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Sclerotherapy

Varicose Veins-- More Patients Look for More Treatments


by CosmeticSurgery.com Staff

As more people become concerned about rejuvenating their appearance, many ask for removal of existing defects like birthmarks, moles, varicose and spider veins, and tattoos. Thus, those practitioners are busier than ever. Cosmetic, plastic and dermatological surgeons are also using new techniques to combat unsightly spider and varicose veins.

Women have always been concerned about the appearance of bulbous, bulging veins known as varicose veins, as well as the smaller blue, red or purple spider veins.

But when the American Academy of Cosmetic Surgery (AACS) requested information from their U.S. cosmetic surgeon members about the number and types of procedures performed in 2007, they found several very interesting statistics about problem veins.

Spider & Varicose Veins

First, sclerotherapy, the standard treatment for getting rid of varicose and spider veins, had become the second most popular procedure in cosmetic surgery. That's not too surprising because 50 to 55 percent of American women complain about vein woes.

The real surprise for the number crunchers was the 226.3 percent increase in men looking for sclerotherapy during the last half decade.

(The top five most popular invasive procedures reported by AACS members for 2007 were liposuction, sclerotherapy, eyelid surgery, breast augmentation, and hair transplantation and restoration. 2007 is the most recent year for which statistics exist.)

"Fewer stigmas are currently attached to guys receiving treatment for bulging or oddly colored spider veins," says Steven Hopping, M.D., AACS president.

Cost of Hair Transplants

An understatement, judging from the impact of another statistic near and dear to mens' hearts: guys have strayed away from hair transplants, a procedure that has declined among both genders by 42 percent from 2002 to 2007.

It's also possible that more men are comparing bottom lines: the cost of hair transplants has increased an average of $1,296 during the last five years, while sclerotherapy has decreased by $103.00.

But what exactly is sclerotherapy and how does it work? And how does a man -- or a woman -- have those tiny, odd-colored spider veins removed?

Spider Vein Removal Before and After Photos
The leg on the left shows spider veins, and some varicose veins before elimination, yielding the smoother "after" leg on the right. (Photos, courtesy of Jose Reyes, M.D.)

"Sclerotherapy has been the gold standard treatment for both varicose and spider veins," says Luis Navarro, M.D., F.A.C.S., founder and medical director of the Vein Treatment Center in New York City.

Sclerotherapy, the most common and oldest treatment for spider and varicose veins on the legs, may also be used for some problem veins on the face and breasts. Also known as "injection therapy," the doctor injects a chemical solution into the vein, causing it to collapse. The human body then absorbs that vein while finding another, healthy vein so that the affected area still has good blood circulation.

Numerous injections are usually done in a single doctor visit. Afterwards, legs are wrapped with elastic bandages to help keep the veins closed. Virtually all patents can return to their normal activities afterwards, with many wearing a compression stocking for several days after the treatment.

Laser Vein Removal

"CO2 Lasers are also used to treat varicose and spider veins," says Anthony Youn, M.D., a board certified plastic surgeon and top celebrity plastic surgery blogger in Rochester Hills, Michigan.

"Facial spider veins are most often the result of rosacea," says Washington, D.C. area cosmetic surgeon and laser expert, Hema Sundaram, M.D. "Other causes can be sun damage and liver disease."

Lasers are also used on the broken facial capillaries and spider veins. A laser works by passing energy through the skin -- without damage -- while heating the problems veins below, causing them to close.

The CO2 laser is attracted to reddish colors and delivers most of its energy to the vein.

"I find that laser treatments alone are especially useful for spider veins located around the ankles and for blue or purple spider veins," says Dr. Sundaram.

Newer forms of problem vein treatment also include:

Radio frequency-
Performed in a hospital or doctor's office, a relatively new device, VNUS Closure, works inside the vein, using radiofrequency energy.

First, the surgeon uses an ultrasound device to pinpoint the exact position of the vein. After injecting some local anesthetic into the treatment area, the surgeon makes a small incision in the skin and inserts a slim probe into the vein that heats the tissues to 185 degrees F., causing the vein to shrink and be absorbed by the body.

"There is basically no recovery period or pain from the procedure," says Walter McCarthy, M.D., section chief of vascular surgery at Rush University Medical Center in Chicago, Illinois.

Endovenus Laser Treatment-
This procedure uses a laser probe instead of radio waves to shrink and close a varicose vein.

The good news: the procedure may be covered by insurance if it is medically necessary due to the patient's pain.

Mini-Phlebectomy with Endolaser-
The mini-phlebectomy is a small invasive procedure between sclerotherapy and the more extensive procedure, vein stripping. Performed under local anesthesia, the bad vein is taken out through incisions so small that they require no stitches and leave no scars. Usually, the patient can walk out of the doctor's office and return to normal activities right away. More.
Foam-
For longer and larger veins, a new type of sclerosing agent with the consistency of toothpaste is injected into the vein. The idea is to displace the blood already inside the vein so that the sclerosing medication comes into contact with the walls of the veins longer, causing them to shrink away faster.

The methods above are less invasive and painful than the older procedure, vein stripping, which uses larger incisions to open the skin and then surgically remove the problem vein or veins. Consequently, recovery time is much longer.

Side effects: Complications of any vein treatment procedure are rare but include thromboembolism, visual disturbances, allergic reaction, skin death, and hyper pigmentation.

According to the Medscape article, What's New in ACS Surgery: Sclerotherapy, skin death happens in 0.2 to 1.2 percent of sclerotherapy injection cases.

Costs of Sclerotherapy

Prices can vary widely depending on where you live, how long treatment is required and if a physician or a technician performs the procedure. The average cost ranges are:

Per leg-
Around $100 to $250 for one leg. Two legs would range in cost from $400 to $1500. The wide range depends on how many vessels are being treated and how big they are, according to the Web site, SclerotherapyInformation.com
Medications-
The total cost depends on how many vials are needed and can be up to $600.
Stockings-
Can start around $60 and go up.
Supplies-
About another $50 is required for needles, bandages, tapes, medications, and other consumables.

Varicose Veins -- Up Close and Personal

Kate S. (she asked for medical privacy) owns a New York City textile firm and loves sports of all kinds. On a regular basis, she plays tennis and baseball with her children, joins in any aerobic classes she can find, swims, practices yoga, does weight training, and finds time to jog three to five miles daily.

"I probably inherited a varicose vein problem from my father," she told CosmeticSurgery.com. "So I had twins at age 29 and then surgical vein stripping. It was painful and required a long recovery."

At 31, Kate had a third child. The extra pounds of pregnancy weight, plus her genetic predisposition for the condition, caused varicose veins to appear again, resulting in the legs appearing much older. (Note the left picture in the before and after pictures below.)

"I was embarrassed wearing shorts or a short skirt," she says.

Finally, at age 40, Kate had a mini-phlebectomy with endolaser. The difference between a laser procedure and the vein stripping? Let her tell it.

"After the endolaser procedure, I walked five miles the next day, had dinner with my husband that evening and wore cute shoes with no problem," K.S. says.

Varicose Veins Before and After Photos



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