What it is
A vascular laser delivers a wavelength of light that is preferentially absorbed by oxyhemoglobin — the protein in red blood cells inside a vessel. The energy passes through the surface of the skin (largely unabsorbed by the epidermis) and is absorbed by the blood inside the target vessel. The blood heats, the vessel wall coagulates, and over the following days to weeks the body reabsorbs the closed vessel.
Two wavelengths cover most vascular work:
- 595 nm pulsed-dye — the gold-standard wavelength for superficial facial vessels, diffuse redness, and rosacea. Strong hemoglobin absorption, shallow penetration. Can produce purpura (bruising) at higher fluence.
- 1064 nm Nd:YAG — penetrates deeper, weaker hemoglobin absorption per pulse but ideal for larger and deeper vessels and safer for darker skin types.
The result is removal or fading of the vessel without breaking the surface of the skin. There is no crust, no scab, no resurfacing — the work happens underneath.
How Dr. Brown approaches it
Vessel depth, vessel diameter, and skin type drive the selection. The wrong wavelength under-treats deep vessels or over-treats epidermal melanin in darker skin.
Esvie protocol:
- Map the vessels. Diffuse redness, distinct telangiectasias, individual lesions like cherry angiomas — each gets its own approach.
- Wavelength selection. 595 nm pulsed-dye for shallow facial vessels and rosacea. 1064 nm Nd:YAG for deeper vessels, larger lesions, and skin types IV–VI.
- Pulse duration. Shorter pulses for small fast-flow vessels; longer pulses for larger, slower vessels and to reduce purpura.
- Endpoint. Visible vessel blanching or graying immediately after the pulse, without epidermal damage.
- Series planning. Distinct vessels often resolve in one or two passes. Diffuse redness and rosacea are a series — typically three to four sessions, four to six weeks apart, then maintenance.
Vascular lasers pair well with 1064 nm Nd:YAG (Laser Genesis) for the residual diffuse redness underneath visible vessels, and with IPL where pigment also needs to be addressed. Where individual leg vessels are the concern, sclerotherapy is often more effective than laser.
What to expect
Day of treatment. Topical numbing optional and depends on area and aggressiveness. Eye shields placed. Each pulse feels like a quick warm snap. Cooling spray or contact cooling protects the skin surface between pulses. Treatment runs 15–45 minutes depending on area and vessel count.
Immediately after. Mild redness, swelling, and warmth for a few hours. For larger vessels or more aggressive settings, expect purpura — gray-to-purple bruising over the treated vessels — for five to ten days. This is the treated blood inside the closed vessel; it resolves on its own. Plan accordingly around social events.
Days 1–14. Vessels fade or disappear. Diffuse redness improves gradually. Mineral makeup may be applied the next day.
Weeks 2–6. Diffuse redness continues to improve. Some patients see substantial change in a single session; most rosacea cases require three to four sessions for full effect.
Maintenance. Rosacea and chronic redness are biologic conditions — the underlying tendency does not go away. Maintenance treatments one to two times per year hold the result. Identifying and reducing triggers (alcohol, heat, certain skincare) makes a measurable difference.
Candidacy
Good candidates have visible facial vessels, diffuse redness, rosacea-pattern flushing, individual vascular lesions, or red or purple scars; have not had recent unprotected sun exposure on the area; are not pregnant or nursing; and are willing to accept a chance of bruising for 5–10 days when treating larger vessels.
Vascular lasers extend safely to all skin types when the wavelength is matched correctly — 1064 nm Nd:YAG is the wavelength of choice for skin types IV–VI.
Not a candidate if you are pregnant or nursing, have active infection at the planned site, are on a photosensitizing medication in the relevant window, or have an active tan on the treatment area.
If your concern is large leg veins, sclerotherapy (an injection-based treatment) is typically more effective than laser. If diffuse redness is the dominant problem rather than discrete vessels, a 1064 nm Nd:YAG protocol like Laser Genesis may be a more comfortable starting point with less chance of bruising.