Ask the Doctor is a blog where Dr. Thomas Wright, MD answers your questions with his blog posts and your comments to this blog.
You can use the Category or Section links on the top and use the Search on the side to look for information relating to Veins, Liposuction, Surgery, Before and After.
Dr. Thomas Wright of the Laser Lipo and Vein Center in O’Fallon, MO has been honored with the 2011 Compassionate Doctor Award. This marks the second consecutive year Dr. Wright has garnered high enough marks in reviews from his patients to earn the prestigious honor.
Physicians achieving this recognition have been rated by the patients they see on a range of factors, including bedside manner, time spent with patients, courtesy of doctor’s staff and office follow-up. While many physicians receive positive reviews from their patients, few receive sufficiently high accolades to qualify for this award.
“Being recognized by patients is a great honor, since their health and well-being is our highest priority,” Dr. Thomas Wright commented in response to the award. “All of us here at Laser Lipo and Vein Center are proud to hear that our patients appreciate their visits with us. We work very hard to ensure their best possible care and happiness.”
Dr. Wright is the Medical Director of the Laser Lipo and Vein Center in St Louis, Missouri. His practice specializes in vein treatment and cosmetic medicine, including liposuction, cosmetic surgery, body sculpting and treatment and diagnosis of vein disease. Dr. Wright was one of the first two-hundred-plus surgeons in the United States to become board certified in Phlebology by the American Board of Phlebology. Dr. Wright received his undergraduate degree from Duke University in Durham, NC and completed his medical training at the University of Missouri at Columbia. He completed his residency at the University of Alabama Birmingham. He is also a registered medical sonographer, credentialed by the American Registry for Diagnostic Medical Sonography, a Fellow of the American Society of Laser Medicine and Surgery, and a former Howard Hughes Research Fellow. Dr. Wright is a board-certified surgeon who has been performing cosmetic procedures for over ten years. He was trained in liposuction by the inventor of tumescent liposuction, Dr. Jeffrey Klein.
In addition to the Compassionate Doctor Award, Dr. Wright has been accorded many other honors during his medical career. Some of these awards include election to the Alpha Omega Alpha Medical Honor Society, the American Medical Association Physician Recognition Award, and appointment as a Howard Hughes Research Fellow. In 2009, Dr. Wright was selected as one of St Louis Magazine’s TOP DOCS. TOP DOCS are chosen by physicians that have been previously honored. The selection represents the endorsement of the St. Louis medical community.
Patient’s Choice, the organization granting this award, is committed to recognizing excellence in patient care and medical expertise among physicians nationwide. Awards are based on patient reviews, and include hundreds of thousands of opinions throughout the year. Only those who receive the highest possible ratings are recognized through the Compassionate Doctor certification. In addition to naming Compassionate Doctor Award winners, the organization also bestows Patients’ Choice Award, which Dr. Wright has won in 2010 and 2011.
Approximately 100 million patients access websites like Patient’s Choice to offer feedback about the care they received from their own doctors. Those physicians who achieve nearly perfect scores in bedside manner and overall care are selected for the prestigious Compassionate Doctor award. This year, the honor was only granted to nearly three percent of the country’s 720,000 physicians in active practice.
For more information about Dr. Wright, please call Laser Lipo and Vein Center at (636) 397-4012 or visit http://www.laserlipoandveins.com.
Dr. Thomas Wright announces a solution for a recurring problem when using the most common method of preparing foam sclerosant.
Dr. Thomas Wright of the Laser Lipo and Vein Center in St Louis presented an abstract at the Annual Congress of the American College of Phlebology which proposes a more efficient means of preparing foam sclerosant. Foam sclerosant is the treatment of choice for varicose vein treatment in areas other than the saphenous veins.
“As foam sclerotherapy becomes more popular for varicose vein treatment, it’s important to develop a method for delivering the treatment that is as effective and efficient as possible,” says Dr. Wright.
At present, the most common technique for preparing the foam sclerosant is to prepare it with atmospheric air. This technique has been popular in application since being described by Italian Phlebologist Lorenzo Tessari in 2000. Tessari’s method combines air and sclerosant and passes it through a stop cock 10-15 times until thick foam is produced. A common problem with this method is leakage of sclerosant from the stop cock.
