Blue blood vessels on the face—can injections make them disappear? What research on sclerotherapy has revealed and its limitations

Sclerotherapy for fine blood vessels is strongly recommended as a first-line treatment option for fine blood vessels in the legs and shows greater efficacy than saline injections[1]. However, most of the research collected here involves blood vessels in the legs, and the same results are not necessarily obtained on the face[1][2]. Recurrence and pigmentation must also be taken into consideration.

Which blood vessels does sclerotherapy work on?

Sclerotherapy is a treatment in which medication is injected into the blood vessel to damage the inside of the vessel wall and close the vessel[3]. A commonly used medication is polidocanol[4].

For fine blood vessels in the legs (capillary telangiectasia or net-like veins), guidelines strongly recommend sclerotherapy with liquid or foam medication.[1]Polidocanol is reported to have similar efficacy to other drugs while causing less pain.[1].

Does the effect last indefinitely?

One treatment session may not be sufficient. In a study following an average of 36 months (approximately 3 years) after a single treatment of fine leg blood vessels, recurrence was observed in nearly all 43 patients with capillary telangiectasia.[2].

In this study, there was no difference in recurrence rates based on the type of medication used.[2]For facial blood vessels as well, it is reassuring to plan ahead assuming that additional treatment may be necessary.

How often do complications such as pigmentation occur?

Brown spot-like pigmentation is a commonly observed side effect.[5]With polidocanol 0.25%, rates were 2–25%; with 0.5%, 12.5–67.9%; with 1%, 13–73%, showing a tendency to increase with higher drug concentration.[5].

Most pigmentation darkening fades within 6–12 months, but 1–2% of cases may persist.[4]Fine new blood vessels, known as matting, occur in 15–20%, and blood vessel inflammation is reported in 4–7.5%.[4].

Animal studies show that high-concentration solution can damage lung blood vessels; literature recommends using lower concentrations.[3].

What points require special attention when treating the face?

Injections to the face, especially around the eyes, rarely cause blood vessel occlusion, leading to reported cases of skin necrosis, eyelid drooping, and vision loss.[6]This report covers facial injection therapy in general and is not limited to sclerotherapy alone.[6].

Under-eye dark circles are classified by cause: pigment, blood vessels, hollowing, or a combination of these.[7]Since the cause is often multiple, several treatments are often combined; identifying whether the blue appearance is truly from blood vessels is the starting point.[7].

Sclerotherapy or laser—which should I choose?

For fine leg blood vessels, laser and sclerotherapy show no clear difference in improvement, and laser may have a lower risk of pigmentation darkening.[1]For fine facial blood vessels treated with laser, a meta-analysis of 6 trials involving 271 patients reported that 1064 nm laser eliminated over 95% of blood vessels.[8].

However, recurrence and incomplete improvement have also been reported.[8]Given that both have limitations, choice depends on vessel caliber and location.

Thicker blue blood vessels that are easily accessible with a needle: sclerotherapy is a candidate.[1]

Very fine blood vessels (under 1 mm) or if you are uncomfortable with medication and injections: laser is a candidate.[1]

Under-eye dark circles: determining whether the cause is blood vessels, pigment, or hollowing comes first.[7]

Whether sclerotherapy suits your blood vessels or laser is better depends on vessel caliber, depth, and location, and cannot be decided from an article alone. During consultation, inform your doctor of the location of the blood vessels you are concerned about and any previous treatments, and confirm the number of sessions needed and precautions against pigmentation darkening.