Until recently, sclerotherapy has been the first line of defense against small to medium sized leg veins. Inserting a needle directly into the vein with a solution of saline and sugar helps the vein to collapse. Sclerotherapy, although ideal for veins large enough to get a needle into, is not a great option for very small spider veins.
With the addition of an Nd:Yag 1064 laser to our cutting edge clinic and new, improved techniques with the laser, it is fast becoming the first line of action against smaller veins. A recent study with both sclerotherapy and the Nd:Yag laser was conducted with both resulting in an over 70% clearance. Unfortunately there is no 100% guarantee with either treatment option.
Patients with numerous varicose and spider veins are not good candidates for the laser, and reticular veins, although considered appropriate to treat with laser, are often too difficult to reach with enough heat to successfully erase the vein entirely. The Nd:Yag penetrates deep enough to be absorbed by hemoglobin and is unlikely to be absorbed by melanin, therefore greatly reducing the chances of post-inflammatory hyperpigmentation, even on dark skin types.
The KTP 532 laser was also tested and was efficient with smaller, superficial veins, usually pink or red. The energy from the KTP penetrates fast, but not deep. The KTP is attracted to melanin as well, therefore increasing the chances of post-inflammatory hyperpigmentation and cannot be used with darker skin types. I find that for my patients, the KTP is invaluable for treating veins on the face where the vessels are small, red and superficial. I have not found the KTP to be efficient on legs or other body areas and tend to eliminate using it at all other than directly on the face. With that said, I have found the KTP laser to be incredibly effective with blue veins around the eyes, whereas no other laser even comes close.
Although no compression is required after laser vein removal (unlike after sclerotherapy where it’s a great idea), wearing compression garments for up to 2-3 weeks following each treatment may improve response. It is suggested to avoid blood thinners prior to any form of vein treatment, and avoid any form of strenuous exercise directly after treatment. We recommend looking into compression garments prior to treating leg veins, unless the treatment area is small.
At Toronto Dermatology Centre, we work with the Cutera Excel V laser which houses both the Nd:Yag and the KTP lasers and with just a touch of a button, we can maneuver easily back and forth as needed. It is important to assess the treatment area, treat each vessel according to its size and colour and watch to see an endpoint for each vein. Our patients are told that, although the vein may appear to disappear immediately during treatment, the vein may come back smaller within 2-4 weeks. As well, some vessels that may appear to not disappear during treatment may completely dissolve before the next treatment. We suggest treatments at 4-week intervals, and often only a few appointments are necessary. Discomfort is modest and bearable.
So for those who have tried sclerotherapy and didn’t like it or didn’t get sufficient results, or for those with a needle phobia or those with smaller veins, don’t give up hope. With the newer long pulsed Nd:Yag laser available at our clinic, we are giving our patients great clearance with the best in laser technology. And although bruising is always a potential side effect with any vein treatment, we have seen a significant decrease in bruising with the Nd:Yag compared to sclerotherapy. Come in for a laser consult today to see if you are a candidate for this type of leg vein removal.
~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre