Procedure

Pulsed Dye Laser (V-Beam)

A laser tuned to the color of blood. It fades facial redness, broken vessels, rosacea flushing, port-wine stain birthmarks and some red scars. The thing to plan around is whether your settings will bruise the skin or not.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
A patient in protective goggles lying under a large laser head positioned over their face

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Almost every conversation I have about this laser comes down to bruise or no bruise: turned up, it bursts the vessel, leaves a deep purple bruise for a week or two, and usually clears more in one visit; turned down, you leave pink and a bit swollen for a day or two and need more visits. Which is right depends on what we are treating and on what your next two weeks look like. It is very good at anything red — broken vessels on the nose and cheeks, the background flush of rosacea, port-wine stains, red raised scars, the red left after a spot — and it does nothing for brown pigment and nothing for the bumps and pustules of rosacea. It is maintenance, not a cure, so keep your prescription cream and daily sunscreen going between sessions.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledPDL, V-Beam, Vbeam Perfecta, Vbeam Prima, Cynergy, 595 nm vascular laser
DowntimeOne to two days of pink and swelling on gentle settings; 7 to 14 days of purple bruising on stronger ones
SessionsUsually 3 to 5 for facial redness and rosacea vessels, 4 to 8 weeks apart, then occasional top-ups. Port-wine stains take many more, often over years
Typical costRoughly $300 to $700 a session for the face in the US, depending on the city, the provider and how much area is treated. Treatment of port-wine stains and infant hemangiomas is sometimes covered by insurance; treatment of rosacea and cosmetic redness usually is not
Results timelineDistinct vessels can look better after one session; background redness usually needs three or more
PainA snap like a hot rubber band, one pulse at a time. A full face takes a few minutes
Skin tone safetyUsable on deeper skin tones with lower energy, longer pulses and careful cooling, but the risk of light or dark patches is higher. Many providers reach for a 1064 nm Nd:YAG laser instead for that reason

What It Is

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The pulsed dye laser produces a single color of yellow light at 595 nanometers, absorbed strongly by hemoglobin — the red pigment inside red blood cells — and much less by the rest of the skin. It is the oldest and most studied laser for redness and blood vessels. V-Beam is a Candela brand name, used so widely that people say V-Beam when they mean any pulsed dye laser. Vbeam Perfecta, Vbeam Prima and Cynergy are versions of the same idea. The provider presses a handpiece against the skin and fires overlapping pulses. Most machines spray cold gas a fraction of a second before each pulse, protecting the surface while the vessel underneath heats. It is used for things that are red: broken vessels on the nose and cheeks, the constant background flush of rosacea, port-wine stain birthmarks, infant hemangiomas, cherry angiomas, red raised and keloid scars, stretch marks while they are still pink, and the flat red marks left after acne. It does not treat brown pigment, and it does not treat the bumps and pus spots of rosacea.

How It Works

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The yellow light passes through the surface of the skin and is absorbed by hemoglobin inside a blood vessel. The blood heats in a few thousandths of a second, and that heat damages the vessel wall from the inside. Over the following weeks your body clears the damaged vessel away. Surrounding skin absorbs very little of that color, so it is left alone — selective photothermolysis, heating one target on purpose, fast enough that the heat has no time to spread.

Two settings decide how much damage each pulse does: the energy, and the pulse duration. Those two are the whole bruise question.

A short, strong pulse heats blood so fast that the vessel bursts. Blood leaks into the skin and leaves a purple bruise, called purpura. Purpura settings generally clear more per session, and the bruise takes 7 to 14 days to go.

A longer, gentler pulse heats the vessel more slowly. The wall is damaged but does not rupture, so there is no bruise. This is sub-purpuric or non-purpuric treatment, far easier to live with and usually more sessions to reach the same result.

Neither setting reaches brown pigment, and neither reliably reaches the larger, deeper blue vessels on the legs. That is why other vascular lasers exist.