In an abstract presented at the Annual Congress of the American College of Phlebology in Orlando, FL, Dr. Wright proposed a method utilizing a solution similar in cost and time to the Tessari method, yet with far less risk of leakage and waste. The method uses a Luer Lock-to-Luer Lock connection to foam the sclerosant. This technique uses materials that are easily re-sterilized and provides a much more secure connection during preparation. Neither material nor time is wasted, conserving physician and patient time, as well as supply.
Sclerotherapy, as a treatment, has existed for over a century. In the early 20th century, innovations in sclerosants led to today’s safe and effective foam sclerotherapy. The Tessari method is popularly used to foam sclerosants for vein treatment today.
Dr. Thomas Wright is the Medical Director of the Laser Lipo and Vein Center in St Louis, Missouri. His practice specializes in vein treatment and cosmetic medicine, including liposuction, cosmetic surgery, body sculpting and treatment and diagnosis of vein disease.
Dr. Wright was one of the first two-hundred-plus surgeons in the United States to become board certified in Phlebology by the American Board of Phlebology. Dr. Wright received his undergraduate degree from Duke University in Durham, NC and completed his medical training at the University of Missouri at Columbia. He completed his residency at the University of Alabama Birmingham. He is also a registered medical sonographer, credentialed by the American Registry for Diagnostic Medical Sonography, and a Fellow of the American Society of Laser Medicine and Surgery, and a former Howard Hughes Research Fellow.
To contact Dr. Thomas Wright of the Laser Lipo and Vein Center in St Louis, Missouri call 636-614-1665 or visit http://www.laserlipoandveins.com.
Patients experienced significantly less pain when the 1470 nm laser was used.
Dr. Thomas Wright of the Laser Lipo and Vein Center in St Louis performed a comparative study finding significant variation in pain and discomfort levels when vein procedures were performed using two different laser fibers, one 1470 nanometer and one 810 nanometer. The results of this study were recently published in the prestigious medical journal Phlebology.
The study was performed on fifty-two (52) patients with incompetent greater saphenous veins. Twenty-six (26) of the patients were treated by 1470 nm radial emitting and twenty-six (26) by 810 nm diode emitting fibers set to 15W. The average diameter of segments treated was 7.54 mm for 1470 nm and 6.56 mm for 810 nm. All laser ablations were performed with perivenous tumescent anesthesia using lidocaine diluted in saline to a concentration of .05%.
The average length of segment treated was 39.88 cm for 1470 nm and 35 cm for 810 nm. The average linear energy density for all segments treated by 1470 nm radial emitting laser was 51.8 J/cm compared to 81.1 J/cm for 810 nm diode emitting fiber.
The results were significant. The amount of pain experienced during the procedure was rated on a scale of 0-10, ten being most severe. The average maximum pain rating for 1470 nm fiber was 0.31 compared to 1.0 for 810 nm fiber. This was a statistically significant difference at the 95% confidence interval, with a p-value of .0500.
Using the same pain scale, Dr. Wright assessed one week post-operative pain. The average maximum pain rating for the 1470 nm was 0.69, and 2.08 for the 810 nm. With a p-value of .0027, the results were statistically significant at 95% confidence interval.
After one week, discomfort was reported by 12 of 26 (46%) treated with the 1470 nm fiber and by 17 of 26 (65.4%) treated with the 810 nm fiber. The calculated odds ratio indicated patients to be 2.22 times more likely to experience discomfort from the 810 nm laser versus the 1470 nm laser.
After both one week and one month, closure rates for 1470 nm fiber were 26 out of 26 or 100%. The closure rate for 810 nm fiber were 24 out of 26 (92.3%) at one week and 25 out of 26 (96.1%) at one month. After one week, discomfort was reported by 12 of 26 (46%) in 1470 nm fiber and by 17 of 26 (65.4%) in 810 nm fiber.
The comparative study demonstrates a significant difference in pain ratings, both during and one week after the procedure. When treated with the 1470 nm radial emitting fiber, patients’ reported pain levels that were significantly lower than patients treated with an 810 nm laser. The risk of patient discomfort was found to be 45% greater with the 810 nm laser.
