Problems with unsightly veins are very common with nearly two thirds of people over the age of 60 suffering from some kind of venous problem especially varicose veins and spider veins. Indeed the incidence of varicose veins and other unsightly veins increases significantly after the age of 40 and women are much more likely to develop them than men.

Varicose veins

Varicose veins occur when veins do not properly return blood from the lower leg to the heart. All veins have valves that open to allow the flow of blood to the heart and close to prevent back flow (know as "reflux") of blood to the foot. When valves fail to function properly, blood leaks through and flows down the leg in the wrong direction. The blood overfills and distends the superficial veins under the skin, resulting in the bulging seen in varicose veins.

The walls and valves of veins are thin and elastic, and can stretch due to a variety of conditions including pregnancy, heredity and age. When varicose veins become severe and compromise the return of blood toward the heart, it is referred to as chronic venous insufficiency. Symptoms of chronic venous insufficiency includes aching pain, easy leg fatigue and leg heaviness, all of which worsen as the day progresses. Left untreated, chronic venous insufficiency can cause ulcerations, which can be very difficult to treat.

Spider veins

Spider veins although similar to varicose veins are much closer to the surface of the skin and are usually red or purple. These veins are most commonly found on the face and legs and appear like a spider's web with short jagged lines.

Causes of unsightly veins

The cause of varicose veins is unknown.  Heredity is the most common factor. Increased pressure in the deep venous system is transmitted to the surface system and slowly compromises the surface veins with defective valves and predisposes to the development of varicosities. Hormonal changes play a large part and this probably explains why more women suffer from varicose veins than men because of the hormonal changes that occur during pregnancy and menopause. Other contributory factors include obesity and prolonged standing. Spider vein and small varicose vein development of the legs are another way the body tries to defuse the increased venous pressure by reducing the volume of blood in the larger surface veins. Development of spider veins on the face are often the result of excessive sun exposure and the development of rosacea.

Ligation and Vein stripping: Until recently the standard treatment of large varicose veins was ligation and vein stripping. With ligation one or more incisions are made over the varicose veins, and the vein is tied off. If the ligation can isolate a faulty valve and the vein and valves below the faulty one are healthy, the remaining vein may be left in place to continue circulating blood. If several valves in the vein and the vein itself are heavily damaged, the vein (or the diseased part of the vein) is usually removed (stripped). Varicose vein surgery has the same risks associated with general surgery, including infection, bleeding, and anaesthesia risks. Common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, haematoma, numbness, and less frequently wound infection.

Sclerotherapy --. Sclerotherapy works by injecting a solution into the damaged veins causing them to collapse, stick together, and eventually break down naturally in the body. Normal blood flow in the leg is thereby re-routed through deeper veins. Although the needle used to administer the sclerosant is small some patients report pain during the process. Side effects can include: brown lines or spots on the skin at the site of the injected blood vessels. In most cases, this discoloration will disappear in time. In a small number of people (less than one per cent), the brown lines may last up to a year or longer. Swelling, matting (the development of numerous fine red veins,) ulcers and inflammation are also possible.  Very rarely phlebitis or blood clots can result from sclerotherapy.

Endovenous Laser Treatment (EVLT) works by means of thermal destruction of the vein. Laser energy from a Nd:YAG laser is delivered to the desired location inside the vein by using a bare laser fiber inside a catheter. Small incisions are made to create an entry and exit hole in order to allow the laser fiber to be passed along. When the laser is fired, it causes the vein wall to shrink and seal shut. The healthy veins that surround the now closed vein can then restore the normal flow of blood to the area treated. The laser is repeatedly fired as the laser fiber is gradually withdrawn along the course of the vein until the entire vessel is treated.

Endovenous Laser Treatment is less invasive than traditional surgical methods of varicose vein removal, has a lower complication rate, and is well tolerated by patients. Moreover recovery time is quick and the treatment produces good cosmetic results. This treatment is principally effective on large truncal veins in the legs. We do not offer this type of laser treatment for varicose veins, but can refer you for treatment if it would be a more effective option than sclerotherapy for you.

Treatment of Spider Veins

Superficial veins, like spider veins, can be treated extremely effectively with laser therapy. The energy from an Nd:YAG laser is absorbed by the blood in the vein, changed into heat and the vein walls destroyed. This process is perfectly safe as other healthy veins will supply blood to the treated area and the body will clear the dead tissue as it clears a bruise. Some patients may only need one treatment but usually up to 3 treatments are required to clear the skin of the spider vein completely. Until the development of the newer ND:YAG lasers, sclerotherapy was the treatment of choice for smaller leg veins.  Laser therapy of small leg veins is now comparable to scerotherpy for treatment efficacy.

For facial vein we also offer KTP laser, Pulsed Dye, NLite and Intense Pulsed Light Treatments. For after care to optimize treatment results, we recommend ace wraps or 20-30mm support stockings for three days post-treatment.  They may be removed for showering.  Avoid hot baths for three days.  Avoid exercise for three days post-treatment as well.  Increasing blood flow to the treated areas of the legs, may help the body re-cannulate the vessels to re-form rather than resolve.

Extensive treatment of leg veins occasionally may cause swelling of the legs and ankles.  This will resolve shortly on its own. Support stockings or ace wraps also reduce the chance of swelling when worn post-treatment.

For any irritation post-treatment, apply aloe gel as often as needed.  Wear a sunblock for 6 weeks post-treatment. Facial skin may become swollen and sore for a few days post-treatment.  Aloe gel can be helpful.  Hydrocortisone 1% Ointment also may be very helpful in improving the symptoms quickly. 

Blood vessels on the nose have a higher penchant for recurring than other facial vessels after treatment and are more likely to require re-treatment. (Robin Sult, RN, Orientation to The Fotona ND:YAG Laser)   

© 2006 Joel A. Sabean, M.D.  Privacy Statement  Disclaimer