Treating Leg Veins - Appalachian Spring Dermatology

Leg veins are something we often notice more in the spring and summer, but fall and winter is the best time to address them and treat them.

Why do some people have visible veins in their legs? Various factors can cause visible legs veins, varicose veins, and spider veins: genetics, prolonged swelling in the legs, trauma to the legs, and faulty valves are the most common.

Who is a candidate for leg laser vein removal?

A candidate for treatment is anyone who has leg veins that are less than 5mm in size, who understands the risks, costs, and time necessary to achieve the full benefit of the procedure, and who has realistic expectations of the outcome. If you are pregnant, take aspirin or other blood-thinning medications, or have a medical condition that prevents your blood from clotting properly, the treatments may be less effective.

Other than procedures to treat the veins, what else can I do?

Stay active and healthy. Regular exercise of the legs pumps fluid out of the legs, reducing the swelling leading to visible veins. Wearing support stockings every day is also extremely helpful. Support stockings encourage the blood to flow correctly, preventing swelling in the legs and supporting the weak veins.

What are the biggest considerations in treating leg veins?

Treating superficial leg veins or spider veins is entirely cosmetic. However, sometimes the superficial veins are an indication of a deeper problem. Full consideration and evaluation of vein health are necessary for adequate treatment. For those who know me, I like to explain things in the skin using simple analogies. So here it goes. Veins are like rivers and streams. The deeper, larger veins are the rivers, and the more superficial veins are streams. Often there is a problem with the deeper veins, the rivers, and when those veins dilate, they sprout streams. Treating the streams without considering and addressing the deeper veins often leads to poor and unsuccessful treatment outcomes. For patients considering treatment of superficial veins, it is important to have the deeper veins evaluated first. This evaluation is often done by vascular or general surgery using ultrasound. The good news is that insurance usually covers the deeper leg veins’ evaluation and treatment if they are determined to be malfunctioning. Often once the river problem is corrected, the streams dry up. Meaning, treating the deeper veins leads to improvement in superficial spider veins as well.

Should I have my superficial spider veins injected?

That is a matter of personal and physician choice. Dr. Rosenberger prefers to laser the veins instead because it is a simpler and safer process in her hands.

Tell me more about Laser Vein Reduction Treatments!

We are pleased to offer our patients over 15 years of experience treating both facial and leg veins with our 1064 NdYag laser. More than other treatments, laser vein reduction requires a consultation to determine if our laser will work the best to treat your veins. Both on the face and the legs, there is an optimal size and color that responds well to laser treatment. Veins that are thin, fine, and red may not respond as well as larger, purple, and blue veins. Our laser works for spider veins only and will not work well on larger reticular or varicose veins.

How does it work?

A laser is a medical device that uses a focused beam of light to target specific structures in the skin. By definition, a laser has a single wavelength of light. The wavelength we use is a 1064nm NdYag laser – called the Cutera Xeo Cool Glide. Why is this important? The higher the number (up to about 1300nm), the longer the wavelength and the deeper the laser light penetrates the skin. Only a 1064nm laser effectively penetrates to the deeper layers of the skin where many blood vessels lie. In contrast, an intense pulsed light device (which we also have in the office but we do not use for larger vein removal) contains many wavelengths of light between 560nm and 1200nm. This type of device is generally less effective for larger veins. Many things are marketed as a “laser.” It is important to understand the above information to evaluate laser treatment options in an educated manner.
In laser vein removal, the laser light targets the pigment in the red blood cells that are in the blood that courses through the veins. The interaction between the laser and the pigment in the blood generates energy, best described as heat. This energy is transferred from the blood to the blood vessel wall. By damaging the blood vessel wall, the blood vessel is no longer a good conduit for blood flow. Using this technology, laser vein treatments enable the treatment of unwanted veins, without needles or cautery, in a few treatments. We use our knowledge of anatomy and plan treatments carefully to ensure the most effective and best cosmetic outcome. We use a similar technique to treat facial veins as well.

