Treatment of Periorbital Veins With Long-Pulse Nd:YAG Laser

Periorbital veins (POVs) are a common cosmetic concern. Anatomically, POVs are formed by superficial facial veins that start from the bridge of the nose, travel as supraorbital and infraorbital veins, and join venous branches from the lateral forehead and scalp. In patients with fair skin, or in patients whose facial skin is atrophied, POVs can become prominent. This can lead to a fatigued appearance, with perceived "dark circles" around the patients' eyes. Previously described surgical therapies for prominent POVs are invasive and can leave unsightly scars, and sclerotherapy has been reported to lead to embolization that could lead to blindness. Here, we give examples of the use of 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to non-invasively treat or at least minimize prominent POVs. We discuss various techniques, and review treatment schedules to achieve the optimal cosmetic outcome. Furthermore, potential pitfalls, such as local site reaction and laser-specific tissue damage, are explored. Overall, Nd:YAG laser does appear to be a safe and effective treatment for POVs that requires minimal post-treatment care.