LASIK SURGERY
Laser treatment of leg veins
Diminishing unsightly 'spider veins'
Millions of women are bothered by spider veins - those small yet unsightly
clusters of red, blue or purple veins that most commonly appear on the thighs,
calves and ankles. In fact, it's estimated that at least half of the adult
female population is plagued with this common cosmetic problem.
Today, many plastic surgeons are treating spider veins with sclerotherapy.
In this rather simple procedure, veins are injected with a sclerosing solution,
which causes them to collapse and fade from view. The procedure may also
remedy the bothersome symptoms associated with spider veins, including aching,
burning, swelling and night cramps.
Although this procedure has been used in Europe for more than 50 years,
it has only become popular in the United States during the past decade.
The introduction of sclerosing agents that are mild enough to be used in
small veins has made sclerotherapy predictable and relatively painless.
If you're considering sclerotherapy to improve the appearance of your legs,
this brochure will give you a basic understanding of the procedure - when
it can help, how it's performed and what results you can expect. It won't
answer all of your questions, since a lot depends on your individual circumstances.
Please ask your doctor if there is anything about the procedure you don't
understand.
What are spider veins?
Spider veins - known in the medical world as telangiectasias or sunburst
varicosities - are small, thin veins that lie close to the surface of the
skin. Although these super-fine veins are connected with the larger venous
system, they are not an essential part of it.
A number of factors contribute to the development of spider veins, including
heredity, pregnancy and other events that cause hormonal shifts, weight
gain, occupations or activities that require prolonged sitting or standing,
and the use of certain medications.
Spider veins usually take on one of three basic patterns. They may appear
in a true spider shape with a group of veins radiating outward from a dark
central point; they may be arborizing and will resemble tiny branch-like
shapes; or they may be simple linear and appear as thin separate lines.
Linear spider veins are commonly seen on the inner knee, whereas the arborizing
pattern often appears on the outer thigh in a sunburst or cartwheel distribution.
Varicose veins differ from spider veins in a number of ways. Varicose veins
are larger - usually more than a quarter-inch in diameter, darker in color
and tend to bulge. Varicose veins are also more likely to cause pain and
be related to more serious vein disorders. For some patients, sclerotherapy
can be used to treat varicose veins. However, often surgical treatment is
necessary for this condition.
The best candidates for sclerotherapy
Women of any age may be good candidates for sclerotherapy, but most fall
in the 30-to-60 category. In some women, spider veins may become noticeable
very early on - in the teen years. For others, the veins may not become
obvious until they reach their 40s.
If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy
treatment. In most cases, spider veins that surface during pregnancy will
disappear on their own within three months after the baby is born. Also,
because it's not known how sclerosing solutions may affect breast milk,
nursing mothers are usually advised to wait until after they have stopped
breastfeeding.
Spider veins in men aren't nearly as common as they are in women. Men who
do have spider veins often don't consider them to be a cosmetic problem
because the veins are usually concealed by hair growth on the leg. However,
sclerotherapy is just as effective for men who seek treatment.
What to expect from sclerotherapy
Sclerotherapy can enhance your appearance and your self confidence, but
it's unrealistic to believe that every affected vein will disappear completely
as a result of treatment. After each sclerotherapy session, the veins will
appear lighter. Two or more sessions are usually required to achieve optimal
results.
You should also be aware that the procedure treats only those veins that
are currently visable; it does nothing to permanently alter the venous system
or prevent new veins from surfacing in the future.
Before you decide to have sclerotherapy, think carefully about your expectations
and discuss them with your doctor.
Risks related to treatment
Serious medical complications from sclerotherapy are extremely rare when
the procedure is performed by a qualified practitioner. However, they may
occur. Risks include the formation of blood clots in the veins, severe inflammation,
adverse allergic reactions to the sclerosing solution and skin injury that
could leave a small but permanent scar.
A common cosmetic complication is pigmentation irregularity - brownish splotches
on the affected skin that may take months to fade, sometimes up to a year.
Another problem that can occur is "telangiectatic matting," in
which fine reddish blood vessels appear around the treated area, requiring
further injections.
You can reduce the risks associated with treatment by choosing a doctor
who has adequate training in sclerotherapy and is well versed in the different
types of sclerosing agents available. A qualified doctor can help you select
which type of sclerosing medication is most appropriate for your needs.
Planning your treatment
During your initial consultation, your legs will be examined. Your doctor
may draw a simple sketch of your legs, mapping out the areas affected by
spider veins or other problems. During the examination, you will be checked
for signs of more serious "deep vein" problems, often indicated
by swelling, sores, or skin changes at the ankle. A hand-held Doppler ultrasound
device is sometimes used to detect any backflow within the venous system.
