After reading The Body Project Leg Veins Part I, I hope you have a better understanding of why spider veins and varicose veins might develop and how you might be able to prevent the extent at which they affect you. Here, in the second part of this series, I hope to enlighten you on the options available to treat these conditions. From Sclerotherapy to surgery there are effective solutions! Below, I hope to help to decifer which treatment modality may be right for you.
- What is it? Your specialist will inject small amount of saline (essentially salt water) or chemical detergent into the lumen of the vein. This will damage and collapse the superficial, aesthetically displeasing, vein. Over days to weeks, the body will dispose of the remaining debris from the damaged vein.
- What kind of veins is it best for? Spider veins or small varicose veins
- Treatment and aftercare? Your doctor will use a tiny needle to inject a small amount of the chosen product into each vein. It may burn a bit but is generally well tolerated.
- Afterwards your doctor will compress the injected site with a cotton ball and place tape over it to hold it in place. You will be instructed to wear compression stockings for a few days. Once you take the stockings off, the bandages can be removed and, you should see a notable improvement. It may take an additional couple weeks to see complete resolution of any redness or bruising.
- How much does it cost? $250-350/ session. You will need 1-3 sessions spaced at about 6 weeks apart.
- Additional considerations? Best to do in winter as the injection sites take a few weeks to heal and must be kept out of the sun.
- Ultrasound guided sclerotherapy? For bigger veins your specially trained physician will use ultrasound – sound waves – to guide the procedure for maximum accuracy and safety.
- Foam sclerotherapy?Is a technique where the sclerosant is mixed with air or gas in a syringe to make a foam. This foam is then injected into the veins and is more capable to making contact with the walls of the vein to cause consequent spasm and closure. Some experts are now saying this is the gold standard for small to medium size varicose veins.
- What is it? Using a laser, specific for the chromophore hemoglobin (the portion of a red blood cell responsible for giving its color), we can heat the vein from within and damage the vessel permanently.
- What kind of veins is it best for? Veins less than 3 mm in diameter and most commonly red spider veins, telangiectasias or telangectasic matting (collection of superficial micro blood vessels that often occurs as a result of injury or sclerotherapy).
- Treatment and after-care? Your doctor or specialist cool the area to be treated and then will deliver laser pulses to several areas along a vein until it blanches or gives indication for successful treatment. Each pulse feels a bit like a rubber band snap. It’s a bit uncomfortable but is over quite quick.
- No bandaging involved but your doctor might prescribe a soothing serum and support stockings. Once again sun exposure is to be avoided at all costs while the treatment area is healing.
- How much does it cost? $150-$300 per session. Like sclerotherapy, you may need up to 3 sessions.
- Additional considerations? There are a variety of different lasers that can be used. Depending on the color, size or the depth of the vein being treated, you doctor may decide to use one type over another. Some of the laser options available in doctors offices are 532nm KTP, 755nm Alexandrite or 1064nm Nd:Yag.
- Laser Therapy is considered an acceptable option for spider veins and telangectasia BUT most agree sclerotherapy is best for those veins you can get a needle into. Laser therapy is a great option for those with facial telangectasias or those who just don’t like needles. Like most laser treatments, you must avoid sun while skin is healing.
- What is it? IPL stands for Intense Pulse Light. Unlike a laser, which uses a specific wavelength to treat a target of a specific color (chromophore) and depth, IPL uses a light spectrum of many different wavelengths. This means: 1) IPL, using many different wavelengths, can treat may different targets of varying depths and chromophores. Being less specific has advantages and disadvantages. Advantage being it can treat for skin quality, pigment problems and vascular issues in the same treatment! Disadvantage being we ar more at risk of affecting skin color when treating a vein; this puts darker skin types at risk for pigment changes and side effects. 2) IPL is a much less powerful treatment than laser for any specific condition. For this reason you may need several treatments of IPL to get the same result as one treatment with laser.
- What kind of veins is it best for? Its best for telangiectasias, hemosiderin staining and residual redness after alternative vein therapy treatment. IPL is the gold standard for mild to moderate Rosacea.
- Treatment and after-care? After applying a protective gel, your doctor will place a cooled crystal tip of varying sizes over the area of concern. Several pulses may be delivered to each site until a visual darkening or resolution of the vascular defect is noted. No specific after care is called for however most often, a hydrating serum or reparative balm may be prescribed along with sunscreen.
- How much does it cost? $200-$400. If you don’t improve after 1-2 treatments you may need to consider a different treatment modality.
