Photo illustration: by The Cut; Photo: Getty Images
This column was first published in Valerie Monroe’s newsletter, How not to get facefuckedwhich you can subscribe to on Substack.
When people say that “aging is a privilege,” I assume they mean how lucky we are to do it. But like the phrase “aging gracefully,” I find it has a slightly different meaning. There’s a certain righteousness to it, a whiff of If you’re not careful, you’ll do things wrong..
I’ve been thinking about this aphorism a lot in recent weeks, as my neighbor, a young woman of remarkable beauty, strength, and compassion, recently passed away after a long battle with cancer. She left behind two young daughters. A psychotherapist, she wore her spiritual and emotional generosity openly, always inviting your presence. After her death, her family released a video they had made to say goodbye to her, an eloquent and loving tribute. In it, she never said that growing old was a privilege, but that idea—expressed in her courage, her regret, her gratitude, her adoration for her beloved family, and her reluctance to leave them—flooded every frame. She was a gift.
And now, a question from a privileged person.
Q: I have a few small broken capillaries visible on the sides of my nose. To minimize them, I have tried intense pulsed light (IPL), Vbeam (pulsed dye) laser, and cautery. None of the results seem to last. The capillaries may disappear briefly or appear to fade, but ultimately, there is not much improvement. The medical aesthetician I see and my dermatologist seem more than happy to try different approaches. But I am tired of spending money only to be disappointed. Should I give up and use concealer? Honestly, I hate concealers.
A: I don’t know why you hate concealer, dear reader, but I don’t like using it either. If I took the time to figure out which concealer would work for me and how to best use it, I might enjoy it more. But my what-you-see-is-what-you-get attitude permeates my makeup routine, such as it is.
When it comes to your capillaries, dermatologist and dermatology specialist Dr. Heidi Waldorf has some suggestions. Those small, dilated superficial veins that often appear as red, threadlike squiggles on either side of the nostrils are officially called telangiectasia. They’re commonly seen in cases of rosacea, photodamage, or after rhinoplasty, she said. They can also be the result of chronic nose blowing and rubbing, exposure to extreme temperatures, and genetics.
Treatments to minimize them can be frustrating for patients and doctors alike, Waldorf said. Have I ever told you about the time—many years ago, when I was a beauty editor—I went to a dermatologist to remove the annoying little veins on my cheeks and chin? I thought they would be easy to erase and that if there was any downtime after the laser treatment, it would be insignificant. I remember the doctor handing me a (cracked) hand mirror after the procedure so I could take a look. As my husband said when he saw me that night, I felt like I had run into a glass door. “You can’t cover the marks with makeup,” the doctor belatedly told me. It was a lesson in… something, as I noted who asked me what was going on with my face and who didn’t mention it. Back in the office, Gayle King exclaimed, “My God, Val, what happened to you?” It took about a week for the marks to disappear, and the veins disappeared with them. Waldorf speculates that the treatment was done with an old, original pulsed dye laser with a single fixed pulse duration and no cooling, which resulted in maximum bruising. This option is still available for resistant veins, but I personally would not recommend it.
Gentle electrosurgery, which uses an electric current to seal the blood vessel, can work, but there is a risk of scarring, Waldorf said. Lasers and IPL work by using a wavelength of light or a group of wavelengths that are absorbed by the hemoglobin in blood cells in these superficial vessels (while sparing surrounding structures). The technology has advanced over the past four decades, Waldorf said, but there are still some vessels that are resistant because of their size, depth, color (red or blue) and/or location.
If you have tried electrodesiccation and it has not improved your wrinkles, it is likely that they are also more resistant to other treatments. This could be a problem with changing the settings used on one device or switching to another with a different wavelength, energy and/or pulse duration. Therefore, it may be worth consulting a doctor with specific expertise in the devices. I would avoid seeing an esthetician and instead seek out a doctor who is knowledgeable about lasers.
Waldorf had some thoughts about your recurrences. You mentioned seeing the spider veins disappear for a period of time and then come back. After some types of treatment, the vessels spasm for a short period of time, seemingly disappearing. Then, after a few hours or a day, they become visible again. It’s important to remember that the mechanism by which the treatment works takes four to six weeks to see visible results. But if the veins come back after several months or a year, it may be due to an underlying predisposition—rosacea, for example—that may require different management.
Waldorf advises patients to have two or three Vbeam laser sessions to reduce the appearance of fine vessels to the point where a concealer is no longer needed. But larger veins may require a longer treatment or follow-up treatment with another laser (such as the long-pulse Nd:YAG laser). She recommends an annual visit for patients with more resistant vessels or rosacea to maintain improvement.
My goodness, there’s a lot to take in. I wouldn’t blame you if you thought, To hell with all that. But I might take my spider veins to a dermatologist one last time for an honest, objective consultation about which treatment might provide the most lasting results. If the doctor can’t guarantee a better result than what you’ve had so far, then I’d put the issue aside. Ignore the offending veins or opt for a highly recommended concealer and only use it when camouflage seems absolutely necessary (like for your child’s wedding… or your mayoral inauguration).
Originally published July 6.
See everything