Varicose veins are a common cosmetic culprit for both women and men. Fifteen to 20 percent of people have some degree of varicose veins, which are usually green or blue and bulging. They can also cause pain or aching in the legs and feet. Spider veins are a milder form of varicose veins that tend to be blue, purple, or red and have smaller size vessels. The reasons varicose veins occur include pregnancy, family history, obesity, standing or sitting for long periods of time, and age. Several ways clients can help avoid varicose veins from occurring or getting worse in appearance include engaging in exercise, keeping weight to normal limits, not wearing high heels, and not sitting or standing for long periods of time. They should also avoid crossing legs constantly, which causes unwanted pressure. If there are significant varicosities, compression stockings are recommended and can be prescribed by a licensed professional and worn daily.
The gold standard therapy for spider and small varicose veins is still sclerotherapy. Sclerotherapy irritates the inside of the vessel with a solution called a sclerosant, which is typically made of hypertonic saline, sodium tetradecyl sulphate (STS), or polidocanol. The latest technology is when STS or polidocanol are mixed with air or carbon dioxide for Foam Sclerotherapy. Foam Sclerotherapy can be done with ultrasound guidance to make sure the sclerosant solution is within the desired vessel. These treatments can be mildly to moderately uncomfortable, and it takes a few treatments, performed one month apart, for best results. The sclerosant solution irritates the vessel, and then the body resorbs the damaged vessel and removes it. When the body breaks down the blood vessel, hemosiderin, an insoluble form of tissue storage iron, is often released, causing a reddish brown discoloration that can last for months. It is best to treat these vessels in the winter in case of any hyperpigmentation to allow time for it to fade before shorts and bathing suit season. Other minor complications can include bruising, discomfort, infection, or inflammation, which is very rare.
Endovenous ablation can be done to larger vessels with a minor surgical procedure. This involves a procedure where a laser is used to heat the blood vessel, thereby damaging the vessel from the inside. Radiofrequency ablation is similar to endovenous ablation, except it requires a radiofrequency device. These procedures do not require sedation, and patients should be able to walk out of the office on their own afterward in most cases. Complications include inflammation of a vein, infection, swelling, and bruising. Usually, a compression-wrapped garment is suggested to be worn for a few weeks afterward on the leg to reduce the risk of complications.
Lasers and light therapy can also be used for small veins as an external treatment. Pulsed dye lasers, Yag lasers, and Intense Pulsed Light (IPL) have been tried with varying degrees of success over the years. This is a less invasive treatment but often requires multiple treatments to see results. These treatments are popular, because they are not invasive. But the success rates are not as good as traditional sclerotherapy or endovenous ablation, and bruising is common.
If the vessels are very large, vein ligation and stripping is required, which refers to tying of the vessels in a surgical procedure and removing them, which leaves small scars. This should be done by a trained vascular surgeon in an outpatient surgical setting as a last resort.
While there are many options available today in the treatment of unsightly veins, it is important to accurately diagnose the problem and communicate with the patient all available options and outcomes to ensure not only the best results but also the most satisfied client.—Rebecca Baxt, M.D., F.A.A.D.
Rebecca Baxt, M.D., F.A.A.D., is a board-certified dermatologist at Baxt CosMedical in Paramus, NJ. To find out more about vein therapy and other dermatology treatments, visit www.cosmedical.com.