Venous Lakes; A Glance
- Best Results1-2+ sessions
- Treatment Recovery1+ days
- Procedure Time3 seconds
- Skin SpecialistDermatologist
- Duration of ResultsLong term
- AnaestheticCooling spray/gel
- Back to WorkImmediately
- Cost$ (Medicare rebate for some cases)
Venous Lake Treatment
Venous lakes are common spots. Most frequently they occur on the lower lip of middle aged to elderly people. They are commonly confused with skin cancers, including melanomas, however venous lakes are benign. The best way to treat these spots is with a vascular laser. This treatment is partially covered by Medicare.
FactsFacts On Venous Lakes
- Venous lakes are a benign proliferation of harmless blood vessels
- They are found in middle aged to elderly patients
- The occur more frequently on the lower lip
- Venous lakes are diagnosed clinically, without invasive testing
- Vascular lasers can erase venous lakes within one simple painless treatment
- Treatments take less than 3 seconds to perform
How do dermatologists diagnose venous lakes?
In 99% of cases a simple clinical examination with a hand held microscope can diagnose these lesions. Rarely, in equivocal cases, a simple skin biopsy can be useful.
What is the best treatment for venous lakes?
A deep penetrating NdYag laser is the best way to treat these lesions. Lasers work by sealing off the blood vessels within the venous lake itself. Not all lasers can treat venous lakes; as this requires a longer wavelength for deeper penetration.
We use the following lasers to treat vascular lesions; DermaV, VBeam Prima & Perfecta, Sciton Joule, 755 Alex as well as the Excel V in my Sydney office.
What is the venous lakes procedure like?
Laser light feels like a short snap on the lip. In most cases we double pulse, meaning 2 short snaps delivered over 1-2 seconds.
What is recovery like?
After the procedure you will have some swelling & color changes within the venous lake (gray to white). Swelling subsides within a day. Avoid hot food & drinks for 24 hours.
Vaseline should be used for 7 nights, longer in the event of an ulcer (rarely). Your venous lake will fade after 1-5 days to reveal normal lip skin.
Will it recur?
Providing the initial venous lake is treated fully, recurrence is slim. Partially treated venous lakes may recur, the caveat is that if you have one venous lake, you may be prone to more venous lakes in the future.
In most cases, small to medium size venous lakes (2 to 7 mm in diameter) require only one treatment. Larger venous lakes, up to & beyond 10 mm may require 2, rarely 3 sessions, spaced 4 weeks apart.
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What are the possible side effects of laser treatment?
Side effects are super rare, but include-
- Prolonged swelling >72 hours
- Ulceration- approximately 5% of cases. May take 7 days to heal
- Scarring from the laser- approximately 1% of cases
- Infection; including cold sores
What causes venous lakes?
In short, genetics. A predisposition to venous lakes is activated at a specific time in your life.
What happens if I don’t treat them?
Left alone, venous lakes will slowly grow over a decade or two. They usually maximize in size to around 4 to 8 mm. They very rarely ulcerate or bleed. It is far easier & more predictable to treat small venous lakes than to let them grow bigger.
Are they dangerous?
No. Venous lakes will never turn into cancer. They are entirely indolent & do not require treatment, apart from their unsightly presence.
What else can look like a venous lake?
Solar lentigos, sunspots, moles, freckles & even melanomas can look like venous lakes. A simple test is with diascopy or dermatoscopy & compression. A dermatologist can assist in the diagnosis.
Under magnification, venous lakes look blue to purple, whilst suspicious lesions look brown. In super rare cases, a biopsy may be required to tell the difference.
How much is venous lake treatment?
Cost for nurse led treatment is $490, performed by a dermatologist, it is $690. A partial Medicare rebate may apply if performed by a specialist. For large venous lakes, 2 sessions may be required. Contact Cutis Dermatology to book in Brisbane or DVP to book in Sydney.
Medicare item number rebate only applies when the lesions are clinically significant & obvious at a distance of at least 3 meters. This distance should be objectively measured, but is dependent on the eyesight of a Medicare review committee.
What are some other ways to treat venous lakes if you don’t have access to lasers?
Lasers are by far the most effective way of treating these lesions. Other treatments include-
- Cryotherapy; second best treatment.
- Intense pulse light or broad band light
Can a GP treat venous lakes or can you use DIY treatments at home?
Some older GPs with lots of experience can treat venous lakes using simple cryotherapy. Liquid nitrogen works well, but it may rarely scar. As for DIY treatments, you can use liquid nitrogen via a wart kill kit; it is possible, but you will need guidance from a professional.
Davin’s viewpoint on treating venous lakes
Vascular lesions on the lower lip are often concerning as they may resemble pigmented lesions such as melanoma or melanoma in-situ (superficial melanomas). Fortunately, venous lakes can be easily diagnosed & treated by dermatologists.
Dermatoscopy will reveal a featureless lesion with absent pigment network. The color is typically blue to purple. Pressure will cause blanching of the venous lake. In the absence of a dermatoscope, a simple glass slide can be used (glass slides are useful to compress the lesion prior to laser if one has a superficial wavelength such as 595 to 755 as these wavelengths do not penetrate deeply. Compression reduces the depth of venous lesions).
I prefer lasers with cryo cooling, the best is probably DermaV; it is more reliable than the Candela Prima laser. Cooling gives that extra level of protection to the epidermis, allowing for higher energy levels & greater patient comfort. In Sydney I use the ExcelV laser by Cutera. Most cases require one session, for venous lakes that are large (>8 mm), 2 to 3 treatments may be required for optimal outcomes.
Another treatment option that works very well is that of cryotherapy with liquid nitrogen. For venous lakes, the on-card cryo time ranges between 10 to 15 seconds, short bursts of nitrogen until the lesion is solid white. Wait for the lesion to completely thaw (about 20 to 40 seconds, depending on the size), then repeat. This constitutes a double freeze thaw cycle. It works; exceptionally well. Most cases resolve without scarring (less than 1 percent chance if done correctly). Cryotherapy is underutilized as it does not have a Medicare rebate.
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