Leg Veins: Combination of Sclerotherapy & Lasers Yields Optimal Results
NEW YORK, NY (December 21, 1998) — Many patients expect lasers to offer a "quick fix" for unattractive spider veins in their legs. However, the combination of sclerotherapy and laser therapy often is necessary to provide an effective and long-lasting result, according to an article in Aesthetic Surgery Journal, an official publication of the American Society for Aesthetic Plastic Surgery (ASAPS).
ASAPS member Victoria Vitale-Lewis, MD, a board-certified plastic surgeon in Melbourne, Florida, uses sclerotherapy as the primary treatment method for leg veins. "Sclerotherapy is effective in treating the varying sizes of spider veins that most patients have," says Dr. Vitale-Lewis, noting that the larger "feeder" vein that leads into the spider veins must be treated as well. She reserves the laser for tiny vessels, such as those left over after sclerotherapy, or for patients who shy away from injections.
With sclerotherapy, a concentrated saline solution or other sclerosing agent is injected directly into the vein. This effects the lining (endothelium) of the vessel, causing fibrous tissue to develop (fibrosis), which obliterates the veins making them invisible. Because sclerotherapy does not affect the pigment melanin in the skin, the risk of blotchy skin discolorations (hypo- or hyperpigmentation) is reduced, and patients with tanned skin are not excluded from treatment.
Laser treatment is indirect: the beam must first pass through the skin before it reaches the endothelium on the inside of the vein. Fibrosis with resulting vein obliteration is achieved when the laser beam is absorbed by proteins in red blood cells (hemoglobin and oxyhemoglobin). "Because of the interlocking network of superficial veins of varying diameters and colors in the legs, one can understand the difficulty in developing laser technology that is as effective or predictable as sclerotherapy," Dr. Vitale-Lewis comments. Laser treatment alone may be adequate for treating tiny spider veins such as those around the feet and ankles. Circumstances also exist where lasers offer the only option for treatment. Although rare, a patient may be allergic to the sclerosing agent, and pregnant women should not be exposed to the chemicals used with sclerotherapy. It is advisable, however, for pregnant women to wait approximately 6 to 12 weeks after delivery to determine if treatment is necessary as there is a high likelihood that prominent veins will regress or disappear when hormone fluctuations stabilize.
"In most cases, veins that have been treated do not recur, at least to the degree they were present before treatment," says Dr. Vitale-Lewis. Those that do recur or newly-developed veins may require continued "touch-ups" every 2 to 3 years.
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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