Eliminating Spider Veins & "Broken" Blood Vessels

Eliminating Spider Veins & "Broken" Blood Vessels

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by Nelson Lee Novick, MD, FAAD, FAACS

It’s summer. The weather is beautiful, the water warm and inviting. It’s time once again for shorts and swimsuits. “Oh, no!” you grown. “I can’t go out with these ugly old spider veins all over my legs.” Sounds familiar. Well, it’s a common complaint for the millions of people who have these unsightly little blood vessels over their thighs and calves.

Spider veins, so called because the “arms” of these tiny dilated blood vessels appear to project outward from a central denser area like the legs of a spider from its torso, are also called sunburst varicosities, for a similar reason, or telangiectasias (“broken” blood vessels) when they cover the face. In fact, they are simply diminutive, thick venules (literally: little veins) that lie close to the surface of the skin. And because they principally carry deoxygenated blood (blood that is not saturated with oxygen needed by the tissues), they actually serve no useful function. Even nutrition-wise, it is the blood vessels hidden below the surface, within the dermis, that carry nutrients to the skin. In short, spider veins and telangiectasias are just plain, disfiguring nuisances.

The precise cause of these unwanted vessels is still the subject of investigation. However, we believe that they develop as a result of a complex interplay of genetic, hormonal and environmental factors. There is often a strong family history for their formation. You might find, for example, a mother, daughter and sister suffering the same problem. Elevated estrogen levels appear also to aggravate the condition. Not uncommonly, they worsen during pregnancy or while taking birth control pills. Individuals whose jobs require them to be on their feet a great deal, overweight persons, and those who have sustained some kind of injury to the area, including blunt trauma, cuts, lacerations, or even surgical procedures are particularly vulnerable. And while alcohol consumption has been associated with their development on the face, there are many tea totlers who complain of them, as well.

Whatever they are called, and however they come about, countless numbers of women and men want them gone. Despite the advent of lasers, sclerotherapy remains the gold standard treatment and the commonest method for getting rid of them on the legs. Sclero, literally means “scar,” and sclerotherapy works by irritating the lining of the unwanted blood vessels to such an extent that they collapse upon themselves and eventually scar over and disappear from view entirely. For this purpose, your doctor can choose from a number of different sclerosing agents, including super concentrated salt solution (hypertonic saline).

Very tiny, dense “mats” or conglomerations of red blood vessels, known as telangiectatic matting is difficult to treat with sclerotherapy and may respond better to laser or other light therapies. On the other extreme, larger varicose blood vessels are best treated by venous stripping and ligation, ambulatory phlebectomy, and the newer, endoscopic radiofrequency surgical technique.

One of the major advantages of sclerotherapy is that it is fast and simple. A typical treatment session may take only about fifteen to thirty minutes depending upon the size of the area to be treated. A very tiny needle, smaller than most sewing needles, is inserted into the venule and the sclerosing material is then injected until it and the vessels in the region immediately surrounding it fade from view as the solution courses through. Each subsequent site is injected in a similar fashion until the entire area to be treated is completed.

Although mild stinging or burning may accompany the injection, except for the use of a topical anesthetic cream (e.g. EMLA or ELA-MAX), most physicians opt to treat without injecting any “freezing” solution. I have found, however, that combining the sclerosant with small amount of lidocaine coupled with epinephrine, a blood vessel constrictor, not only makes the procedure entirely comfortable, but enhances the cosmetic result by promoting a tighter contact between the blood vessel walls and the sclerosing solution owing to the blood vessel narrowing.

Your doctor may cover the treated sites with compression bandages consisting of cotton balls that are taped in place and left for three days. Others additionally recommend that support hosiery be worn for several days or even weeks afterward. I personally find these measures unnecesary, except when treating larger varicosities.

While some patients obtain a satisfactory outcome after just one treatment, optimal esthetic improvement generally require two or more sessions, spaced at four to six week intervals. Each visit can be expected to yield a 50 percent improvement in appearance, but of course the results are highly individual. Unfortunately, eliminating existing blood vessels does nothing to prevent new ones from developing at a later date that will necessitate additional treatments. Persons with diabetes, heart disease or circulatory problems are not considered good candidates.

Following treatment you might experience some mild leg cramping, bruising, or redness, but in most cases, you will be able return to work or social activities immediately (ie. no “down time”). Occasionally, the skin over the treament sites can become temporarily stained a coffee color, and tiny clots may form under the skin that need to be drained. Tiny skin ulcerations and scarring are rare complications.

Sclerotherapy sessions typically range from $200 to $400, depending amount the number of syringes used or the area covered. The accompany photos demonstrate before and after four treatments to the back of thigh region with hypertonic saline.

Although larger blood vessels, especially around the nose, or on the temples, may likewise be treated by sclerotherapy with good results, facial telangiectasias are generally best treated by other methods. These include the use of radiowaves, electrolysis and light therapies. As with sclerotherapy for the legs, most people require between two to four treated per area with any of these techniques, spaced at two to four week intervals, in order to be able to see a 60%-80% overall cosmetic improvement.

Laser light, which targets and heats up the red hemoglobin pigment within blood cells works by thermal destruction of the tiny blood vessels. With Intense Pulsed Light therapy (IPL), which is not technically a laser, gentle pulses of light penetrate the skin and are absorbed by the abnormal blood vessels, heating them and leading to their destruction and eventual absorption by the body. Patients may experience a transitory stinging during light treatments, as well as some redness in and around the treated sites that may last for a few days.

Electrolysis involves the use of high-frequency electrical current to generate tissue-destroying heat that is discharged into the skin via a tiny probe inserted through the skin to the tiny blood vessels. Before the introduction of lasers, this was the only modality available for dealing with facial capillaries and was quite successful. Since tiny pit scars occasionally develop at treatment sites, electrolysis is a less attractive treatment option than the other methods currently available. Fees per session for any of these techniques parallel those for sclerotherapy.

Radiowaves are my treatment of choice and over the years have yielded consistently gratifying results. A high-tech device using a radio frequency current, similar to the kind used to operate an ordinary radio is used. The radio waves, which work by sealing off the blood supply to the troublesome little vessels, are introduced through an ultrafine probe that is placed directly on the skin surface and moved rapidly from site to site. Sessions usually last no more than ten or fiteen minutes and typically require only the prior application of a topical anesthetic cream. Two to four treatments are generally needed per site for best results.

As opposed to light therapies, it has been my experience that radiowave treatments are less likely to result in prolonged facial redness or long-lasting blotchy brownish discoloration. The average fee is $300 per treatment for the cheeks and nose.

So, if you really can’t stand anymore to see those unsightly strands and networks of blues, purples and reds coursing along your face or your legs, with today’s technologies, now is a great time to see your doctor and do something about it.

Q. After finishing a series of treatments, when will I need to return for further work?

A. In general, those people exhibiting a tendency to make “broken” blood vessels on the face or spider veins on the legs will continue to do so throughout life. It is difficult to predict, but it has been my experience that a whole new batch will crop up every two to five years.

Q. Since broken blood vessels seem to recur every few years, should I just wait until I get a massive batch of them before seeking treatment?

A. Telangiectasia and spider veins are typically part of a large network of interconnected tiny blood vessels that spread out like the limbs of a tree into ever smaller branches. The earlier one is treated, the easier it is to keep the proliferation at bay. In short, sooner is better than later.