Sclerotherapy for Spider Veins

Spider veins of the legs are extremely common, affecting millions of men and women. These veins may be red, blue, or purple and arise anywhere on the leg – from the thigh to the ankle. These veins may not only be unsightly but cause symptoms including aching, burning, swelling and cramping during the night.

Sclerotherapy is a simple procedure that involves the injection of a solution that causes the vein to collapse and fade away. Leg vein sclerotherapy has been used in Europe for over 50 years but has only recently become popular in the United States.

Tattoo MD Laser Clinic now offers this simple yet effective procedure to treat spider veins of the leg. Please read further for additional information.

What Are Spider Veins?

Spider veins, also known as telangiectasias, are small, thin-walled veins that appear just under the surface of the skin. They differ from varicose veins in that the latter are much larger, may cause a bulge of the skin, and are more likely to be associated with painful symptoms. While sclerotherapy may sometimes be used with varicose veins, surgery is often indicated to treat them. Spider veins may develop due to genetics, pregnancy and hormonal changes, weight gain, and prolonged standing.

Who is a candidate for sclerotherapy?

Women of any age are candidates for sclerotherapy, however, at Tattoo MD, we defer treatment on women who are pregnant. Men are also candidates, although they may be less bothered by the spider veins since they may be covered by leg hair.

What to Expect From Sclerotherapy

Sclerotherapy is a very effective procedure, but results vary on an individual basis. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to achieve results, although as many as six sessions may be needed. Some veins may be resistant to treatment. Additional veins may develop with time and prior sclerotherapy will have no effect on these.

If you have a medical condition related to your spider veins, such as liver disease, hormonal imbalance or another disorder, we advise you to first seek treatment for that prior to considering sclerotherapy.

Side Effects and Risks

Serious medical complications from sclerotherapy are extremely rare but may occur: There may be some bruising or increased pigmentation in the area which are temporary. More serious side effects are rare and will discussed with you during your consultation.

Sclerotherapy Procedure

Your sclerotherapy session will probably last around 30 minutes. No anesthetic is needed. Approximately one injection is used for every inch of vein. You may feel the mild pricks of the needle and a burning sensation. Afterwards, a cotton ball and compression tape is applied at the injection sites.

You will be provided with specific but simple aftercare instructions after your treatment. Treated veins will initially look worse and you may notice some bruising, but this fades with time. Treatment of the same area can be repeated after 1 month. As the injected areas heal, you will notice improvement with each session.

Your New Legs

Most patients are amazed by the difference that sclerotherapy makes in their appearance. You may notice that you are able to wear shorts or skirts that you previously felt too uncomfortable to wear. With time, new spider veins may appear for which you may want to return for a “touch-up.”

If you are interested in any of our skin rejuvenation procedures, call TATTOO MD Laser Clinic and schedule your FREE CONSULTATION today!�

Intense Pulsed Light (IPL) was developed in the 1980’s for the treatment of photo-damaged skin. Unlike laser devices that use a single wavelength of light, IPL uses a xenon flashlamp to generate intense pulses of broadband light at very high energy. Filters are used in the IPL device to restrict the actual wavelengths that are emitted. Thus, various IPL’s have been developed with a range of filters depending on the application that the machine is used for. For instance, a filter that lets out light of a shorter wavelength would be expected to treat melanin in sunspots, while a longer wavelength filter would let through light that would tend to heat collagen and penetrate more deeply to stimulate collagen remodeling.

IPL has gained great popularity through its application for the “photofacial.” This is generally a quick and relatively painless office procedure. Patients with sun damage in the form of sun spots / age spots, abnormal redness and sallow skin tone stand to benefit the most from the treatment. Additionally there are benefits for superficial wrinkles and other textural problems. Unlike lasers that are used for skin resurfacing, such as the CO2 laser, IPL is better tolerated and has fewer side effects. Typically it is administered as a series of 4-6 treatments with incremental results from each visit. Common side effects include redness and roughness of the skin that may last up to a week. Contrast this with treatments by lasers used for resurfacing, such as the CO2, that can leave denuded skin that requires prolonged healing and carry a higher risk of scarring.

As with other lasers that target melanin, darker-skinned patients are not good candidates for IPL. The increased baseline melanin in darker skin creates a stronger background target for the light and increases the risk of a burn. If the skin is too dark, then the therapeutic window may be too narrow to expect good results. An ideal candidate is one who is fair-skinned but who has significant photodamage, usually from years of sun exposure.

More recently, a novel approach to facial rejuvenation has arisen that combines light sources, such as IPL, with photosensitizers that increase the effect of the light. This is termed photodynamic therapy. The most commonly available photosensitizer in the US is 5-amino levulinic acid (5-ALA). 5-ALA was previously described with the use of a light source for treatment of actinic keratoses on the face. Subsequently, it was shown that 5-ALA could be combined with IPL to increase the effectiveness of photorejuvenation. This showed significantly increased benefit for fine lines and pigmentation.