Endovenous laser treatment has become a popular procedure for superficial vein treatment since the approval of laser ablation by the FDA in 2002. Two of the most popular lasers in use today for treatment of veins are the 1470 nm and 810 nm lasers. An important concern of patients that led to this comparative study is the pain and discomfort experienced, which this study found is a direct result of the difference in energy levels of the lasers.
Dr. Thomas Wright is the Medical Director of the Laser Lipo and Vein Center in St Louis, Missouri. His practice specializes in vein treatment and cosmetic medicine, including liposuction, cosmetic surgery, body sculpting and treatment and diagnosis of vein disease.
Dr. Wright was one of the first two-hundred-plus surgeons in the United States to become board certified in Phlebology by the American Board of Phlebology. Dr. Wright received his undergraduate degree from Duke University in Durham, NC and completed his medical training at the University of Missouri at Columbia. He completed his residency at the University of Alabama Birmingham. He is also a registered medical sonographer, credentialed by the American Registry for Diagnostic Medical Sonography, a Fellow of the American Society of Laser Medicine and Surgery, and a former Howard Hughes Research Fellow.
To contact Dr. Thomas Wright of the Laser Lipo and Vein Center in St Louis, Missouri call 636-397-4012 or visit http://www.stlouislaserveins.com.
Dr. Thomas Wright, Phlebologist & Cosmetic Surgeon of the Laser Lipo & Vein Center in St. Louis, MO has been awarded the Patient’s Choice Award for 2011.
Dr. Thomas Wright of the Laser Lipo and Vein Center in St Louis, Missouri, has been chosen as one of the nation’s top physicians honored by the 2011 Patients’ Choice Award.
Dr. Wright received near perfect scores from his patients rating such areas as follow-up care, accuracy of diagnosis, the doctor’s bedside manner, the amount of time patients spend with the doctor and overall opinion. Dr. Wright was a Patients’ Choice honoree in 2010 as well.
“Patient experience is our highest priority,” stated Dr. Wright. “To earn the trust and approval of our patients and to assist in their health care is an honor for me.”
Dr. Wright is the Medical Director of the Laser Lipo and Vein Center in St Louis, Missouri. His practice specializes in vein treatment and cosmetic medicine, including liposuction, cosmetic surgery, body sculpting and treatment and diagnosis of vein disease.
Dr. Wright was one of the first two-hundred-plus surgeons in the United States to become board certified in Phlebology by the American Board of Phlebology. Dr. Wright received his undergraduate degree from Duke University in Durham, NC and completed his medical training at the University of Missouri at Columbia. He completed his residency at the University of Alabama Birmingham. He is also a registered medical sonographer, credentialed by the American Registry for Diagnostic Medical Sonography, and a Fellow of the American Society of Laser Medicine and Surgery, and a former Howard Hughes Research Fellow. Dr. Wright is a board-certified surgeon who has been performing cosmetic procedures for over ten years. He was trained in liposuction by the inventor of tumescent liposuction, Dr. Jeffrey Klein.
In addition to the Patients’ Choice Awards, Dr. Wright has been accorded many other honors during his medical career. Some of these awards include election to the Alpha Omega Alpha Medical Honor Society, the American Medical Association Physician Recognition Award, and appointment as a Howard Hughes Research Fellow. In 2009, Dr. Wright was selected as one of St Louis Magazine’s TOP DOCS. TOP DOCS are chosen by physicians that have been previously honored. The selection represents the endorsement of the St. Louis medical community.
Of over 700,000 active physicians in the United States, only 5 percent received the prestigious Patients’ Choice Award in 2011. The voting takes place exclusively among patients.
To contact Dr. Thomas Wright of the Laser Lipo and Vein Center in St. Louis, Missouri, call 636-397-4012 or visit http://www.laserlipoandveins.com.
Botulinum toxin as a cosmetic treatment has been around for quite some time. It is a purified protein derived from bacteria. Its first therapeutic use, in the 1980s, was in treating crossed eyes and rapid blinking. In 1989, studies first emerged about its effectiveness easing wrinkle lines when injected into facial muscles. The Botox craze was born.
