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I’m so vain… that this whole story is about me. My veins, that is. For the past several years I’ve been increasingly bothered by the very-visible veins near my eyelids: two large, dark, webs that sit above my lids—right near my brow bones—on both sides. Once I hit my mid-30s and the skin around my eyes grew thinner, it got to a point where I felt I needed heavy concealer to hide them.

I had decided to live with them—and resign myself to a lifetime of using concealer—until it occurred to me, a beauty writer, that surely there was a way to treat these highly-visible veins with one of the array of lasers, peels, or products currently on the market. The good news is that I was right: they’re treatable. The bad news: sometimes they can return after treatment. In any case, I also learned there’s a name for them: periorbital veins.

Whether yours are visible or not (perhaps one day they might be, younger readers), is strictly a cosmetic issue. Since having mine zapped, I’ve felt a sense of renewed confidence: My eyes appear lifted and more awake.

Courtesy of subject

First of all, what exactly are periorbital veins?

Periorbital is the technical name for the area around the eye socket. Periorbital veins—or periorbital reticular veins as they’re medically referred to—are “are a network of superficial veins that surround the eyes,” explains Pooja Rambhia, MD, a board-certified dermatologist in New York City. It’s completely normal—in fact, healthy—to have these veins; it’s their job to “bring deoxygenated blood away from the cells and then back, ultimately, to the heart,” says Daniel Belkin, MD, a New York City-based board-certified dermatologist.

Though we have reticular veins all over our bodies—you’ve probably seen them on your legs before—they’re more noticeable on the face, especially around the eyes, because the skin in that area is so delicate and thin. “While they’re anatomically small to moderate, reticular veins can appear prominent and cosmetically concerning in individuals with thin skin or minimal subcutaneous fat in the periorbital region,” says Dr. Rambhia. “As we age, we lose subcutaneous fat [in that area], which normally provides cushioning that helps to camouflage these vessels.”

Dr. Belkin explains that it’s possible to have visible periorbital veins on your upper eye area, as I do, but “most people have them on the lower lateral orbit, more on the under eye area, which is why a lot of people will find that they enhance the appearance of their dark circles.”

Whether or not yours appear—and where—can also depend on your skin tone (those with darker skin may not notice their periorbital veins becoming more prominent until much later in life, if at all) and unique underlying vascular anatomy. “In some cases, periorbital reticular veins may appear as subtle shadowing, while in others they present as distinct linear markings,” says Dr. Rambhia.

Another factor: chronic sun exposure, “which contributes by accelerating collagen breakdown and skin thinning, making periorbital veins appear more prominent,” says Dr. Rambhia. Hormones, untreated allergies (and in turn, frequent eye rubbing), smoking, drinking, and poor sleep can all play a role as well, she adds.

Though there are also certain medical conditions that can contribute to the visibility of periorbital veins—including thyroid disorders that impact circulation, and sleep disorders leading to fluid retention—it’s very rare that they indicate an underlying health concern, says Dr. Rambhia. But if prominent periorbital veins seem to appear overnight “accompanied by swelling, pain, or vision changes” you should seek medical attention immediately, she says.

Periorbital veins aren’t the only aesthetically pesky vessels on the face. “You can have what we call telangiectasias, which are little, tiny, visible red veins often around the nose or cheek,” says Dr. Belkin. “We also see what we call diffuse erythema, which is kind of like flushing that often happens in areas where people get rosacea, such as the middle cheek, nose, and sometimes between the brows and chin.”

You can also have reticular veins on the forehead. “That’s the one that people hate, the central vein on their forehead,” says Dr. Belkin. But unlike the aforementioned others, “that’s a functional vein that you need” and therefore it cannot be removed, he says. (Though strategic placement of neurotoxin can soften the muscle on the forehead and make the vein less visible.)

Can you make periorbital veins look less prominent?

As we’ve established, veins are vitally important to the health and function of our bodies. But we don’t need all of them to keep our blood flowing: When one vein closes, the blood reroutes to another one nearby, says Dr. Belkin.

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The most common and safest option for treatment is a laser, he says, specifically a long-pulsed Nd:YAG laser. This type of laser uses a 1064 nanometer wavelength light that penetrates deeper into the skin to target blood vessels while minimizing damage to any surrounding tissues. A laser at this wavelength, Dr. Belkin says, can target hemoglobin, a protein that gives blood its red color. “The longer the wavelength, the deeper into the skin it goes,” he says. “And because veins are under the dermis and in the fat layer, [that’s what you want in this case].” The laser heats up the blood in the vein until it bursts and is eventually absorbed by the body, says Dr. Rambhia.

Depending upon individual anatomy, you may need two to four treatments spaced four to six weeks apart to minimize or completely erase the appearance of your veins. (The average cost is about $1,500 per session, which will vary based on geographic location and provider.) “Patients may experience mild swelling and temporary darkening of treated vessels before they fade,” says Dr. Rambhia.

Despite the safety of the laser treatment, not all reticular veins on the face are created equal—and some, like temple and forehead veins, may retaliate if you attempt to remove them. That’s because when you remove a vein, your body makes new ones, explains Dr. Belkin. “During my fellowship training, we did not touch reticular veins in the temples; my mentor noticed that when he was treating temple veins, people would get veins popping up elsewhere, like their cheeks,” says Dr. Belkin. “At the end of the day you do need some veins and when you get rid of some, you may get others. Which is why I don’t like to treat temple veins. However, the reticular veins around the eye are suitable to treat because they’re small, and you just don’t need them as much.”

