Vascular lesion laser treatment guide: spider veins, broken capillaries, and cherry angiomas

Vascular lesion treatment with laser and intense pulsed light (IPL) uses selective photothermolysis — targeting the chromophore oxyhemoglobin within abnormal blood vessels — to heat and close unwanted vasculature while leaving surrounding skin intact. Different lasers and wavelengths target different vascular lesions based on vessel depth, diameter, and chromophore concentration. Here is a complete guide.

The mechanism: selective photothermolysis for vascular targets

Oxyhemoglobin as chromophore

Anderson and Parrish (1983) established the principle of selective photothermolysis: a laser wavelength absorbed preferentially by a specific chromophore, with a pulse duration shorter than the thermal relaxation time of the target, selectively heats and destroys the target while sparing surrounding tissue.

For vascular lesions, the chromophore is oxyhemoglobin — the oxygen-carrying form of hemoglobin in blood. Oxyhemoglobin has absorption peaks at:
418 nm (Soret band — ultraviolet-visible boundary; not used clinically)
542 nm (visible green — KTP and some IPL channels)
577 nm (visible yellow-green — pulsed dye laser)
1064 nm (near-infrared — weaker absorption but penetrates deeper)

When laser energy at these wavelengths is absorbed by oxyhemoglobin:
Heat is generated within the blood within the vessel
Vessel wall is thermally damaged → endothelial damage → vessel coagulates
The closed vessel is cleared by the body's immune system over days to weeks
The overlying skin, which has much lower oxyhemoglobin absorption, is spared

---

Laser wavelengths by lesion type

Pulsed dye laser (PDL) — 585/595 nm

The PDL is the gold standard for vascular lesion treatment — designed specifically for oxyhemoglobin absorption at 577/595 nm (the Q-switched iteration improved from the original 577 nm to 595 nm for deeper penetration).

Mechanism: 595 nm is strongly absorbed by oxyhemoglobin; pulse durations of 0.45–40 ms allow selective thermal damage to vessels of varying diameters.

Best for:
Port wine stains: PDL is the first-line treatment for port wine birthmarks — the most extensively studied vascular laser indication. Multiple sessions (typically 6–10+) produce significant lightening
Facial telangiectasia (fine broken capillaries): Spider-like vessels on the nose, cheeks, and chin; excellent clearance with 1–3 sessions
Hemangiomas (infantile and adult)
Rosacea vascular component — the diffuse redness and visible capillaries of rosacea; significant improvement in erythema after a series
Erythematous (red) scars and striae — the vascular component of new scars responds well to PDL

The purpura reaction: At standard PDL settings, the rapid thermal damage to blood vessels produces immediate purpura — a bruise-like redness that turns purple within minutes, representing blood extravasation from thermally damaged capillary walls. Purpura resolves in 7–14 days. Sub-purpuric settings (lower fluence, longer pulse duration) can minimize purpura with reduced efficacy per session; multiple sessions at sub-purpuric settings vs. fewer sessions at purpuric settings is a clinical tradeoff.

KTP laser — 532 nm

The KTP (potassium titanyl phosphate) laser at 532 nm also has strong oxyhemoglobin absorption — slightly less than 577/595 nm but in the same spectral territory.

Best for:
Superficial facial telangiectasia: Fine capillaries on the nose and cheeks; highly effective with less purpura than PDL in many patients
Cherry angiomas: Small bright-red benign angiomas common from the 30s onward; 1–2 sessions typically clear these completely
Rosacea diffuse redness: The 532 nm provides efficient treatment of diffuse erythema; well-suited to the widespread capillary network of rosacea
Flat facial spider veins

Advantage over PDL: The 532 nm KTP tends to produce less purpura than PDL at equivalent efficacy for superficial vessels — more socially acceptable immediate downtime for many patients.

Disadvantage: Shallower penetration than PDL — less effective for deeper or larger caliber vessels.

Nd:YAG 1064 nm (long-pulse)

Long-pulse Nd:YAG at 1064 nm has weaker oxyhemoglobin absorption than the 500–600 nm range but significantly deeper tissue penetration (6–8 mm vs. 1–2 mm for KTP).

