Bulging and visible veins, usually on the legs, are frequently a concern for most of us, especially during "expose your legs" weather. Although most common as we age, prominent and visible veins can occur even in the young, especially during and after pregnancy. People that spend a lot of time on their feet are more prone, due to the effects of gravity. The veins fill with blood but the pumping action of the veins that usually returns the blood to the heart is weaker, so the blood stays in the veins, causes them to dilate and become visible. "Spider veins" are small networks of interconnected veins that are visible and unsightly. Varicose veins are frequently hereditary.

Most of these veins can be safely treated by one of the methods described below, all of which are offered by our office. Frequently, the appropriate treatment may include a combination of these methods.

Sclerotherapy

This is a method whereby the unwanted vein is injected with a "sclerosing" solution, a material which collapses and eventually eliminates the vein. This occurs because the solution irritates the inside of the vein, making it sticky. The walls close, blood can no longer enter the vein, and since it is now non-functional, the body (eventually) rids itself of the useless vein. Most of these small superficial (close to the surface) veins are not needed by the body, so losing them is not a health hazard.

As you can imagine, this is not a rapid process. As a matter of fact, the veins look worse for a while after injection,  from the irritation and inflammation we caused. But things start to look better in a few weeks, and usually by 2-3 months, the veins are gone. We cannot destroy all the veins at once, since not all veins respond to the first treatment. 70% improvement after the first session is a reasonable expectation. Therefore, one or two repeat treatments are usually necessary.

There is virtually no pain with this procedure. In the old days, when we used hypertonic saline, patients did get significant burning with the injections. But these days we have newer and more effective agents that are painless. The needles we use are specially designed for this purpose, are very tiny (32 gauge -- not much bigger than a fine wire) and cause very little discomfort. If many veins need treatment, the length of a session can be up to an hour. Also, veins that are too tiny to be entered with a needle cannot be treated with this modality.

All patients are asked to use some form of compression (elastic bandage if a small area is treated, or surgical-grade compression stockings for larger areas) for 2 to 5 days after treatment to maximize vein collapse and assure a good outcome.

Ambulatory Phlebectomy

This procedure involves surgical removal of varicose veins that are too large to be successfully injected with sclerotherapy (described above.) It is performed under local anesthesia, and involves actual removal of the enlarged veins through very small incisions in the skin. There is no down time and no significant pain involved.

Phototherapy

This method obliterates veins by "zapping" them with high-energy light beams. This can be accomplished by using a laser or  Intense Pulsed Light (IPL). These treatments are quick and cause only mild discomfort. They have the advantage of being able to treat very tiny veins which cannot be entered with a needle (such as the ones that sometimes form on the nose or cheeks) and they cause less post-treatment irritation and discoloration than sclerotherapy. These treatments are also usually done in a series, since once alone is usually not enough.

More serious varicose veins

Very large varicose veins are a different matter, and are frequently due to valvular incompetence of the larger vein junctions.  These are much more serious and need to be treated surgically, not cosmetically. We perform a venous assessment on all of our potential vein therapy patients to identify these conditions ahead of time.

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