What It Treats

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Close-up of a cheek with pink flushing and fine visible red blood vessels beside the nose
Rosacea
Strong evidence
The treatment of choice for visible thread veins and settled background redness — the parts of rosacea that creams and tablets do not touch. It targets the blood in the vessel and closes it. Expect a course of about three sessions rather than one, expect bruising for a few days at stronger settings, and expect occasional top-ups, because rosacea carries on making new vessels.
Keratosis Pilaris
Keratosis Pilaris
Moderate evidence
Aimed at the redness rather than the texture, so it is for the variant where the background color bothers you more than the bumps. Several sessions are usually needed and the bumps themselves are left much as they were. On deeper skin tones it is less useful and carries more risk of pigment change, so it is not usually the first suggestion.
Close-up of the lower cheek, mouth and jaw of a young person with light skin, turned three-quarters away from the camera against a pale blue background. Scattered flat pink-red marks cover the cheek and run down towards the jaw. The skin surface is smooth and even, with no raised spots and no change in texture.
Post-Inflammatory Redness
Moderate evidence
The most direct treatment there is, because it is absorbed by the blood inside the widened vessels and collapses them. Usually two to four sessions, and it works best on marks that have stopped improving on their own. Most people never need it, and it is normally kept for marks that have not moved after a year.
Stretch Marks
Stretch Marks
Moderate evidence
Targets the widened blood vessels that make new marks red or purple, so it is for the early stage only and does nothing for white ones. It can take the color down over a few sessions. On deeper skin tones it carries a real risk of leaving dark marks behind, so it is used cautiously and after a test patch, if at all.
Close-up of the cheek, nose and mouth of an adult with light skin, turned three-quarters away from the camera against a pale blue background. The surface of the cheek is uneven, dimpled with shallow depressions and small pits that catch the light. There are no active spots — the change here is in the texture of the skin rather than its color.
Acne Scarring
Moderate evidence
Targets the blood vessels rather than the texture, so it calms the redness in and around a fresh scar and helps flatten raised ones. It will not lift a dent. It is most useful in the first year, when the color is what makes a scar stand out.

Not the Best For

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Keloids
Keloids
Limited evidence
A laser aimed at the blood vessels in the scar. It helps with the redness, and some people find it softer and less itchy afterwards, so it is used alongside injections rather than instead of them. It does not flatten a thick keloid, and settings have to be chosen carefully on deeper skin tones to avoid pigment change.
Dark Circles Under the Eyes
Dark Circles Under the Eyes
Limited evidence
Targets blood vessels rather than pigment, so it is aimed at the blue-purple type and does nothing for brown. It can soften the color where prominent veins are the main problem, but bruising for a week or two is usual and the vessels often refill over time. It is a niche option, tried after sleep, allergy treatment and not rubbing have been given a fair go.
Warts
Warts
Limited evidence
The laser targets the small blood vessels feeding the wart rather than the virus itself. It is an option for stubborn warts on the hands and around the nails when freezing has not worked, and it spares the skin around it, which matters on the face. Several sessions are needed, results are inconsistent, and it is not usually covered by insurance.

Pros and Cons

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Pros
  • Very selective It targets blood, so skin around a vessel is not wounded.
  • Two ways to run it Bruise and clear faster, or no bruise and go slower.
  • The longest track record Used on redness and birthmarks for decades.
  • Sometimes covered Many insurers treat port-wine stains as medical.
Cons
  • The bruise On purpuric settings you look bruised for one to two weeks.
  • It fades Vessels reform, so most people need a top-up every year or two.
  • It only does red Not brown marks, not melasma, not the bumps of rosacea.
  • The cost adds up Three to five sessions, and insurance rarely covers it.
  • More care on deeper skin tones Melanin absorbs some of this wavelength too.

How to Prepare

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4 weeks before1 week beforeOn the day
Sun and tanning
4 weeks before
Avoid sun, sunbeds and self-tanner on the area. A tan puts extra pigment in the laser's way and raises the chance of a burn or a patch.
Actives and hair removal
1 week before
Stop waxing, threading and hair removal creams. Stop retinoids, benzoyl peroxide and exfoliating acids 3 to 5 days before.
Clean skin
On the day
Clean skin, no makeup.
Before you book
If bruising would be a problem, say so before the first pulse — it changes the settings. With purpuric settings, leave two clear weeks before an event.

