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

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.

Ask a Cosmetic Dermatology Expert about Coolsculpting™

Have you ever considered a cosmetic dermatology procedure, but had a question you couldn’t find the answer to online?  Can you really trust the information you find on Yahoo Answers, Twitter or Google?  Here’s your chance to ask a cosmetic dermatology expert!  Every month, Dr. Zimmet will provide up-date answers to frequently asked skincare & cosmetic dermatology questions submitted to his blog.

This month’s topic is CoolSculpting™.

What is CoolSculpting™ and does it have a long term effect?

CoolSculpting™ is an FDA-approved non-invasive treatment that uses cooling technology to reduce fat from targeted areas such as the abdomen, love handles, and other areas of fat. The affected fat cells are eliminated permanently.

See Coolsculpting Before & After Photos

Is Coolsculpting™ safe?

Water freezes at 32º F while fat freezes at a much higher temperature, around 50º F if administered for a long enough period of time. CoolSculpting™ takes advantage of this fact, and thereby provides treatment of fat cells that is very unlikely injure skin and other tissue.

What are the advantage and disadvantages of CoolSculpting?

The advantages are that the treatment is non-invasive and that the impacted fat cells are permanently cleared, with an average reduction of 20% of the fat cells in the treated area with a single one-hour treatment. Treatment of an area can be repeated if desired, but one should wait at least two months in order to obtain maximal improvement from the previous treatment. Areas most commonly treated include abdomen, love handles, back/bra fat, triceps, inner and outer thighs. An applicator must fit the area to be treated.

Results are less dramatic than liposuction, but it is much less invasive, less expensive and lower risk than liposuction.

There is pain, primarily during the first few minutes of the treatment. This quickly numbs. I’ve had several patients snooze during the treatment. I myself had the treatment and during the treatment, I’ve chatted with people, checked email, and browsed the web.  The next day, I flew to a meeting in Florida, gave several presentations, and participated in several board meetings without difficulty. I believe it is the most effective non-invasive treatment for localized fat removal currently available. However, it does not replace a healthy lifestyle.

Do you gain the fat back after the  Zeltiq (CoolSculpting™) treatment?

If you follow a poor lifestyle and gain weight, existing fat cells can enlarge and/or you can form new fat cells. However, the fat cells that are impacted by CoolSculpting™ are cleared permanently and do not return.


Will my skin sag after Zeltiq (CoolSculpting™)?

Typically the skin re-drapes after elimination of the fat- we have not seen increased skin sagging after CoolSculpting™.


What’s the difference between Zeltiq and Zerona?

That’s a great question. Zeltiq and Zerona are both non-invasive treatments for fat reduction. I evaluated both technologies very carefully before deciding which, if any, to bring into my practice. I studied the science and talked to the major scientific principle for Zerona, and the two main scientists who did the research on which the Zeltiq system is based. The bottom line is that I think Zeltiq (CoolSculpting) offers significantly better long-term results.

Zeltiq is based on solid research, recently highlighted on Good Morning America and Nightline.  Dr. Dieter Manstein and Dr. R. Rox Anderson of Massachusetts General Hospital (a teaching affiliate of Harvard Medical School) invented the patented cooling technology known as CoolSculpting, which takes advantage of the fact that fat cells are much more susceptible to cold than other tissue.  Several weeks after the procedure, the cooled fat cells die and are eliminated. On average a single one-hour treatment eliminates about 20% of the fat cells in the treated area.

Zerona generally consists of a series of about 8 treatments done over a couple of weeks time frame. It is a low level laser that is stated to cause shrinkage of the fat cells. The results to date have only been reported at two weeks. There is no evidence of any long-term benefit, and rather inconclusive evidence in my opinion of real short-term benefit.


After Coolsculpting™, how long does my skin stay red?

The skin is usually red after treatment, but normally clears within a few hours. Other side effects include temporary bruising, tingling, tenderness, and temporary numbing in the area.

Is tingling normal after Coolsculpting™?

Numbness and tingling of the treated area is common after CoolSculpting™ . It lasts an average of about 3 1/2 weeks.

Is hyperpigmentation a side effect of Zeltiq?

Hyperpigmentation is a rare side effect of Zeltiq, reported in about 1 in 1000 treatments. To date, hyperpigmentation has resolved in all cases within a few months.

Didn’t get your question answered in today’s post?  Post your own question through the “Have a Question?” section of Dr. Zimmet’s homepage. Due to the volume of questions received, it is not possible to answer every inquiry through the blog. However, we make every effort to address multiple questions in a single post.

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