Cosmetic Procedures
Vein Treatments: What to Expect Before, During, and After

If you are considering a cosmetic procedure to diminish the appearance of spider or varicose veins, your dermatologist may recommend one of the following:

  • Sclerotherapy - A solution that seals off the vein is injected with a very fine needle.

  • Ambulatory phlebectomy - The vein is surgically removed one small section at a time via micro-incisions.

  • Laser therapy or radiofrequency - Energy from the laser or radiofrequency device closes the vein.

What to Expect Before Vein Treatment
A physical examination and complete medical history are necessary to determine which treatment will provide the patient with the best results. Sometimes the dermatologist needs to see how the blood is flowing within a vein, and the patient undergoes a non-invasive imaging scan such as a Doppler ultrasound. The dermatologist considers all of this information before recommending treatment.

What to Expect During Vein Treatment
If your dermatologist recommends one or more of these procedures, this is what you can expect:

Sclerotherapy – The most widely used procedure, doctors have been treating unwanted veins with sclerotherapy for more than 100 years.

When a patient undergoes sclerotherapy, a solution is inserted into the vein with a very fine needle. This solution causes the walls of the vein to thicken and stick together. The vein will begin to seal shut. Eventually, the closed vein is eliminated by the body.

After the injections, the treated area is dressed and the patient is asked to walk around the office. If a leg has been treated, the leg is wrapped in a compression bandage or a compression stocking is placed on the leg before the patient stands up.

The patient may be asked to wait in the office for 15 to 30 minutes before leaving so that the dermatologist can evaluate the results.

More than one office visit may be needed to treat the veins.

Ambulatory phlebectomy – Used to treat a wide variety of veins, ambulatory phlebectomy is commonly the best option for younger patients with varicose veins. The walls of their veins are usually too thick and strong for sclerotherapy to be effective. Ambulatory phlebectomy also is commonly used to treat varicose veins on the trunk of the body.

This procedure begins with the patient standing so that the dermatologist can outline the vein(s) to be treated with a special pen. The patient then lies down, and the dermatologist re-inspects the vein(s). Once the dermatologist has marked all the areas, the patient is given a type of anesthesia called tumescent anesthesia, which causes the area to swell. This anesthesia can cause temporary loss of sensation in the leg for up to 10 hours.

Leg marked before ambulatory phlebectomy

Leg two years after vein treatment

Legs veins marked before an ambulatory phlebectomy

2 years after the ambulatory phlebectomy

(Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)

Once the anesthesia has taken effect, the dermatologist makes a series of micro-incisions. Special surgical instruments are then inserted so that the vein can be gently lifted and loosened until it easily slides out. Stitches are generally not needed unless a large vein is removed.

After removing the vein, the treated area is dressed to prevent infection. A compression bandage or compression stocking is applied before the patient is asked to stand. The entire procedure takes 30 to 60 minutes.

Once standing, the patient is asked to walk around the office for about 10 minutes. If the patient looks well upon re-examination, the patient often can leave.

Laser treatment and radiofrequency – These newer treatment options offer some patients an alternative to a traditional surgical procedure called vein stripping and ligation, which must be performed in a hospital. Radiofrequency can be used to treat larger leg veins. Lasers are suitable for treating some larger leg veins, very fine spider veins, veins in the foot or ankle, and spider veins that can appear after sclerotherapy.

When used to treat a larger leg vein, the procedures are similar. The skin is anesthetized and a small incision is made so that either a radiofrequency catheter or laser fiber can be inserted into the vein. As the catheter or fiber is withdrawn, energy is emitted that causes the vein to collapse and seal shut.

After the procedure, the area is dressed to prevent infection, a compression stocking or bandage is applied, and the patient is asked to walk. Both procedures can be performed in less than 1 hour.

When used to treat spider veins, a laser fiber is not inserted. Instead, the laser beam is directed at the spider vein. A few treatment sessions are generally needed to diminish spider veins. Each session lasts about 10 to 15 minutes, and a session can be repeated every 1 to 2 months.

What to Expect After Vein Treatment
While most patients can return to work the day after one of these procedures, some at-home care is required. The dressing on the treated area must be changed as instructed.

When a leg is treated, a compression stocking or bandage may be prescribed to ensure the best possible cosmetic results. A compression stocking or an elastic bandage may be prescribed for 7 to 21 days — and sometimes longer.

Walking is essential part of recovery when a leg is treated. Walking helps prevent potential side effects. Your dermatologist will tell you how often to walk and for how long. Strenuous physical exercise such as weight training should not be resumed until the dermatologist says it is okay.

After each laser therapy session, it is important to protect the treated area from sun exposure for 14 days. Sun exposure can cause dark spots on the skin.

References:
Goldman MP, Weiss RA, and Sadick NS. “Sclerotherapy and Ambulatory Phlebectomy.” In: Bolognia JL, Jorizzo JL, Rapini RP et al, editors. Dermatology. 2nd edition. Spain, Mosby Elsevier; 2008. p. 2329-43.

Weiss RA and Dover JS. “Leg Vein Management: Sclerotherapy, Ambulatory Phlebectomy, and Laser Surgery.” In: Kaminer MS, Dover JS, Arndt KA, editors. Atlas of Cosmetic Surgery. United States of America, W. B. Saunders Company; 2002. p. 407-31.

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Cosmetic Procedures:
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