If such problems are identified, your surgeon may refer you to a different
specialist for further evaluation. Problems with the larger veins must be
treated first, or sclerotherapy of the surface veins will be unsuccessful.
Your doctor will ask you about any other problems you may have with your
legs, such as pain, aching, itching or tenderness. You will also be asked
about your medical history, medications you take, or conditions that would
preclude you from having treatment. Individuals with hepatitis, AIDS or
other blood-borne diseases may not be candidates for sclerotherapy. Patients
with circulatory problems, heart conditions, or diabetes may also be advised
against treatment.
It's important to be open in discussing your history and treatment goals
with your doctor. Don't hesitate to ask any questions or express any concerns
you may have. Your doctor should explain the procedure in detail, along
with its risks and benefits, the recovery period and the costs. (Medical
insurance usually doesn't cover cosmetic procedures.)
Preparing for the procedure
ou will receive specific instructions from your physician on how to prepare
for your treatment. Carefully following these instructions will help the
procedure go more smoothly.
You'll be instructed not to apply any type of moisturizer, sunblock or oil
to your legs on the day of your procedure. You may want to bring shorts
to wear during the injections, as well as your physician-prescribed support
hose, and slacks to wear home.
When scheduling your procedure, keep in mind that your legs may be bruised
or slightly discolored for some weeks afterward. You probably won't be comfortable
wearing shorts, a swimsuit or a mini skirt until after your legs have cleared
up a bit.
Where your treatment will be performed
Sclerotherapy of spider veins is a relatively simple procedure that requires
no anesthesia, so it will be performed in an outpatient setting, most likely
your doctor's office.
The procedure
A typical sclerotherapy session is relatively quick, lasting only about
15 to 45 minutes. After changing into shorts, your legs may be photographed
for your medical records. You will be asked to lie down on the examination
table and the skin over your spider veins will be cleaned with an antiseptic
solution. Using one hand to stretch the skin taut, your doctor or nurse
will begin injecting the sclerosing agent into the affected veins. Bright,
indirect light and magnification help ensure that the process is completed
with maximum precision.
Approximately one injection is administered for every inch of spider vein
- anywhere from five to 40 injections per treatment session. A cotton ball
and compression tape is applied to each area of the leg as it is finished.
During the procedure, you may listen to music, read, or just talk to your
practitioner. You will be asked to shift positions a few times during the
process. As the procedure continues, you will feel small needle sticks and
possibly a mild burning sensation. However, the needle used is so thin and
the sclerosing solution is so mild that pain is usually minimal.
After your treatment
In addition to the compression tape applied during the procedure, tight-fitting
support hose may be prescribed to guard against blood clots and to promote
healing. The tape and cotton balls can be removed after 48 hours. However,
you may be instructed to wear the support hose for 72 hours or more.
It's not uncommon to experience some cramping in the legs for the first
day or two after the injections. This temporary problem usually doesn't
require medication.
You should be aware that your treated veins will look worse before they
begin to look better. When the compression dressings are removed, you will
notice bruising and reddish areas at the injection sites. The bruises will
diminish within one month. In many cases, there may be some residual brownish
pigmentation which may take up to a year to completely fade.
Getting back to normal
Although you probably won't want to wear any leg-baring fashions for about
two weeks, your activity will not be significantly limited in any other
way from sclerotherapy treatment.
You will be encouraged to walk to prevent clots from forming in the deep
veins of the legs. However, during the period of time to complete your treatment
program, prolonged sitting and standing should be avoided, as should squatting,
heavy weight lifting and "pounding" type exercises, including
jogging.
A one-month healing interval must pass before you may have your second series
of injections in the same site. After each treatment, you will notice further
improvement of your legs' appearance.
Your new look
Most patients are pleased with the difference sclerotherapy makes. The skin
of your legs will appear younger, clearer and more healthy-looking. If you've
been wearing long skirts and slacks to hide your spider veins, you'll now
be able to broaden your fashion horizons. Often, patients are surprised
at the dramatic difference in appearance between a treated leg and an untreated
one.
Although sclerotherapy will obliterate the noticeable veins for good, it's
important to remember that treatment will not prevent new spider veins from
emerging in the future. As time passes, you may find that you need "touch-ups"
or full treatments for new veins that surface. But even if you choose not
to have further sclerotherapy, your legs will look better than if you never
had treatment at all.