Nd:YAG clears facial spider veins and broken capillaries reliably, usually in one session. Leg veins are a different problem — and if yours keep returning, the surface was never the issue.
1064nm Nd:YAG passes through skin and is absorbed by the blood inside the vessel, coagulating it so the wall collapses and the body clears it. Treats vessels up to about 3mm — facial spider veins, broken capillaries, small leg veins. Usually one to three sessions, minimal downtime. Does not treat varicose veins, and recurring leg veins often mean something underneath needs assessing first.
Facial and leg vessels behave differently. Facial veins are usually a local problem — sun damage, rosacea, or a vessel that dilated and stayed that way. They clear well and tend to stay clear.
Leg veins frequently aren't local at all.
Deep in the leg, vein valves are supposed to stop blood flowing backward. When they stop closing properly — venous insufficiency — blood pools and pressure is transmitted outward to the small surface vessels.
Those surface vessels dilate under that pressure. That's the spider vein you can see.
Lasering it removes the visible vessel and changes nothing about the pressure. So new ones appear, often within months, often nearby. The treatment worked. The cause didn't go anywhere.
Any of those and the useful next step is venous assessment — usually a duplex ultrasound with a vein specialist — rather than another course of surface treatment. Treating the reflux first makes the cosmetic work last.
The 1064nm wavelength does two things that matter here.
It penetrates deep enough to reach the vessel. Superficial vascular lesions sit below the epidermis, and shorter wavelengths are absorbed before they get there.
It's absorbed poorly by melanin. That's the safety argument — the laser passes through pigmented skin and acts on the blood rather than heating the surrounding tissue. It makes Nd:YAG the safest vascular option across a broad range of skin tones.
IPL is broad-spectrum light and treats diffuse redness well — rosacea, general flushing, background colour across a whole area.
It's a poor choice for discrete vessels. A single visible spider vein needs energy delivered into that vessel, not scattered across the region. And because IPL is absorbed by melanin as well as haemoglobin, it carries meaningfully higher pigmentation risk above Fitzpatrick III.
Different jobs. More on device selection.
For leg veins this is the more useful question, and the answer isn't always laser.
Sclerotherapy's real advantage is that the sclerosant travels along the vessel and reaches feeding branches the eye can't see. Laser treats only what's directly targeted. For a network of leg veins, that difference matters.
Many patients with leg veins do better with sclerotherapy — and being told that is more useful than being sold a course of laser that clears the visible vessels while the feeders stay open.
See a vein specialist or your physician rather than booking cosmetic treatment if you have bulging or ropey varicose veins, persistent leg swelling, skin colour changes or thickening around the ankle, or an ulcer or non-healing area on the lower leg.
Sudden pain, swelling, warmth, or redness in one leg needs urgent assessment — that can indicate a clot.
None of these respond to surface laser, and some indicate a condition that will worsen without treatment.
Almost everything above concerns legs. Facial vessels — the fine red lines on the cheeks, the broken capillaries around the nostrils — usually have a local cause and clear reliably, often in a single session.
The one thing worth knowing: if the redness is diffuse rather than a discrete vessel, or if you flush easily, that may be rosacea. It's managed differently, and treating individual vessels won't address the background colour.
Facial vessels I'm happy to treat same day — it's a quick, reliable, satisfying treatment. Legs I ask more questions about, because a patient who's had spider veins lasered twice already and is back for a third round usually has something upstream that nobody's looked at. Treating the surface again is the wrong answer, even though it's the one they came in asking for.
How does laser vein removal work?
Nd:YAG laser energy at 1064nm passes through the skin and is absorbed by haemoglobin inside the vessel. That heats and coagulates the blood, collapsing the vessel wall. The body then clears the collapsed vessel over the following weeks and blood reroutes through healthy vessels nearby. The overlying skin is not ablated.
What size veins can be treated with laser?
Superficial vessels up to approximately 3mm respond well — facial spider veins, broken capillaries, and small red or blue leg veins. Larger reticular veins are often better treated with sclerotherapy, and bulging varicose veins are not a cosmetic problem at all. Those require vascular assessment.
Why do my leg spider veins keep coming back?
Most commonly because of underlying venous insufficiency. When vein valves deeper in the leg fail to close properly, blood pools and pressure is transmitted to surface vessels — which is what produces the visible spider veins. Treating the surface vessel removes what you can see without addressing the pressure causing it, so new vessels appear. Recurring leg veins, particularly alongside aching, heaviness, or evening ankle swelling, warrant vascular assessment before further cosmetic treatment.
Is laser or sclerotherapy better for spider veins?
They suit different vessels. Laser is better for facial vessels, where injection is impractical, and for very fine leg veins too small to cannulate. Sclerotherapy is generally more effective for larger leg veins and reticular veins, because the sclerosant travels along the vessel rather than treating only what is directly targeted. Many patients with leg veins do better with sclerotherapy, or with both.
Does laser vein removal hurt?
Most patients describe a snapping or stinging sensation with each pulse, similar to a rubber band. Cooling is used during treatment and topical numbing is available. Sessions are brief, typically ten to thirty minutes depending on the area.
How many sessions are needed?
One to three for most areas. Facial vessels frequently clear in a single session. Leg veins generally need more, and results depend heavily on whether an underlying cause is present.
Is laser vein removal safe for darker skin tones?
Nd:YAG at 1064nm is the safest vascular wavelength across skin tones because it is absorbed relatively poorly by melanin and penetrates deeply enough to reach the vessel. This is a meaningful advantage over IPL for vascular treatment, which carries higher pigmentation risk in deeper skin types.
What is the downtime after laser vein removal?
Minimal. Mild redness and swelling around the treated vessel for a day or two, with occasional bruising. Treated vessels darken briefly before fading over two to six weeks. Normal activity resumes immediately, though sun protection is advised on treated areas.
If yours have been treated before and come back, that's the useful thing to mention at consultation — it usually changes the plan.
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