Venous Ligation for Treatment of Cosmetically Unwanted Periorbital Facial Veins

Introduction: Treatment of unwanted periorbital facial veins is a challenge. Common modalities used to treat facial veins include electrocautery, radioelectrosurgery, laser, and microsclerotherapy. Periorbital veins resistant to electrocautery, difficult to safely target with laser, or at risk for sclerosant flow to ophthalmo-cranial anastomotic circulation may be treated with a vein ligation technique in properly selected patients. Methods: Patient selection, preoperative evaluation, exclusion criteria, and anatomic considerations are described in detail. The surgical technique is described in conjunction with intraoperative photos. Discussion: Patient selection and characteristics of ideal target vessels are reviewed to optimize results. Less than ideal patient and target vessel characteristics are reviewed in relation to inclusion and exclusion criteria for periorbital vein ligation technique. Results: This ligation technique provides a useful approach for treatment of cosmetically unwanted 1.5- to 3.0-mm facial veins in properly selected patients. Partial to full resolution may be expected for individual veins. Postoperative photographic documentation shows the typical improvement obtained. Conclusion: Periorbital facial vein ligation is a useful technique for addressing the problem of cosmetically unwanted periorbital facial veins in properly selected patients.