What happens to the veins after the treatment?

Although we can visually see the veins responding during the treatment session, the veins are not “vaporized” by the laser. The laser damages the blood vessel making it less conducive to blood flow. As blood flow ceases, the blood vessel loses its nutrients and dies. However, the blood vessel “pipe” remains even though it is empty. In the weeks following the treatment, the body breaks down the blood vessel “pipe” and removes it. Until this removal process occurs, the veins often may look darker and more visible. We like to allow six weeks between treatments to see the full effect of the treatment. Even after the treatment, continual improvement can occur. As larger veins “rivers” are shut down, often smaller veins “creeks” dry up as well.

What results can I expect?

If a vein goes completely away with treatment, it should not return. Occasionally the body reopens the vessel before it is completely reabsorbed, or the vessel only partially responds. Because of this, we find that patients may need 3-4 treatments that are 6-8 weeks apart. Also, the factors that contributed to the enlarged leg veins, such as standing for long periods, female hormones, pregnancy, being overweight, or a family history of varicose veins, may not change. Therefore, new veins tend to form over time. Thus it is important to prevent the development of new leg veins by wearing compression stockings before and after the treatment.

What is Laser Vein Reduction like?

During a Laser Vein treatment, we will apply aloe vera gel to the area being treated. Depending on the extent of the veins, each treatment takes between 10 and 30 minutes. Subsequent treatments are performed no closer than 6 to 8-week intervals. Most people find the treatment of facial veins slightly uncomfortable, but the treatment of leg veins is more painful. No sedation or pain reliever is desired or required, but patients should expect discomfort with both procedures. The leg veins treated will usually look darker and a bit swollen after the procedure. There may be small pink bumps that resemble mosquito bites that can last a day or two. We STRONGLY recommend wearing medical-grade support stockings for seven days after the procedure to alleviate these symptoms and to prevent the leg veins from reopening. Wearing stockings is very important for successful treatment. You will need to wear goggles during the entire treatment to protect your eyes from the laser.

Why does it take multiple treatments?

Some veins respond less well and may need multiple treatments. More importantly, I like to use this analogy: If you say to me, ” Beth, go clear off all the trees on that mountain over there.” I follow your request and remove all of the poplar, oaks, and large trees. “This is great,” but now you say… what about the scrub pine trees, rhododendrons, and hollies? You couldn’t even see these at the start, but as the larger trees (Veins) are removed, now you see more things than you did before.

Are there any negatives?

There is some discomfort with this procedure, but it is usually tolerable and short-lived. When you leave the office after the procedure, you should not be in any pain. The veins treated will usually look darker and a bit swollen after the procedure. The entire treated area may be red for a few hours after the treatment, mainly from the body’s response to the cooling. When we treat larger veins, it is possible that a small amount of blood can “leak” out of the vessel before it is heat-sealed, resulting in a bruise or discoloration of the skin. Bruises are temporary and resolve in 1-2 weeks. The risk increases if you take aspirin products or are on blood thinners. Because blood contains iron, it is possible for a brownish discoloration to result after the bruise fades. This is temporary and will resolve in 1-2 months. To decrease the risk of bruising and discoloration as well as increase the effectiveness of the treatment, we ask that you wear prescription strength compression stocking for at least seven days after the procedure.

Uncommonly, a skin wound such as superficial blisters and scabs can occur, which heal within two days to 14 days. The use of antibiotic ointment regularly usually results in uneventful healing. There is a <0.5% possibility of a skin wound leaving behind a permanent scar. It is also rare for an infection to occur since the skin is usually not broken.

What is the cost of Laser Vein Removal?

The fee for Laser Vein treatments depends on the extent of your leg veins. Please call our office to schedule a consultation exam. At that time, Dr. Rosenberger will give you an estimate of the number of treatments needed and the cost of each treatment.

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