What Happens

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ArrivingThe treatmentLeaving
Arriving
Skin is cleaned and photos usually taken. This is where you agree purpuric or non-purpuric settings. Many providers test a few pulses in a discreet spot first, especially on deeper skin tones. Numbing is often skipped because the cold spray does most of the work; cream for 30 to 60 minutes suits larger areas, children, and anyone who wants it. Your provider will ask about these things.
The treatment
You wear opaque eye shields, with metal shields under the eyelid near the eye. The handpiece fires overlapping pulses, each preceded by cold gas, with a snapping sound and a smell of cold. Nose and cheeks take a few minutes, a full face 10 to 20 minutes. Each pulse is like a hot rubber band snapped on the skin: sharp, brief, worst on the nose and upper lip.
Leaving
Warm, red and slightly swollen, like mild sunburn. On purpuric settings, gray-purple spots appear within minutes and darken over the next hour into a bruise the shape of the treated area. It looks alarming even when everything went correctly.

Recovery

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Days 1 to 3Days 3 to 14Weeks 2 to 8
Days 1 to 3
Swelling is worst the morning after and settles over two to three days, with cheeks and under-eyes puffing most. Sleeping propped up helps, as does a cool pack for 10 minutes at a time. Non-purpuric treatment is often back to normal by day two.
Days 3 to 14
Purple turns brown, then green, then yellow, then goes. Two weeks is the usual outside limit on the face, longer on the neck and chest. Green-tinted makeup covers it well once the skin is intact.
Weeks 2 to 8
Once the bruise clears, the change from the session becomes visible. Treated vessels keep fading for several weeks, so judge the result at six to eight weeks, not at two.

Aftercare

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24 to 48 hours5 days2 weeks
Makeup and exercise
24 to 48 hours
Makeup the next day, once the skin is intact and not blistered — green-tinted concealer covers bruising better than skin-tone concealer. No exercise for 24 to 48 hours; heat and flushing add to swelling and make bruising heavier.
Actives
5 days
Restart retinoids, acids and benzoyl peroxide after about five days, once the skin is calm and unbroken.
Sun
2 weeks
SPF 30 or higher every day, and strict avoidance for two weeks. Sun on freshly treated skin is the main cause of dark patches.

Risks

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Most of what happens after a pulsed dye laser is expected: redness, swelling and, on stronger settings, a bruise. Real complications are uncommon in trained hands, and rise when energy is pushed, when skin is tanned, and when the wavelength is a poor match for the skin tone.

Dark patches
New brown patches two to four weeks later, most common on deeper skin tones and after sun. They usually fade, faster if treated early.
Light patches
Areas paler than the skin around them. Less common, slower to recover, sometimes lasting.
Crusting or a blister
Small blisters or scabs mean the surface was heated more than intended. They usually heal without a mark if left alone, but the settings need changing.
Swelling that is not settling
Swelling should peak around day one and improve. Getting worse after day three needs looking at.
A cold sore outbreak
Laser near the mouth or nose can trigger one. Antiviral medicine works best started at the first tingle.

In Deeper Skin Tones

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The pulsed dye laser is used on deeper skin tones routinely, including on children with port-wine stains. It needs different settings and a provider who uses them often.

Melanin, the brown pigment in the surface of the skin, absorbs some 595 nm light as well. On deeper skin tones more of each pulse is soaked up on the way in, so less reaches the vessel and more heat lands where it is not wanted. That is what causes a burn, a blister, or a patch darker or lighter than the skin around it. Dark patches usually fade over months. Light patches are the ones that may not come back.

What a careful provider does about it: a test spot in a hidden area first, lower energy, longer pulse durations, generous cooling, fewer passes, and more sessions spaced further apart. Expect a slower plan, not the same plan. Some also prescribe a pigment-blocking cream for two to four weeks beforehand.

Many providers choose a different laser instead. The 1064 nm Nd:YAG is absorbed far less by melanin, which makes it the safer wavelength on deeper skin tones for vessels and hair. It is less efficient at picking out fine surface vessels, so it is a genuine trade rather than an upgrade. Ask which wavelength is planned and why, and how many people with your skin tone that provider treats.

If You Stop

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Nothing bad happens when you stop, and there is no rebound. The redness gradually comes back.

Treated vessels are gone for good, but new ones form. Rosacea is the underlying condition and the laser does not change it, so the tendency to flush and grow new vessels is still there. Most people notice redness creeping back over one to two years and come in for a single maintenance session rather than a whole course.

