What it is
The excel V+ fires two wavelengths at hemoglobin, the red pigment in blood. 532 nm handles bright red vessels near the surface; 1064 nm reaches deeper, bluer vessels and is the safer wavelength on darker skin. Each pulse heats the blood inside a vessel until its wall collapses, and your body clears the remnant over the following weeks. Surrounding skin is largely spared because it holds far less hemoglobin.
That selectivity defines what the laser can and cannot do. Discrete targets respond fastest: broken capillaries around the nose, cherry angiomas, the red vessels sun leaves on cheeks. Diffuse rosacea redness and flushing improve too, but they come from a vessel-forming tendency rather than a fixed set of vessels, so maintenance visits belong in an honest plan. Small brown sun spots respond to the 532 nm side as well, since melanin also absorbs that wavelength.
What responds
- Broken capillaries around the nose and across the cheeks
- Diffuse redness and flushing that flares with heat, alcohol or exercise
- Cherry angiomas: small bright-red bumps on the face or trunk
- Red marks that linger after acne heals (post-inflammatory erythema)
- Small brown sun spots on lighter skin, via the 532 nm wavelength
What happens, step by step
- 1
Exam and mapping
Dr. Mueller examines your skin in person (California law requires it before any laser) and maps which targets get 532 nm and which get 1064 nm.
- 2
Shields and cooling
You wear metal eye shields while the sapphire tip chills the skin before and during every pulse.
- 3
The pulses
Each vessel is traced or spot-treated; a full face takes about 15 to 20 minutes, a few discrete vessels far less.
- 4
Right after
Skin runs pink and slightly swollen for a few hours, and treated vessels may darken before they fade.
- 5
The weeks after
Vessels break down and clear over 2 to 6 weeks; strict sun protection keeps pigment from moving into the treated area.
Risks, stated plainly
Honest list, not fine print. Every one of these is part of the consent conversation at your exam.
- Redness and swelling for a few hours up to 2 days
- Bruising or gray-white vessel darkening that takes days to clear
- Blistering or crusting if a vessel absorbs more energy than planned; uncommon, and it usually heals clean
- Pigment change (darker or lighter patches), the main risk on tanned or darker skin with 532 nm; wavelength choice and test spots are the mitigation
- Recurrence: rosacea keeps producing new vessels, so cleared does not mean cured
- Eye injury without proper shields, which is why the shields are never optional
The evidence
- A 2022 pooled analysis of rosacea trials found microsecond 1064 nm laser treatment reduced facial redness on par with pulsed dye laser, the long-standing reference device for vascular work.
- A 2024 systematic review of 16 studies on energy devices during isotretinoin found vascular laser treatment did not need to be delayed, consistent with the 2017 ASDS consensus that specifically named vascular lasers.
Straight answers
- Does it hurt?
- Each pulse feels like a rubber-band snap chased by cold from the sapphire tip. Spot treatments need no numbing, and most full-face sessions skip it too.
- How many sessions until a vessel is gone?
- A single visible capillary often clears in 1 to 2 sessions. Diffuse redness typically takes 2 to 3, spaced about a month apart and judged on standardized photos rather than memory.
- Will the redness come back?
- A destroyed vessel does not return, but rosacea is a tendency, not a lesion: new vessels form over months to years. Plan on occasional maintenance rather than a one-time fix.
- Can I get this while on isotretinoin?
- Yes, under physician judgment. The 2017 ASDS consensus lists vascular lasers among procedures that need not wait out an isotretinoin washout, and a 2024 review of 16 studies reached the same conclusion. It pairs naturally with the online prescription program.
- What does it cost?
- A full-face session is $250 and a spot treatment is $95, itemized on the pricing page; nothing is added at checkout.
- Does it work on darker skin?
- The 1064 nm side passes through melanin lightly enough for vessel work on Fitzpatrick IV to VI. The 532 nm side is reserved for lighter skin, and Dr. Mueller makes that call at the exam.