Botox is perhaps the best-known botulinum toxin formulation, and has been around commercially the longest. Officially a neurotoxin, meaning an inhibitor of nerve tissue function, Botox is widely used to treat wrinkles. It works by blocking the signal to “contract!” or “scowl!” from the brain to the muscle.
An injection of botulinum toxin around troubling facial lines – such as scowl and frown lines between the eyebrows and surrounding the mouth – causes the wrinkle-causing expressions to ease and the resulting wrinkles to stop appearing.
Recently, two new botulinum toxin formulations have received FDA approval for cosmetic treatment. Xeomin (ZEE-oh-min) and Dysport (DIS-port) are treatments that, like Botox, use botulinum toxin for treatment of wrinkles (and excessive sweating and some jaw disorders).
Dosing
Xeomin, newly announced from Merz Pharmaceuticals, is a botulinum toxin preparation that is used at the same rate as Botox cosmetic. However many units a patient required of Botox, he or she will receive the same number of Xeomin units.
Dysport is administered somewhat differently. Approximately 2.5 units of Dysport correspond to one unit of Botox or Xeomin.
Manufacturing
Botox and Dysport vials contain, in addition to the botulinum toxin, a substance called albumin. This is a protein found in the blood. Its presence in Botox and Dysport vials makes the chemical stay stable in its jar between uses. Xeomin, on the other hand, just contains boltulinum toxin and has no additives.
Side Effects
All botulinum toxin formulations carry some risk of side effect with treatment. These include dry mouth, fatigue, headache, nausea, neck pain, pain, redness, bleeding at injection site, swelling, or tenderness at the injection site, sinus inflammation, sore throat, stiff or weak muscles at or near the injection site. Very rare but serious side effects include allergic reactions, difficulty swallowing or breathing, dizziness, drooping affected area, facial paralysis, fainting, loss of bladder control, loss of strength, seizures, severe or persistent muscle weakness, shortness of breath, slow heartbeat, speech changes or problems, vision changes or problems, wheezing.
I had EVLT 3 weeks ago. When I went for the 2-week follow-up, it showed that the vein was still open. My doctor said he needed to redo the procedure. I thought this was a one-time procedure, and am confused as to what my options are.
An EVLT is usually, 98% to 99% of the time, a one-time treatment. That is 98-99% that after treatment, the vein is closed and it stays closed for at least several years. Since our data only goes back years, that is all we can demonstrate, though it’s possible we may learn the vein stays closed forever.
Redo procedures do occur, but they should be uncommon after a treatment.
- Dr. Wright
Q: I have a small blue vein under my eye. It is becoming more noticeable. Can the Veinwave be used safely to remove this vein?
A: Bluish veins are usually too large to be treated effectively with a Veinwave. Without seeing it, I cannot be sure. The Veinwave can be used near the eye but it tends to be a bit more painful. You should seek evaluation by a physician experienced with Veinwave to advise you the best course of treatment.
- Dr. Wright
Q: I have friend aged 34, modestly built. He travels all day by 2-wheeler. He has dark pigmentation of both legs. It started around ankles and is now spreading up. No veins are visible. Feet are spared. Doctors suggested varicose vein surgery. Does it help?
A: Ankle brownish skin pigmentation is a classic sign of venous insufficiency and resulting tissue damage. The fact that no veins are seen is irrelevant, as large varicosities frequently may be visually masked by the swelling that usually is present with this condition. Further, many varicose veins bulge “in” and can be palpable though not visual. Finally determining whether vein treatment will help is dependent on the confirmation of the above issues by an expert.
- Dr. Wright
Q: I have 7 cuts in my leg between my knee and ankle from vein stripping and 3 above. I have just awful tingling and numbness especially at the inner ankle. All the cuts and areas are sensitive 6 months after surgery. What do I do? I have adductor tenditis too.
A: With routine daily use of support hose and time, patients who have tingling with the numbness usually will find the symptoms resolve. Some patients who undergo vein procedures, especially vein stripping, may experience some residual numbness that does not resolve. If it is very bothersome, you can talk to your doctor about possibly taking neurontin or other medication for nerve pain.