- Additional considerations? Extra care must be taken with darker skin individuals as IPL, since less specific for blood hemoglobin, can impose higher risk of pigmentation irregularities secondary to treatment.
4. Invasive Options: Endovenous Ablation and Vein Stripping
- Procedure: Your doctor will use ultrasound to guide him in the correct treatment of the varicose vein.. A needle will be inserted into the vein to help wire and catheter placement. Next a probe is inserted into the catheter tube in order to be treat the varicose walls from within with the RF or Laser. Both mechanisms will use heat to damage the inside of the vein. This damage will shut down the vein and cause the body to eliminate the damaged portions.
- Envenous Ablation is considered a minimally invasive procedure. It is best indicated for medium to large size varicose veins and is considered a less risky treatment that Vein Stripping (see below).
- RF causes less heat than laser and therefore may be a gentler form of endovenous ablation to damage the varicose veins. New studies report less side effects with RF.
- Both RF and laser endovenous ablation techniques use tiny incisions that heal without stitches and rather quickly.
- These treatments can usually be done on as an outpatient basis but someone must drive you home after treatment to avoid agitation to treatment area. Compression stockings are to be worn continuously for two weeks after endovenous ablation and you are not allowed to get the area treated wet during this time.
- Although one treatment takes care of most bothersome vasculature and relieves any associated discomfort, an additional treatment may be necessary to see complete aesthetic resolution of varicosities.
- Those with spider veins, hemosiderin staining or telangectasic matting, will benefit from additional treatment of IPL and sclerotherapy.
- Treatments average about $1200 a treatment session.
- Vein stripping is an older surgical technique in which your doctor will make incisions to remove unwanted portions of the vein.There are some doctors extremely experienced with this technique but stripping requires longer recovery and carries increased risk of side effects and DVTs.
- For smaller varicose veins a procedure called hook phlebectomy can be used. Hook phlebectomy consists of the use of multiple small incisions to “hook and fish out” the vein using surgical hooks or forceps. The procedure is done under local or regional anesthesia, in an operating room or an office “procedure room.”
- Larger veins require larger incisions made behind the knee or in the groin area. These incisions require several stitches and therefore are associated with increased risk of infection. Anesthesia is always needed as well as an overnight stay.
Last but not least, I’m happy to report a new exciting approach to varicose veins just on the horizon! Lucky for me I happen to have spent a lovely evening with Dr Proebstle of Mannheim Germany at a Solta Event Launching their new Total Tip for Thermage. Dr Proebstle is a valued visionary and practitioner in the field of dermatology. This said, he often helps medical companies improve and test their newest and most innovative products. He shared with me his preliminary thoughts on VenoSeal varicose vein therapy. Here is what I found out!
- The treatment involves injecting a glue type substance called Cyanoacrylate into the veins. This glue shuts off the lumen and causes a foreign body reaction forming fibrosis (a scar) in place of the damaged varicosity and therefore aesthetic resolution.
- This treatment protocol has been previously performed by vascular surgeons to safety treat congenital vein abnormalities, but, only recently, attempted for varicose vein treatments.
- The VenaSeal treatment is quick…most take only about 15 minutes.
- Requires no anesthesia or use of compression stockings, and normal activity can be resumed immediately after treatment.
- Currently this treatment is being studied in an international trial –eSCOPE (European Saphenous Closure System Observational Prospective) and is only available to those patients whose doctors are acting as trial investigators.
- It is NOT FDA approved but we are hoping commercial availability in Europe soon!
Check out this video here for more details http://www.venaseal.com/how-venaseal-works/
Which procedure is right for you?
- All techniques are effective when conducted by experienced practitioners.
- I often find that the best treatments are not device or procedure dependent but depend on the expertise of the doctors or specialist performing them.
- You must get a consult from a several highly recommended providers. They will access your health and individual needs prior to recommending one procedure over another.
Will they return once treated?
For many, Yes. Unfortunately, if you have a strong family history of accumulating spider or varicose veins, others will form with time. However, if you take my tips from the first part of this series seriously, you can slow the rate at which they tend to sprout. Again, check out my tips here!
If these veins are an inevitable part of your future, be aware of what you can do to make sure your lifestyle, diet and habits don’t contribute to the gravity of their presence. Also, once you have them, it’s a good idea to treat them early and prevent them from progressing into more than just aesthetic nuisances. Especially with varicose veins, the older they become the more likely to get larger, more painful, and complicated to treat!
Bottom line….get proactive, see a specialist and one step closer to replacing those leggings for summer dresses and boy shorts!