For years, every time that Sally visited her family doctor complaining of the unsightly veins on her legs, she was told that they were only cosmetic. Her family and friends told her to “get a tan” to make them less visible. So for many years, Sally lived with these ugly and sometimes painful veins that continued to grow worse, thinking that nothing could be done. As she aged, her ankles then started to swell and develop brown discoloration that would not resolve. Finally, she saw an advertisement for a physician specializing in varicose veins and spider veins and went in for a consultation.
The line between medical and cosmetic can often be blurry or even overlapping in superficial vein care (varicose and spider veins). Do not fret that you do not know which category covers your particular leg veins. The good news is that the treatment of varicose and spider veins is now encompassed in the advanced subspecialty called phlebology where these particular vein problems, whether cosmetic or medical, are evaluated and treated with today’s minimally invasive vein care.
To determine if your problem is cosmetic or medical in nature, start your exploration with a board-certified phlebologist, a doctor who specializes in varicose and spider veins care. These physicians have special training and have passed a comprehensive medical board test to ensure that they are qualified to treat superficial vein disease. Board-certified phlebologists are also required to stay up-to-date on the latest education and training in their field or risk losing their certification. They must attend meetings in the field with the most current research and take board maintenance exams.
Once you have found a reputable board-certified phlebologist, he or she will then determine through a complete history, physical examination, and possibly an ultrasound if your issues are medical and/or cosmetic. Many times, patients will come in with what they think is only a cosmetic issue that when further evaluated, it is determined to be a medical problem. If a patient has an underlying medical problem and then proceeds with only cosmetic treatment, the treatment will either not work or these and other veins will return very quickly. It is important to be evaluated by someone trained in vein disease when treating medical issues as well as cosmetic problems as to not lose time and financial resources on procedures that may not work or last.
For spider veins, which may seem less serious, the gold standard in the treatment of cosmetic spider veins is sclerotherapy. Sclerotherapy is the injection of a solution into the spider veins that causes them to be absorbed by the body. Sclerotherapy has been around for many years; however, the solution and technique has advanced quite a bit over the past ten years. Make sure to inquire about the type of solution that will be injected. For example, a hypertonic saline solution is less expensive but has many more potential side effects and a lower success rate than some of the newer solutions. Also, make sure you are comfortable with the credentials and experience of the person who will be injecting your legs. Do they understand how vein disease works? How long have they been an injector? If there is a problem, who will take care of that problem? A thorough history should be taken before your treatment to make sure you are a candidate. There are many people who claim to be “trained” in injecting sclerotherapy, so do your homework as not to waste your time or risk an unwelcome outcome.
Another treatment for spider veins that is highly publicized, but must be used properly in order to be effective, is the use of a topical laser. Many people believe they can simply go to a medispa and have spider veins lasered. There are specific important details about spider veins that must be met in order for a topical laser to be successful. A vein-care professional should also evaluate these patients, for they may have an underlying medical issue as well as a cosmetic issue. The same questions about credentials and experience that arise in sclerotherapy should be inquired about before having a topical laser procedure.
Always give yourself permission to seek a second opinion. If you have concerning, unsightly and/or painful varicose or spider veins, please call a board-certified phlebologist who will evaluate and help you reach your cosmetic goals and determine officially if there is a need for further medical evaluation and treatment.