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

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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.

When’s the last time you wore shorts or short skirts without feeling self-conscious? If you’re a woman between the ages of 40 and 50, you’ve noticed the increase of those pesky spider-like purple-bluish veins blemishing your legs. Over 50% of the population is affected by unsightly varicose or spider veins. Age is just one contributing factor to spider vein development. Hormonal factors, genetics, pregnancy, injuries, and prolonged standing still also contribute to this cosmetic condition.

Many Vitamin-K based creams and gels claim to remove spider or varicose veins, but researchers have shown that topical remedies are not effective at penetrating the skin’s surface. Which treatment options offer optimal, long-lasting results? Sclerotherapy is an effective, scientifically-proven procedure to eliminate a vein’s appearance. “The gold standard of spider vein treatment is sclerotherapy,” says Dr. Steven Zimmet, President of the American Board of Venous and Lymphatic Medicine, a non-profit group to provides certification to vein physicians in the US.

In sclerotherapy, a fine needle is inserted into the vein. A sclerosing agent is injected into the vein itself, causing the vein walls to shrink and collapse. Since veins vary in depth and thickness, the injection is customized according to each patient’s condition. Various sclerosants are used, including dextrose/saline, Sotradecol® and Asclera®. Dr. Zimmet does not recommend routine use of hypertonic saline as this causes significant burning. Performed in a doctor’s office, the outpatient procedure takes an average of 20 minutes and patients can resume normal activities the same day of treatment. According to The American Society of Plastic Surgeons, more than 572,863 sclerotherapy treatments were performed in 2010.

The procedure’s popularity may be due in part to its success rate. The Mayo Clinic for Medical Education and Research reports that sclerotherapy has an overall success rate of 50% to 80% in eliminating treated veins. Maximal clearing generally requires a few sessions, with results seen about one month after each treatment.

With spring and summer around the corner in Austin, it is an ideal time to start spider vein removal. Learn more about leg veins and sclerotherapy vein treatment at Dr. Zimmet’s website.

We are proud to announce that Best Doctors® has informed Dr Zimmet that he has been elected by his peers for inclusion in Best Doctors in America® from 2011 to 2012 in dermatology/phlebology. Best Doctors, based in Boston, Massachusetts, was founded in 1989 by physicians affiliated with the Harvard Medical School to provide expert medical consultation services. Best Doctors is improving the quality and cost of healthcare by giving individuals access to these consultations. A group of well-recognized experts serve as their medical leadership.

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