Port-wine stains are the exception. They commonly re-darken over years after treatment stops, which is why they are treated on and off across a lifetime rather than finished once.

What slows the return is unglamorous: daily sunscreen, avoiding your own flushing triggers, and staying on prescription rosacea treatment. People who keep those going stretch the gap between sessions considerably.

Combining Treatments

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Same day
Rosacea creams
Azelaic acid, metronidazole and ivermectin continue, restarting five days after.
Same day
Oral doxycycline
An anti-inflammatory dose is prescribed alongside laser for rosacea.
Same day
Low-dose isotretinoin
In stubborn rosacea, prescribed alongside laser.
Same day
Brimonidine or oxymetazoline
For temporary redness relief, but not on fresh skin.
Same day
Sunscreen
Daily use is the single most useful thing you add.
Wait 2 weeks
Peel, microneedling or wax
About two weeks either side on the same area, same for another laser.
Wait 2 weeks
Toxin and fillers
A separate visit, most often two weeks before or after.
Different visit
IPL and pigment lasers
Sometimes done in one session by experienced providers, more often alternated.
Wait 6 months
Isotretinoin course
Most providers wait about six months; for vascular laser it is often shorter.

Insurance Coverage

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Insurance almost never covers laser treatment of rosacea redness or facial vessels — it is classified as cosmetic. Port-wine stains and infant hemangiomas are treated differently by many insurers, since they are congenital and can cause functional problems, and treatment is often covered with prior authorization. Laser for raised or keloid scars sits in between. Ask the office to check your plan before the first session.

Ask Your Doctor

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If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding first.
If you take a blood thinner
This covers aspirin, fish oil and high-dose vitamin E. Bruising will be heavier and last longer. Never stop a prescribed blood thinner on your own.
If you get cold sores
Say so before treatment near the mouth or nose, so an antiviral can be started beforehand.
If you have a deeper skin tone
Ask which wavelength and settings are planned, ask for a test spot, and expect a slower course.
If you are tanned
Or have used self-tanner recently. Wait. Treating tanned skin raises the risk of burns and blotchy pigment.
If you have taken isotretinoin
Say so if you finished in the last six months, and agree the timing.
If you take a sun-sensitizing medicine
Doxycycline, some diuretics and others make skin more reactive. List everything you take.
If you have melasma
Heat and light can make melasma worse. You need a provider who treats melasma specifically.
If you have a history of keloid scars
Discuss it before treating raised or scarred skin.
If you have a photosensitive condition
Lupus is one example. Check with the doctor managing it first.
If your goal is brown marks or melasma
This is the wrong laser, and you want a different conversation.

At-Home Versions

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Daily broad-spectrum sunscreen
Good alternative
Sun is one of the biggest drivers of facial redness and new vessels, and the least glamorous part of the plan does the most work. Mineral sunscreens with iron oxide also give slight tint, which covers redness while it protects.
Five azelaic acid tubes and bottles on white, most marked 10 percent, from Peach Slices, Paula's Choice, Facetheory, The Ordinary and Naturium
Azelaic acid, metronidazole or ivermectin
Good alternative
These calm the inflamed bumps and papules. They do not remove visible vessels, so they complement laser rather than replace it.
Green-tinted color-correcting makeup
Good alternative
Green cancels red visually and covers both redness and a fading bruise well. It changes nothing underneath, and it is honest to say so.
Trigger tracking and avoidance
Okay alternative
Heat, alcohol, spicy food, hot drinks, sudden temperature change and stress trigger flushing in many people, though the list is individual. Two weeks of notes finds yours faster than a generic list.
Home IPL and “vein removal” pens sold online
Bad alternative
Do not use these on facial vessels. They cannot be aimed the way an office device can, and burns, scars and pigment marks from them are the reason dermatologists see them.

