasions. So day to day, they’re not too bothered, but if they’ve got a important social engagement, a job to do, whatever it may be, they can use the creams. But once you get to the stage where you can actually see the vessels with your eyes, topical treatments won’t work.
Are there any other treatments that listeners might find effective before considering laser?
Those would be the main things, I suppose, to think about.
When you’re talking about laser, that’s a relatively specific term. Outside of laser, there’s also something called “IPL” which is a similar concept to a laser. Strictly speaking it’s not a laser, but it’s still light-based energy. Depending on the settings that you use, you can focus on redness with IPL as well.
While we’re on laser and IPL, which specific treatments do you find are the most effective for dilated capillaries?
The treatment that I find the best is the pulse dye laser.
Let’s talk a little bit about what a laser is. A laser is energy of a specific wavelength, and the thing that’s special about the laser is that all the beams are traveling in sync with each other. It’s a very targeted tool. So each laser will release energy that gets absorbed by a particular structure within the skin. There’s actually dozens and dozens of lasers that are available on the market, so just because someone said “I had laser,” the next question should be “Which laser?” because they’re not all the same. Your listeners might be familiar with things like laser hair removal- that’s totally different to the laser that you use for, say, broken blood vessels. And then IPL is different again, even though it feels like the same experience. IPL is a much blunter tool, so it’s not just one specific wavelength, it’s lots and lots of wavelengths. And sometimes that’s actually quite a helpful tool.
If you have lots of reds and lots of browns and there’s a few different things that you want to target, IPL is certainly good in that way. But if you want to really focus on broken blood vessels, then my favourite tool is the pulse dye laser.
The pulse dye laser has been around for decades, all around the world. It’s used for a range of different things. You can use it for vascular birthmarks, you can use it for things like rosacea or broken blood vessels. So that’s the one that I find the most effective, and it’s also probably the one with the most amount of scientific studies out there.
One listener has asked “Is there any harm in getting the ‘spot laser treatments’ for broken capillaries on the face?”
The short answer is “no.” As I alluded to, I have the vessels around my nose and I get the Candela Vbeam once a year. One of the questions that people often ask me is “If you shut down the vessels in one area, are you going to get other blood vessels in other areas which try to compensate?” And the short answer to that is no. I suppose with any medical procedure, there’s always risks and benefits. With any kind of laser treatment, you’re still introducing energy to the skin. So with that, depending on what settings you use, there are certain things that you need to be mindful of. But in terms of compensation or redistribution of the blood vessels, that’s not something we really see.
Another listener has written in saying “Be honest, because I want to prepare myself- how painful is laser treatment for facial capillaries going to be?”
It’s not actually that bad! It’s a couple of shots here, a couple of shots there. It’s a bit of a different story when you’re getting your whole face done, so it does sting a little bit. It’s like a rubber band kind of flicking you on the knuckles. But there’s things that you can do to help with the pain. I will routinely use numbing cream. There’s lots of different numbing creams that you can use- some of them actually cause an increase of blood flow to the skin, which means that the laser can then pick up a lot more of the vessels. I find that to be quite helpful. Cooling fans are really helpful, [as are] ice packs, and you can always do things like take a Panadol beforehand.
I’m a paediatric dermatologist as well, so I have kids with things called port wine stains and I do this treatment with kids in primary school who tolerate it pretty well.
A reader has asked “What is the safest way to remove broken capillaries?” adding “Should I see a dermatologist or dermal clinician, or is this something that a beautician can treat?”
I think the safest thing is to see a dermatologist. That’s a medical specialist who’s done their medical training, and then in Australia, an extra four years of training to be a specialist in anything wrong with the skin, hair and nails. The main reason I say that is you want to know what you’re treating. Most of the time, it’ll just be bits of sun damage or things like rosacea. But if it is something like a genetic condition, or even more importantly, something like a skin cancer (that’s something really pertinent in the Australian population- two out of three Australians will get some form of skin cancer by the time they reach retirement age), you actually want to know exactly what something is before it gets blasted into smithereens. So I think the diagnosis is the most important thing.
In as much or as little detail as you wish, how does the laser actually treat the dilated capillary, and does it affect the skin around the capillary at all or just the specific thing that you’re treating?
The nice thing about the laser is that it actually leave the top layer of the skin perfectly intact. So again, I’m talking specifically about the lasers we use for vascular indications. The top layer of the skin is left perfectly intact because the laser is only absorbed by things that are essentially things that are the colour red. So if you’ve got a bit of brown to the top layer of your skin then there can be a little bit of cross-reaction, but you can change the settings so that it’s just the blood vessels that are targeted. There’s some neat videos! You can have a look on my Instagram. I have a red balloon inside a clear balloon, and I can actually use the Vbeam to target the red balloon and the outside balloon is left perfectly intact. What happens is the laser energy penetrates through the skin, it gets absorbed just by the blood vessels itself, and then depending on what settings you do, you get shut down of the blood vessels. You can change the settings in a very bespoke way to either bruise or not bruise.
