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Spider Veins

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What are spider veins?

Spider veins are abnormally dilated blood vessels in the skin. They usually appear on the legs but can also occur on the face and less commonly the chest, arms, and back. Contrary to what many physicians are taught, spider veins can cause the same symptoms as much larger varicose veins including itching, burning, heaviness, and fatigue in the legs. Although they may be symptomatic, spider veins are not usually a health hazard and do not lead to serious complications. In rare cases they can bleed profusely after being injured, but otherwise they are treated mostly as a cosmetic problem.

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What causes spider veins?

Spider veins develop in two ways. First, tiny pre-existing veins can enlarge and become dilated over time. Secondly, your body actually grows new veins where it doesn’t need them…in the skin. Pregnancy, hormone-containing medications, and hormonal fluctuations may stimulate their appearance, thus, spider veins are more common in women. They are not caused by crossing the legs or by years of prolonged standing or sitting at work. The tendency to develop abnormal veins is largely hereditary, and there is not much you can do to prevent them. Support hose, exercise, and dietary supplements are helpful for symptoms, but the veins keep growing. In some cases, the appearance of spider veins may be an indication that there are larger diseased veins underneath. The physician may use ultrasound to search for any larger diseased veins that may be causing your spider veins. If larger diseased veins are found, they need to be treated first and eliminated or else spider vein treatment will be ineffective.

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How are spider veins treated?

Sclerotherapy is the treatment of choice for spider veins. In sclerotherapy, a safe, painless solution is injected into the abnormal veins causing them to shrivel and disappear. Blood is re-routed into nearby healthy veins. Although there has been much publicity about ‘laser’ treatment for spider veins, most vein specialists consider laser therapy to be less effective and more painful than sclerotherapy. Interestingly, spider veins on the face appear to respond better to laser than do spider veins on the legs.

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Foam Sclerotherapy (Sclerofoam)

Foam is made by mixing gas bubbles with a liquid, giving a consistency like shaving cream or mousse. One part of liquid solution will make 3-5 parts of “bubbly” foam. When injected inside a vein, the micro foam displaces the blood (rather than mixing with it) creating better contact with the vein wall. Improved contact between the medication and vein wall gives better and faster results. The expanded volume of the mixture also allows for less medication to be used at a weaker strength.

Foam Sclerotherapy is nothing more than injecting air mixed with a liquid sclerosing solution (sclerofoam) rather than just the liquid sclerosing solution into the veins to be treated. The amount of foam used is limited to avoid side effects and both techniques may be used together to obtain optimal results.

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How long does it take to look better?

The tiniest spider veins may disappear quickly. Larger veins require a few weeks to improve in appearance. No treatment can eliminate 100% of all spider veins. Improvement of 70-80% is realistic and will be cosmetically appealing. Normal healing can take several weeks, so your treatment sessions will be separated by at least 3-4 weeks to allow for healing to occur. Sun exposure and tanning bed use are discouraged during the first 2 weeks after each treatment.

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How long is each appointment?

Each treatment session takes 30 minutes. We treat both legs, front and back, during each treatment session. This results in a gradual cosmetic improvement all over rather then treating one area at a time. Initial treatments will focus on the most heavily involved areas or the most symptomatic areas. The average patient usually requires 3 to 6 treatment sessions. Significant cosmetic improvement can usually be expected near the end of the prescribed treatment course. For example, if 4-6 treatments have been recommended, one should not expect significant cosmetic improvement until after the 4th session. In most cases it has taken years for these veins to develop. They will not go away over night. It will take weeks or months to eradicate them. Contrary to reports in the media “there is no one treatment solution”.

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Basic information about spider vein treatments.

All patients are instructed to walk as much as possible in the days following each treatment. This helps to re-route blood to the deeper, healthier veins. Support stockings are worn for one to three days after each treatment to assist in healing and reduce any mild discomfort which may occur. Spider vein treatments are relatively painless. Sedation and local anesthesia are not needed. You may drive yourself to and from your appointments and go right back to work and resume your normal routine immediately following treatment.

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Laser treatment for spider veins.

It is much more difficult to get light energy safely through the skin and into a spider vein than it is to directly inject the spider vein with sclerosing medication. More importantly, by treating only the spider veins visible on the surface, larger diseased veins nearby that may be causing the spider veins are not addressed. The depth of penetration of most commonly available light or laser devices is insufficient to treat deeper veins that sometimes cause spider veins. For these reasons lasers and intense pulsed light sources are not yet a substitute for sclerotherapy. For surface veins on the face, especially those too small to inject, lasers and intense pulsed light sources do have a distinct advantage and work well. When applied to the legs, however, difficulties arise due to the fact that the veins are of multiple sizes and depths, and the overlying skin is thicker, causing greater scatter of the light. In general, sclerotherapy is usually less painful than laser treatment and can treat many more veins in a treatment session than lasers or light therapy, making sclerotherapy the treatment of choice for most patients with spider veins.

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