How It Compares

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Intense pulsed light (IPL)
Intense pulsed light (IPL)
Different job
Not a laser but a broad band of light, so it treats brown pigment and redness in the same session, which the pulsed dye laser cannot. More dependent on the operator's settings, and generally not used on deeper skin tones because it carries more pigment on the way in.
Nd
Different job
YAG laser at 1064 nm: Strong evidence for larger and deeper vessels. Absorbed far less by melanin, which makes it the safer wavelength on deeper skin tones. Less precise on fine surface vessels than the pulsed dye laser, and more painful.
KTP laser at 532 nm
Different job
Moderate to strong evidence. Very good at picking out individual bright red surface vessels with little or no bruising, and does not reach as deep. Carries more risk on deeper skin tones, because that wavelength is absorbed strongly by melanin.
Electrosurgery for single vessels
Different job
A fine needle and a current to seal one vessel at a time. Cheap, quick and useful for a few scattered vessels, with a small risk of a pit or a mark at each point. No use for diffuse redness.
Topical brimonidine or oxymetazoline
Different job
Constricts vessels for several hours from a cream, and does nothing lasting. Some people get rebound redness when it wears off. Useful for an event, not a treatment.
Rosacea creams and tablets
Different job
For bumps and pustules, limited for redness. Azelaic acid, metronidazole, ivermectin and doxycycline handle the part of rosacea the laser does not, which is why they are usually used together rather than chosen between.

Finding a Provider

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Who may legally fire a laser varies a great deal by US state. Some restrict it to physicians, physician assistants and nurse practitioners; others allow a registered nurse, laser technician or esthetician under some level of physician supervision, sometimes remote. Look up your own state.

Port-wine stains, hemangiomas in infants, and anything near the eye should be handled by a dermatologist or another physician who treats them regularly. Ask which device and wavelength they use, how many sessions they expect, whether they are planning purpuric or non-purpuric settings, how often they treat your skin tone, and what they would do if you developed a dark or light patch.

Red flags: a promise that one session will clear the redness, no discussion of bruising before you are in the chair, no eye protection, no test spot on a deeper skin tone, pressure to buy a large package, and a provider who cannot name the wavelength of their machine.

Myths

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  • “The bruise means something went wrong.” It usually means the laser was set to bruise on purpose. Purpura is the intended endpoint of the stronger settings, and it generally clears more per session. If nobody explained that beforehand, the problem was the consultation.
  • “Laser thins the skin.” A vascular laser does not remove or thin skin. It heats blood inside vessels and leaves the surface intact, which is why there is no peeling and no open wound.
  • “Deeper skin tones cannot have laser for redness.” They can. It needs lower energy, longer pulses, good cooling and an experienced provider, sometimes a different wavelength such as 1064 nm Nd:YAG. The answer is different settings and more caution, not no.
  • “One session and the redness is gone.” One session can clear a few distinct vessels. Diffuse redness takes a course, and it comes back over time.
  • “It cures rosacea.” It treats one part of rosacea, the visible vessels and flush. The condition is still there, and the bumps and pustules need creams or tablets.
  • “If it did not bruise, it did not work.” Non-purpuric settings work, just more slowly. Bruising is not a quality check.

Questions Patients Ask

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Will I have a bruise?

Only if the laser is set to give you one. Purpuric settings burst the vessel and leave a purple bruise for 7 to 14 days, and generally clear more per session. Non-purpuric settings leave you pink and slightly swollen for a day or two and need more sessions. Decide before the first pulse.

Does it treat rosacea?

It treats part of it. Visible vessels and the background flush respond well. The bumps and pus spots do not, and those need creams or tablets. Most people with rosacea use both.

How many sessions will I need?

For facial redness, usually 3 to 5, spaced 4 to 8 weeks apart, then a top-up every year or two. A few isolated broken vessels may need only one or two. Port-wine stains take many more, over years.

Is it safe on deeper skin tones?

It is used on deeper skin tones, with lower energy, longer pulses and more cooling, often with a test spot first. The risk of a light or dark patch is higher than on fair skin, so many providers choose a 1064 nm Nd:YAG instead, because that wavelength is absorbed much less by pigment.

Will the redness come back?

Usually, gradually. The laser clears the vessels that are there; it does not stop new ones forming or change the rosacea underneath. Most people return for maintenance every one to two years, and sunscreen and prescription creams stretch that out.

Does it help brown marks or melasma?

No. This wavelength is aimed at blood, not pigment. Melasma can even be provoked by heat and light, so if pigment is your main concern this is the wrong device.

References

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