In terms of the surrounding skin, in general, it shouldn’t have any adverse impact. In theory, there might be a little bit of remodelling and collagen stimulation as well with the pulse dye laser.
Let’s move on to the rest of the body. We tend to use the term “spider veins” exclusively when we’re talking really about the legs. Are they any different to what we’re seeing with dilated capillaries on the face? And, if so, what are spider veins? We touched on this earlier, but the differentiation between the face and the body was something I got asked a lot about.
It’s a different kind of process when we get to the lower legs. Going back to how we started this conversation, you’ve got your heart, your heart sends your blood out through the arteries, and then it has to come back through the veins. So in your lower leg, if you think about it, the blood actually gets to your toes and then it has to come up against gravity, traveling upwards to your heart. And so the way that happens is through a series of valves within the veins. There’s lots of reasons why those valves, with time, can stop working. Anyone will probably know that at the end of the day, if they’ve got really tight socks, when they take their socks off, there’s a bit of a transition point between where the socks are, where the skin’s kind of been compressed and then that layer on top. But, as time goes by, your body just stops being as good at getting the fluid back to the heart. So things that can contribute to that are things like surgery or pregnancy as well. That’s kind of a classic story where, when you’re pregnant, you get litres and litres of extra blood going through your system, and then you also have got this baby pushing on the pipes which return to the heart, so your blood flow kind of accumulates in your lower legs. And then that can bung up some of the valves. When that happens, you get back flow, back flow, black flow, and then that kind of declares itself on the skin, because that’s one of the intersection points between the arteries and the veins. With that backflow, that then manifests with the broken blood vessels on the lower legs.
In terms of treating the spider veins, there’s a few different options for that. The first thing is to work out is where along your plumbing the problem is, because if the plumbing is deeper, in the deep veins within the legs… anything to help the surface veins might just be a bandaid. You need to get to the root of the problem. So in terms of treatment options for spider veins, again, you can use the pulse dye laser very happily. You can inject a little sticky substance into the vein so that they shut down, and those are for the superficial types of veins. But then if the problem is deeper, then no matter what treatment you do, it’s just going to bounce back with time.
So what is the difference between a spider vein and a varicose vein?
Colloquially, spider veins refer to the small little venules or the small veins that you see on the surface of the skin, whereas varicose veins refer to the deepest structures, and I suppose the most superficial structures as well, where you have problems with the valves and you’d get that back flow.
I assume this is the same answer as when we were talking about the face, but a listener has asked “Are spider veins hereditary?”
Not so much. That’s the short answer.
And can anything be done to prevent them ahead of time?
Maintaining a healthy lifestyle as much as possible, not carrying too much weight, exercise, if you’re on your feet a lot that can contribute as well. At the first instance that there is a signal that maybe the blood flow isn’t doing what it should be doing in the lower legs seeking, treatment earlier, or investigation rather, earlier, and treatment if needed is always better earlier rather than later.
You’ve touched on how to go about treating them. I had a few questions about specific treatments. Is there a scale of sorts, perhaps a gentle kind of entry level treatment, and then a more intense one for those that have tried just about anything and will give whatever you recommend to go?
So exercise, compression garments (not just stockings- it’s the horrible, uncomfortable ones that you can buy for when you’re going on flights). The longer the better.
And if that doesn’t work, getting the ultrasound done as well to see how the internal veins are going. And if they’re all okay, then it’s just the superficial problem. Then, like I said, things like laser or the injections into the veins as well.
You mentioned pregnancy, and that was a subject I was asked so much about, so perhaps a nice one to wrap up on as there were so many questions on the one subject. Several listeners have asked “Do spider veins ever just go away on their own after they’ve appeared during pregnancy?” And another has asked “Should I wait until after I have children…” she’s not pregnant yet, but she’s planning on it, “Should I wait until after I have children to get my spider veins dissolved?”
So sometimes they can go away after pregnancy. You have giant changes in terms of the fluid load that your blood vessels have to carry. You don’t have the baby causing some backlogging in terms of blood flow. And so they can certainly help. But often there’s still a little bit of damage which happens to the veins. So it might be a signal that that’s on the cards in the future.
In terms of waiting until after having children, I guess the risk you take, if you get the veins treated prior to having kids is then you have your baby, you’ve spent all this money and have gone through all this pain having the treatment and then the veins come back… it’s kind of a risky time for spider veins. I think there’s a very good argument, if it’s not too functionally bothersome, to wait until you’ve finished all your kids and then invest your money. But, at the same time, sometimes picking things up earlier can prevent problems down the line. So there’s no hard and fast answer.