5-ALA is applied to the skin for at least 30 min. prior to the procedure and allowed to soak in. After treatment with IPL, the patient may experience more redness and scaling than with IPL alone. Furthermore, strict sun avoidance and protection is required for 48 hours since the 5-ALA remains within the skin and can increase redness and discomfort if the skin is exposed to sunlight. Also, commercially available 5-ALA, marketed as Levulan Kerastick, costs approximately $100 per application. On the other hand, the increased effectiveness of photodynamic therapy makes the addition of 5-ALA an attractive option.

Further research is constantly being pursued in this popular area of laser and light source technology. Already, companies have combined additional technologies with IPL. Syneron, for instance, has added bipolar radiofrequency with the idea of enhancing the IPL’s effect. Aesthera, has combined suction with broad-band light to increase effectiveness. Watch for future developments in this exciting arena.

Keywords: IPL, Intense Pulsed Light, Los Angeles, Photorejuvenation, Photoaging, Photodamage, Sun damage, wrinkles, sun spots, age spots, rosacea, redness, sallow skin, skin tone, levulan, photodynamic therapy, PDT, 5-ALA, photosensitizer

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Summary: Hyperhydrosis, or excessive sweating, is a condition that causes social embarrassment and interferes with quality of life. Most available methods of treatment are either highly invasive or require very frequent re-application. Botulinum toxin has been shown to be an effective treatment that requires re-treatment infrequently.

Hyperhidrosis is a condition characterized by over-secretion of sweat, most commonly in the underarms and the palms. It can take a heavy toll on those affected, leading to embarrassing social situations and limitation on career mobility. Underarm hyperhidrosis, besides causing wet clothing, can cause skin maceration, skin infections, and unpleasant body odors.

Sweating in hyperhidrosis can arise from different triggers. Localized underarm and palmar hyperhidrosis is usually triggered by emotional stimuli. Generalized hyperhidrosis, with overactive sweating of much of the body, may be associated with certain medical conditions, such as diabetes, hyperthyroidism, and cancer. Therefore, when seeking treatment for excessive sweating, it is important to exclude medical causes of the disorder.

Treatment of hyperhidrosis is varied. Only recently has a low-impact, yet effective treatment become available, in the form of botulinum toxin (Botox). Local treatments for hyperhidrosis include metal salts, such as aluminum chloride. These salts function by plugging up the ducts of the seat glands. This needs to be performed daily at the commencement of treatment, then followed with maintenance regimen once or twice a week. Another method is tap water iontophoresis. The hands or feet are immersed in tap water for 10 minutes while an electric current is applied. The mechanism of action is unknown. Treatments are usually performed several times a week. Surgical treatment is also an option. The sympathetic nerves in the chest can be cut. Finally, the sweat gland-bearing underarm skin can be surgically removed.

Botulinum toxin A (Botox) is a chemical produced by a bacteria, clostridium botulinum. It is the substance found to be responsible for botulism. Botulinum toxin was first used therapeutically in the 1960’s by ophthalmologists, for the treatment of eye muscle disorders. Use of botulinum toxin spread with the treatment of other disorders of muscle spasm. Finally, it was applied cosmetically for the treatment of dynamic facial wrinkles. Simultaneously, it was noted that patients had decreased sweating in areas where botulinum toxin was injected. This led to investigation into its use for hyperhidrosis.

Sweat glands secrete sweat in response to the release of a neurotransmitter, acetylcholine, from nerve endings. Botulinum toxin functions by blocking the release of acetylcholine from the nerve endings. It is not known hoever, whether this is the definitive mechanism of action of botulinum toxin in hyperhidrosis treatment.

Botulinum toxin A, is commercially available as BOTOX in the United States. It is used clinically as follows. Prior to injection, the area of sweating is visualized using the Minor test. First, iodine is applied to the skin and allowed to dry. Corn starch is applied and turns blue in areas where sweating is occurring. The loose starch is then brushed off, allowing one to see where injection is needed. In the underarms, a standard dose of 50 units per side is generally needed and is broken up into smaller aliquots that are injected throughout the involved area. Injection in the underarms is well tolerated and doesn’t require anesthetic. Treatment of the palms and soles, however, is very painful and requires nerve block in the wrist or ankle or the use of topical anesthetic cream.

BOTOX takes effect after approximately 3 days, and is usually maximal after one week. It is approximately 90% effective and generally lasts about 7 months, with a range of 3 to 17 months. In a study by Hornberger et al, mean sweat production at 24 weeks was still below 50% of the preinjection level. 92% of patients were satisfied with the treatment at 4 weeks after injection. Higher doses can somewhat prolong the duration of effect, but at an unacceptably increased cost. Repeat treatments do not lead to the decreased need for BOTOX in the future.

Side effects include those that would be expected from poking the skin with a needle, such as bleeding or infection, although these are uncommon. Rarely, repeated use of botulinum toxin can lead to the development of antibodies to it. This is not harmful but causes the toxin to become ineffective. Use of the toxin in the palm can lead to temporary weakness of hand muscles. Pregnancy, breast feeding, and certain conditions of muscle dysfunction, such as Myasthenia Gravis, are contraindications to the use of botulinum toxin.

In conclusion, when hyperhidrosis causes extreme discomfort or anxiety for an individual, botulinum toxin is the ideal treatment, despite the expense and the need for repeat treatments.

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