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Young Body, Old Hands- Exploring Endovenous Laser Treatment vs. Sclerotherapy

Celebrities in their forties, fifties or sixties can spend thousands of dollars on over the counter creams and plastic surgery. No matter how much cosmetic work they’ve had done, there is one oft-neglected body part that almost always reveals their “true” age- their hands. Hands and lower arm veins become more visible with age, but are often overlooked by patients who are considering cosmetic dermatology procedures.

Ropey veins are more noticeable in middle-aged women who are in-shape and have slender frames since they have little fat to hide the vein’s appearance. Currently, there are three minimally invasive treatments designed to reduce and eliminate appearances of veins.

Sclerotherapy is the injection of a sclerosing agent (such as Sotradecol or Asclera) into the veins, causing them to shrink. This is my preferred method, as advantages include speed of treatment, ease of recovery and lower cost. Most patients see significant improvement in the appearance of their hand veins. It’s also easy to repeat treatment when needed. Disadvantages are that it may take 2-3 sessions to obtain maximal improvement. Allergic reactions and other side effects are possible but rare.

Endovenous laser treatment (EVLT), involves the insertion of a small laser fiber, usually through a needle stick in the skin under ultrasound visualization, into the vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut. Blood flow is diverted to nearby veins, minimizing the vein appearance in hands. The procedure is done in-office under local anesthesia. Advantages of this approach are that treatment is generally effective with one treatment. Disadvantages include high cost, need for local anesthesia, increased risk of skin injury, and potential for longer recovery times. Also, veins to be treated with EVLT need to be relatively straight.

Ambulatory phlebectomy is the removal of veins, under local anesthesia, through small punctures in the skin. Advantages are that usually one treatment session is effective. Disadvantages are that it requires small incisions, local anesthesia, and compression bandages. Bruising is common.

Given that each patient condition varies, Dr. Zimmet begins by taking a medical history and performing a physical examination. While most patients with prominent hand veins can be treated safely, it’s important for the physician to rule out certain underlying conditions before embarking on treatment. Also, it’s important not to close all superficial hand/arm veins in case a need arises for intravenous lines.

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