Best for:
Deeper facial vessels and larger telangiectasia not reached by KTP or PDL
Leg spider veins (telangiectasias): Superficial leg veins 0.3–1.0 mm diameter; Nd:YAG 1064 nm is the most appropriate laser for leg veins (the vessels are deeper and larger than facial capillaries)
Reticular veins on the legs (blue-green 1–3 mm vessels)
Resistant port wine stains — as combination with PDL for darker lesions

Safe for darker skin types: 1064 nm has relatively less melanin absorption — safer for Fitzpatrick types IV–VI compared to KTP and PDL.

IPL (Intense Pulsed Light) — broadband 500–1200 nm filtered

IPL is not a single-wavelength laser but a broadband light source filtered to selected wavelength ranges. For vascular treatment, filters selecting 515–600 nm or 560–600 nm target oxyhemoglobin.

Best for:
Diffuse facial redness and rosacea: IPL is highly effective for treating the widespread vascular component of rosacea — treating a broad area efficiently in each pass rather than targeting individual vessels
Mild-to-moderate telangiectasia across large areas
Photorejuvenation combining vascular + pigment: IPL simultaneously addresses diffuse redness and brown pigmentation (solar lentigines) — useful for patients with general sun damage

Limitations: IPL is not appropriate for port wine stains, hemangiomas, or significant individual vessels where precise wavelength and pulse targeting are needed. More operator-dependent than single-wavelength lasers.

---

Specific lesions

Cherry angiomas

Cherry angiomas (senile angiomas, de Morgan spots) are benign vascular proliferations — bright red, dome-shaped papules 1–5 mm, appearing from the 30s onward. They contain a dense nest of dilated capillaries.

Treatment: KTP 532 nm or PDL are both highly effective — typically 1–2 sessions for complete clearance. Electrocautery (simple, inexpensive, immediate) is an alternative for very small lesions. No recurrence of the treated lesion; new cherry angiomas may continue to appear elsewhere.

Spider veins (leg telangiectasia)

Superficial red and blue leg veins 0.1–1.5 mm diameter. Treatment options:
Sclerotherapy: Injection of sclerosant solution (polidocanol, sodium tetradecyl sulfate) into the vein — the gold standard for leg spider veins; more cost-effective than laser for multiple vessels
Nd:YAG 1064 nm laser: Alternative to sclerotherapy; no injection; appropriate for very fine vessels or those resistant to sclerotherapy

Broken capillaries (facial telangiectasia)

The fine red vessels visible on the nose, cheeks, and nasal ala — most commonly from rosacea, sun damage, or hereditary predisposition.

Treatment: KTP 532 nm or PDL; 1–3 sessions; IPL for diffuse cases. Individual discrete vessels are targeted and immediately blanch during treatment.

---

Treatment experience and downtime

Facial vascular treatment (PDL / KTP)

During treatment: Mild stinging or rubber-band-snap sensation at each pulse. Topical anesthetic reduces discomfort; most patients rate 2–4/10.

Post-treatment (no purpura settings): Immediate redness and mild swelling at treated vessels; resolves within hours. Makeup applicable same day.

Post-treatment (purpuric PDL settings): Immediate purpura (blue-purple bruising) at treated areas — inevitable at standard PDL settings. Resolves in 7–14 days. Concealer covers adequately after Day 2.

Results timeline: Treated vessels gradually fade over 2–6 weeks as the body clears the coagulated vasculature.

---

Skin type considerations

| Wavelength | Fitzpatrick I–III | Fitzpatrick IV | Fitzpatrick V–VI |
|---|---|---|---|
| PDL 595 nm | Excellent | Caution (melanin competition) | High risk — avoid |
| KTP 532 nm | Excellent | Caution | Avoid |
| Nd:YAG 1064 nm | Good | Good | Appropriate (less melanin absorption) |
| IPL | Excellent | Caution | Avoid |

For Fitzpatrick types IV–VI with vascular lesions, Nd:YAG 1064 nm is the laser of choice — its longer wavelength has significantly less epidermal melanin absorption, reducing the risk of post-treatment hyperpigmentation or burns.

---

Looking for a vascular lesion or laser treatment provider? Browse med spa providers on MedSpot →