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Laser Varicose Veins Superficial And Deep

With laser varicose veins can be really effectively treated with long term resolution.  As long as the correct treatment and laser type is used.

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As I mentioned in the page on veins and laser generally treatments need to be targeted for the correct approach for each vein problem.

Laser & Large Varicose Veins

Large varicose veins are usually associated with damaged, or incompetent, deeper draining veins.  Like the saphenous vein.

These deeper draining veins require laser energy to be applied from inside them.

Laser varicose veins by endovenous laser fibre energy application from inside the veins shown diagrammatically

Schematically it works as noted in the illustration.

Treating The Large Surface Veins

The larger surface vessels will not respond to laser treatments for two reasons.

One, they are too tortuous to allow a laser fibre to track inside them.  It gets caught in the wall at the bends.

Two, they are too large in diameter for an externally aimed laser beam to penetrate effectively enough.

Limits Of Surface Laser Treatments

The limit in surface tissue penetration means that only vessels up to certain size can be treated from the outside.

This applies to everything you can see looking at the legs.  Everything you would be aware of.

As I mentioned vessels up to 3mm diameter can be managed with an appropriate laser.  I use the Xeo Cool Glide for these.

Xeo Cool Glide Laser Platform

As a stand-alone platform they are known as Excel lasers.

Made by Cutera in Brisbane, California, within Silicon Valley south of San Francisco, they have the grunt needed to close vessels.  The drive unit can generate enough power for a high power short pulse.

Controls for this need to allow variation for the amount of power with each pulse, the timing it is delivered over - longer for wider veins - and the size of the actual beam.

Laser varicose veins by the Cutera Xeo Cool Glide laser touch screen control panel showing power, pulse width, repetitions and beam size informationTouch screen panel on Xeo Cool Glide laser.

The width of the beam embraces two elements in effective laser varicose veins treatment.

The vessel size can be matched. 

The depth of penetration can be varied.

Laser Varicose Veins Penetration Considerations

On average increasing wavelength of lasers allows for deeper penetration into the tissue. 

Too long a wavelength as I mentioned will strongly absorb into water.  It will get absorbed almost immediately at the surface of the skin.


As the beam size increases you can penetrate ever deeper.  But there is a limit.  Once this is reached larger beam widths get no further in.

Laser varicose veins Xeo Cool Glide laser hand-piece showing adjustable beam width controlBeam adjustment in millimetres

With the 1064nm NdYAG Cool Glide laser 7mm is about this limit. 

Going to 10mm, which we can use for hair removal, tracks no deeper.

Larger Surface Veins By Laser

Therefore 7mm tends to be the size we use for treating most larger surface veins.

Then varying the length of the time the laser fires over allows us to match the size of the vessel we are closing down.

Tissue End Points

I adjust the energy supplied by each pulse to get the end effect I am looking for in laser varicose veins.  It should spasm and appear to disappear.

Too much energy and I will cook the protein element of the skin. 

Just like the white or albumin of an egg going from transparent to white, too much energy shows as a whitening of the tissue.

It needs adjusting down.

Individual Variation

No two people will be alike in the energy settings they require for effective laser varicose veins treatments. 

There is a general range I am aiming at.  But individual responses determine each person’s settings.

This will be affected physically by skin depth, vessel size and flow and general tissue transparency.

Fine Surface Veins By Laser

Smaller vessels like the associated spider veins are usually treated with a 5mm beam. 

As they are situated in the skin itself, the energy does not need to penetrate as deep.

Just as with the larger blue veins, the timing of energy delivery is varied according to spider vein size.

Mechanics Of A Session

Really efficient treatment with laser varicose veins requires repeated shots along the length of each vein.  A bit like spot welding. 

Generally a longer length of the vein than the actual beam diameter will close.  But still quite close to the shot.

The effective metal cooling tip of the Xeo Cool Glide makes treatment much more comfortable than other equivalent lasers.

You will feel an instantaneous zap - a bit like a pinprick in the spider veins.

More like a deep immediate ache zap for the bigger blue veins.  


Unlike surface vein sclerotherapy, or injection treatment, there is no after sting.  There might occasionally be a very mild ache.

Comparison With Sclerotherapy Injection Treatment

On the other hand the advantage with sclerotherapy is the treatment solution will follow along the vein for quite a distance.

This means fewer injections than the close repeated shots for the laser varicose veins approach. 

It easily follows a tortuous track for effective closure.  Especially if those tortuous tracks dive down deeper from the skin as they can do.

Sclerotherapy After Endovenous Laser

Which is one of the reasons apart from just size why the large varicose veins are ideally managed after the deeper vessels are treated with endovenous laser by sclerotherapy.

Injection treatment can close down really large vessels.  The solution or prepared foam will track along the interior of the vessel.

Solutions and foam create a very superficial graze inside the vessels resulting in closure.  They cover the lining very evenly.

Debate With Phlebectomy

Some vein treatment centres will advocate pulling out these surface segments of large veins, especially in the thigh. 

With injection approaches at times small amounts of blood get trapped around knotty corners as the veins close and will slowly clear with the body’s remodeling methods.

In doing so some iron pigment is left behind for body stores.  A brown mark will appear.  A bit like an old bruise.

Releasing Trapped Blood

For this reason I will release most of these trapped blood areas when I follow up on your veins.  It minimises the brown staining line.

Others will leave these collections as they all will go with time.

But, as I suggested, there are centres preferring to pull out such vessels to prevent this temporary effect.

Phlebectomy Effects

Even so pulling the vessels out will cause bruising. 

Tissue reactions can occur producing smaller surface vessels.  They may settle.  Some will not. 

Then they will require further treatment.

Each nick in the skin carries risks of other injury to small nerves and local lymphatic drainage.  If too large, scars will result.

Laser Versus Sclerotherapy Tissue Effects

Unlike sclerotherapy laser varicose veins causes a deep reaction within the vessel walls.  Not just along the very surface.

Laser varicose veins results in deeper tissue effects compared with sclerotherapy. Label from Venacure 1470nm laser for endovenous treatments showing power delivery levels.Power production levels for Venacure endovenous laser

This can result in a stronger closure.

Considerations With Surface Laser

As well as the chance to not have to wear the associated compression stockings for as long.  Which is a win for most people.

On the other hand as laser surface work requires more time it is usually more expensive.

Surface vein laser treatments are usually spaced six or more weeks apart. 

This is to allow for the treatment effects inside the vessels to settle down.  It results in a more comfortable subsequent treatment.

Compare With Endovenous Laser Management

The endovenous sessions by fibre to the deeper veins vary from this.

Laser varicose veins in endovenous laser treatments showing the Venacure laser perforator fibre with its delivery tip.End of the Venacure laser perforator fibre with delivery tip showing

I will advise wearing the compression stockings for two weeks after the laser session.

However the surface treatment, by sclerotherapy, can be done from around two weeks after this type of laser varicose veins session.

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