Venous Lakes on the Lips and Face: Laser Options

A venous lake is a small, soft, dark blue or purple bump caused by a widened vein just under the skin, most often on the lower lip, ears or face. It is benign, and a vascular laser such as Nd:YAG can often close it in one or two sessions. Because a few serious conditions can look similar, a dark spot on the lip should always be examined before anyone treats it.

What a venous lake is

Doctors sometimes call these lesions venous lakes or venous varices. Each one is a single small vein, or a tiny pocket of connected veins, that has stretched and filled with slow-moving blood. They usually measure a few millimetres, feel soft and squashy, and range in colour from deep blue to violet.

They are most common in adults over 50 and tend to appear on skin that has had years of sun exposure. The lower lip is a classic spot, followed by the rims of the ears, the cheeks and the neck. Long-term sun damage is thought to weaken the support around small vessels, allowing them to widen. Many people who spend time outdoors, whether fishing, gardening or working on the water, notice them over time.

Venous lakes are harmless, but they can be a nuisance. On the lip, they may be bitten, catch on a toothbrush, bleed after minor injury, or simply be more visible than you would like.

Ruling out other lesions first

A dark bump on the lip is not something to diagnose by looking in the mirror. Other conditions that can look similar include:

• Melanoma, a serious skin cancer that may appear as a dark or bluish spot
• Pigmented basal cell carcinoma
• Blue naevus, a type of mole
• Mucocele, a fluid-filled bump from a blocked saliva gland
• Pyogenic granuloma, a fast-growing bump that bleeds easily

One helpful bedside clue is that a venous lake usually empties and pales when gentle pressure is applied with a clear glass slide, then refills when the pressure is released. Moles and cancers do not behave this way. Even so, if a lesion is firm, growing, ulcerated, very dark or irregular, or if there is any doubt, your family doctor or a dermatologist should assess it, and a biopsy may be suggested before cosmetic treatment is considered.

How Nd:YAG laser treatment works

Laser treatment relies on the fact that blood absorbs certain wavelengths of light. The Fotona system's Nd:YAG wavelength (1064 nm) reaches deeper than many other vascular lasers, which suits the darker, fuller vessels of a venous lake. Heat from the pulse causes the blood inside to coagulate and the vessel walls to seal, and over the following weeks the body gradually absorbs what is left.

During treatment, the skin is cooled and short pulses are applied to the lesion. You may see it shrink and change colour right away. Numbing cream or a small injection of local anaesthetic can make the lip more comfortable, as the lips are sensitive. Protective eyewear is worn throughout.

Other options include surgical removal, electrocautery and other vascular lasers. Your clinician can talk through why one may suit your lesion better than another, especially for larger or unusual lesions.

How many sessions

Smaller venous lakes often resolve after one session. Larger ones may need a second treatment after about four to eight weeks. Results vary from person to person, and new lesions can form elsewhere over the years if sun exposure continues.

Healing after treatment

Swelling is the most noticeable effect, especially on the lip, and is usually worst for the first day or two. A cool compress wrapped in a cloth can help. The treated area may look darker or bruised, and a small crust or blister may form, which usually heals within one to two weeks.

A bland lip ointment keeps the area moist while it heals. Avoid picking, very hot food and drinks on the first day, and strong lip products until healed. Daily lip balm with SPF helps protect the area afterward, which also reduces further sun damage to the lips.

Cold sore precautions

Laser treatment around the mouth can trigger a cold sore in people who carry the herpes simplex virus. If you have had cold sores before, tell your clinician. Your physician may discuss a short course of preventive antiviral medicine. For more on this, see Cold Sores and Laser Resurfacing: Antiviral Precautions.

Who should not have it, or should wait

Treatment may need to be postponed or avoided if you:

• Have a lesion that has not been confidently diagnosed
• Have an active cold sore, infection or cracked, inflamed lips
• Are pregnant
• Have a fresh tan or recent sunburn on the area
• Have taken isotretinoin recently or are prone to keloid scarring

If you take a blood thinner, let your clinician know; please do not stop it on your own.

Risks and side effects

Expected effects are swelling, redness and bruising. Possible complications include blistering, crusting, infection, pigment change, a small depression or texture change, and, rarely, a visible notch or scar at the edge of the lip, where precise lip borders matter. A venous lake may also only partly respond and need further treatment.

Frequently asked questions

Is a venous lake dangerous?

No. Once confirmed, it is a benign vascular lesion. The main concern is making sure the diagnosis is correct.

Will it come back?

A lesion that fully closes rarely returns in the same spot, but new ones can develop on other sun-exposed areas.

Can I just leave it alone?

Yes. Treatment is optional unless it bleeds or bothers you. Leaving it alone is a reasonable choice once your doctor has confirmed the diagnosis.

Next steps

If you have a dark bump on your lip or face, a medical look comes first. After that, HealthPark Medical Aesthetics can offer a consultation to examine the lesion, explain whether laser is appropriate, and review healing, risks and fees before any decision. For similar spots elsewhere on the body, you may also find our article on cherry angiomas helpful.