- Dr. Wright
Q: Can a laser effectively occlude an incompetent Sapheno-Femoral Junction? If it does, which modality is better: Diode or NdYag?
A: Technically, you do not want someone to occlude your saphenofemoral junction. The occlusion should extend to a short distance below the saphenofemoral junction. All of the LASERs in routine use for saphenous vein ablation work very well. There is some research that some may be slightly better tolerated but they all work.
- Dr. Wright
Q: I had vuvlar/labia veins during my 3rd pregnancy. I had to spend a lot of time in bed with pain and heaviness. This continued 3 yrs postpartum so I had the surgery, 9 mos ago the Dr. said I had pcs and removed some huge veins, now 6 mos pregnant and veins are back, help!
A: It would help you greatly to wear a pelvic support garment. Your OB/Gyn should give you a prescription, and a medical equipment supplier would measure and fit you. I have also heard reports that the Spanx(r) garments (which you can obtain online or at stores) and compression with elastic biker shorts with a pad against the vulva will help some.
- Dr. Wright
Q: Is it possible, ablating perforators by endovenous lasers?
A: Yes, Endovenous Lasers can be used to treat refluxing perforator veins. Insurance companies often times will not cover this treatment as they consider it too “experimental.” However, in some cases doing an appeal with your insurance company can result in coverage for this. At any rate, the treatment is effective.
- Dr. Wright
Q: I am only 21 years old but I have painful veins on my left leg. I have had them since I was very young, and they only become worse. They are only on one leg. That is the best option to treat the appearance? Thank you.
A: You need to see a qualified Phlebologist for a clinical evaluation. Some patients need treatment for varicose vein problems in their teenage years. A few patients have abnormally formed veins at birth which become more evident with time. It is important to have a thorough clinical and ultrasound exam in order for anyone to give you further advice. If you are having symptoms, I strongly encourage you to seek evaluation no matter what your age. Varicose and abnormal veins are not strictly an age-related concern; symptoms at any time must be taken seriously.
- Dr. Wright
Q: Most youtube videos I have watched show only thigh veins being tackled by EVLT. No videos show leg veins or tortuous veins. Does this mean it is difficult to use lasers in these situations?
A: The ELVeS and EVLT are use primarily used to treat the saphenous veins from the mid-calf up to the thigh. Refluxing saphenous veins are often give rise to the more superficial tortuous veins on the thigh and further down the leg. Although the laser fiber has some flexibility, it cannot travel very tortuous tributary veins. The same problem with radiofrequency ablation (RFA). There are other approaches that can be used for those veins. These methods can be as effective to treat them and have excellent results as well.
- Dr. Wright
Q: Do Sunburns Cause Spider Veins?
A: Did you know that if you are fair skinned, you are more at risk for facial spider veins?
As you certainly know, people with fair skin have a higher tendency for their skin to be more damaged by the sun than their darker skinned friends. Sun damage can cause a variety of harmful skin issues, the most immediately noticeable of which are sunburns. Repeated sunburns cause damage to the skin, and skin damage caused by the sun can lead to facial spider veins. So yes, sunburns and spider veins can go hand in hand (sometimes).
Spider veins can be completely unrelated to sun exposure, however, so if you have spider veins already, they may well not have been caused by too much fun in the sun.
What can you do to protect your skin against facial spider veins? Your number one defense is to wear daily — EVERY day — sunscreen with a high sun protection factor. You should probably be doing this anyway if you are frequently exposed to strong sunlight, as it can prevent a plethora of other medical complications in the future. Also, a hat or similar extending protection keeping your face from the sun’s rays may be beneficial.
If you have already noticed spider veins on your face,the Veinwave may be an option to eliminate them.Veinwave involves radiowave pulsed on the vein to close it so you don’t have the visible spider veins anymore. Luckily, facial spider veins are usually more of a cosmetic nuisance than a painful medical problem, as varicose veins can be. Your doctor can help you determine whether or not your spider veins are a substantial problem, or merely something you wish to be rid of for aesthetic reasons.
- Dr. Wright
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