Assessment, treatment and new approaches to facial veins

Patients with prominent or cosmetically embarrassing facial veins may often seek an aesthetic opinion for removal. The authors present a methodology to approach classifying facial veins by describing the veins in terms of position, colour, size and flat or bulging appearance. Tiny telangiectasia (also known as thread or spider veins) or smaller discrete blue/green or green veins are regularly treated by heat, using electrocautery, radiofrequency, intense pulsed light or extra-corporeal laser. However, the authors present the use of microphlebectomy, endovenous laser and arterial ligation for larger facial veins and arteries that are often thought to be too big or complex to treat.

Adjuvant radiofrequency thermocoagulation improves the outcome of liquid sclerotherapy in the treatment of spider veins of the leg: A pilot study

Objective This study evaluated the effect of low-energy radiofrequency thermocoagulation added to standard liquid sclerotherapy on clinical outcomes of patients with venous insufficiency. Patients and method We included 111 patients with spider veins CEAP/C1 stage. The patients were randomized into sclerotherapy (Group 1) and sclerotherapy + sclerotherapy immediately followed by low energy percutaneous RF thermocoagulation (Group 2) groups and followed up with same protocols prospectively. Results The study groups did not differ in terms of the mean age, body mass index, the number of spider veins and pre-interventional venous clinical severity scores (VCSS). Patients' self-assessed satisfaction ratings of cosmetic outcomes were found to be higher compared to the baseline (p = 0.001). While both techniques caused a significant decline in VCSS at postprocedural third month, it was observed that the type of applied intervention did not affect the VCSS (p = 0.43 and p = 0.93, respectively). There was a significant difference in hyperpigmentation and trapped blood between the two groups after the procedure (p = 0.009 and p = 0.02, respectively), there was no statistically significant difference in terms of skin necrosis (p = 0.52). A significant difference in the self-assessed cosmetic outcomes was observed in patients treated with sclerotherapy followed by low energy percutaneous RF thermocoagulation compared with patients whom sclerotherapy performed alone (p = 0.001). Discussion This study suggests that radiofrequency thermocoagulation added to the sclerotherapy provides better cosmetic outcomes with less treatment sessions and no additional complication rates.

Initiation of reticular and spider veins, incompetent perforantes and varicose veins in the saphenous vein network of the rat

In an attempt to induce experimental varicosity, reverse perforant vein development was initiated in the rat leg by applying a chronic (14 and 32 weeks) partial stricture on the main branch of the deep femoral vein. At surfacing of the incompetent perforantes, typical reticular vein plaques and spider veins were identified by video-microscopy and quantitative histology. Deep vein blood was channeled by them into the saphenous vein system, the extra flow deforming these vessels, causing local dilations and broken course, even undulations of larger branches.

Selective photothermolysis of spider veins and reticular varices with the long-pulsed Nd:YAG laser

The therapy of spider veins, telangiectasia and reticular veins of lower extremities can be successfully performed with sclerotherapy or by using the long pulsed (LP) Nd:YAG laser. A matter of discussion, however, is how should laser parameters – such as wavelength, fluence, pulse duration, number of pulses – be utilized for effective and selective photothermolysis treatment without any side effects. The selective photothermolysis was introduced in 1983 by Anderson and Parrish 1 as a concept in laser treatment, meaning the selective thermal destruction of the target tissue (the chromophores – the light-absorption molecule is here the blood vessel) using a specific laser light wavelength, with minimal injury to surrounding tissue (the skin). The effectiveness of the selective photothermolysis process using an LP Nd:YAG laser at 1064 nm for the treatment of leg veins telangiectasias up to 2 mm in diameter, is the result of 30-years clinical experience sustained by patient satisfaction and photo documentation. The use of double and triple pulses seems to be the key of success in treating even larger vessels and has demonstrated superior safety and efficacy. Even bigger telangiectasias, reticular veins or other dilated veins on neckline, upper abdomen or in the face can be successfully treated with the LP Nd:YAG laser.

Muller’s phlebectomy

SummaryMore than 50 years ago, the Swiss dermatologist Dr Robert Muller developed ambulatory phlebectomy, a brilliant demonstration of the major role of dermatologists in the field of phlebology. The technique is safe, reliable and cost-effective, while at the same time producing aesthetically pleasing results. Patients can usually resume normal daily activities immediately after the procedure or are off work for a few days at most. Indications for ambulatory phlebectomy include incompetent saphenous veins (except the junctions) and their tributaries, perforators, reticular veins and reticular feeder veins, large spider veins and dilated veins in other areas such as around the eyes, on the arms or on the back of the hands.The tiny skin incisions do not usually leave any scars or give rise to complications. Phlebectomy can be used alone or in combination with other procedures such as sclerotherapy, endovenous techniques and surgery.