Another, less commonly-used (for good reason) option is sclerotherapy, which involves injecting sclerosin, a chemical solution, into the vein, which in turn causes it to close off and collapse. “That’s what we inject to treat spider and varicose veins in the legs, but the problem with using it on the face is that the veins in the face connect with the veins in the brain,” says Dr. Belkin. “So if you were to propagate a clot from doing sclerotherapy, you could cause a clot to enter the sinus of the brain, which would be a huge problem.”

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The most invasive means of getting rid of periorbital veins is surgery. Surgical removal of veins is called microphlebectomy and requires removing the vein through a tiny incision to “ligate the vein or tie it off,” says Dr. Belkin. It carries a high risk of scarring, infection, and potential damage to surrounding structures of the delicate eye area, says Dr. Rambhia.

Another option: dermal fillers, which may be used to address hollowing and thicken the skin, therefore minimizing the visibility of veins. Topical treatments like retinol may also be recommended to help build collagen and improve skin thickness over time as part of a multi-pronged treatment approach.

Tracy Evans, MD, a board-certified dermatologist in San Francisco, uses hyaluronic acid-based filler “to add a layer of thickness to the thin tissue underneath the eyes to camouflage the veins.” She also injects platelet-rich fibrin (PRF), derived from patients’ own blood, to help support tissue rejuvenation—which in turn adds more softness underneath the eyes so that veins cannot be seen.

My experience with periorbital vein removal

After months of daily poking, prodding, and lifting my brows in the mirror, I was ready to have the prominent purple veins on my brow bone treated, opting for laser removal with Dr. Belkin, who performed the treatment gratis for me as a member of the media. While I had been dreaming about the results, I was still nervous about a powerful laser being that close to my eyes, and having to wear metal ocular eyeshields on my eyeballs. But I knew I was in good hands with Dr. Belkin. He explained how important it was for me to wear these shields because of the wavelength of the laser and the depths it can travel.

Dr. Belkin numbed my eyeballs using tetracaine eye drops, which would allow him to place the metal ocular shields (coated with lubricant) into my eyes. Before he began, I wiped my eyes with a cotton pad soaked in micellar water to make sure the area was completely clear of makeup and mascara to prevent anything from scratching my eye. Afterwards, he placed the numbing drops in both my eyes, which worked almost immediately. Having your eyes numbed is a very weird, almost inexplicable feeling. I didn’t fully grasp the sensation or lack thereof until he placed the metal ocular shields over my eyes—it was only then that I realized that I didn’t feel a thing.

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Then, Dr. Belkin turned to the Excel V laser. Starting with my right eye, Dr. Belkin applied a gel and used an attachment on the laser that helps to cool the skin; this was used to both protect my skin and help the laser to glide more easily. As he began to fire the laser, it felt like a heated rubber band snapping against my brow bone. I’m not going to sugar coat this, it was painful—I needed to take a breather once or twice. Because he was using a near infrared laser, which is heat-based, he could only do one pass at time. “You can only do it once, so if the setting is not quite right, you have to wait until the next time because if you double pulse it or hit it twice, you risk heating the skin too much and causing an ulceration,” he told me.

What is weirdly cool about the treatment is that as you fire the laser, it heats up the blood and the doctor can actually see the vein being destroyed. “You can see the vein fry. You can see it coagulate under the skin and turn gray,” he said. He finished the pass with the laser and repeated the same thing on my left side. Despite the discomfort, the treatment itself was very quick, taking less than five minutes.

Once he removed the ocular shields, I had to rinse my eyes because they were blurry from the lubricant. My eyes went back to normal after about two hours and my upper eyelids were only slightly red and swollen after the laser. I could immediately see a difference in the appearance of the veins: They looked smaller and much less pronounced. I was already happy, but told me we’d know if the treatment was successful after four weeks—and if not, we’d do it again.

My periorbital vein removal results

I ultimately went through the treatment twice, spaced about four weeks apart. Though the first treatment was successful for the large vein on my right brow bone, the one on the left stood its ground and was not giving up so easily. It was a little bit smaller than before but must have reestablished a little bit of a flow, as Dr. Belkin described it.

Today, my periorbital veins are still not completely gone—but the difference is significant. My eyes look more refreshed, even-toned, and brighter. Dr. Belkin cautioned that the treated veins could come back to some extent or my body could be agreeable and they would be gone for good. “Treated veins themselves typically do not return once successfully closed by laser therapy. However, new veins can develop in the same area over time due to the body's natural ability to form collateral circulation and new blood vessels,” says Dr. Rambhia.

And while I’m not eager to put on those ocular shields again any time soon, “many patients benefit from periodic maintenance treatments to address new vessel formation before it becomes cosmetically bothersome,” says Dr. Rambhia. For now, I’m going to enjoy the results I did get—and keep my concealer nearby, just in case.

Read more about eyes:

Your Ultimate Guide to Treating Dark Circles, According to Dermatologists

Even Your Eyeballs Lose Collagen as You Age

10 Best Eye Creams for Every Possible Skin Concern