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.
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
Q: How do vein doctors help with problem veins?
A: Our veins can cause trouble in many areas of the body, but by far the most common reason people visit vein doctors is for problems with the veins in their legs. The reason is simple: The veins in our legs do a tremendous amount of the work circulating blood. They have to fight gravity constantly to keep pumping blood back up to our hearts. They use an ingenious system of valves to keep blood from flowing back down into our legs—where gravity keeps pulling it. And sometimes, as your vein doctor will explain, the valves can wear out, slow down, or even stop working entirely.
Weak or faulty valves can be an inherited trait, and are more common in women than in men. The government reports that up to 55% of American women and 45% of American men will suffer with vein problems in their lifetime, and varicose veins affect one out of every two people over 50. Today’s vein doctors are treating a growing percentage of those afflicted.
Vein doctors — phlebologists — have powerful technology-guided diagnostic tools like ultrasound to discover underlying causes of vein problems, which often announce themselves either via a heavy, aching feeling, restless legs, or by the appearance of varicose veins. And your vein specialist will be skilled in a number of minimally invasive procedures that can dramatically improve not only your comfort but often the appearance of problem leg veins as well. And today’s treatments don’t require taking off work, result in only minimal discomfort, and quickly improve how you feel. Diagnosis and minimally invasive treatment to offer relief of symptoms are what you can expect from your phlebologist. If you are experiencing symptoms, you ought to seek medical attention for this often-overlooked issue.
- Dr. Wright
Q: How do I choose a vein doctor?
A: When you’ve decided to do something as personal as having your varicose veins fixed, you want to be sure you’re choosing just the right vein doctor. Remember to ask yourself this: How do you feel now that you’ve interviewed the vein doctor? Here are some important questions to help you work through the decision process of selecting an appropriate vein specialist:
1. Do you feel at ease when you visit the vein clinic or center where the vein doctor practices? Do the facilities look clean and professional? This is an important occasion for you and, even though you’re not going into a hospital, you should feel the same level of confidence about the place where you’ll have this work done.
2. Are you satisfied with the vein doctor’s credentials? Be aware that many doctors may claim to be able to fix veins even though they may not be specially trained in vein treatment techniques. Not everyone who claims to be an expert in these procedures has the kind of medical training or expertise you would expect a vein doctor to have. You deserve the best attention to your medical needs.
3. Most importantly, are you comfortable talking to the vein doctor? You don’t want to be in a position of having this important work done to your body without feeling comfortable that you can ask as many questions as you like–and be completely satisfied with the answers you receive. Your trust in your doctor is key, and your doctor ought to be someone with whom you feel comfortable discussing your symptoms, your concerns, your expected outcome, your apprehensions, your billing and insurance situations, and your thoughts.
In short, seek a qualified specialist whose background and credentials are solid and whose judgement you trust, and whose care of you is up to your expectations.
- Dr. Wright
Q: Why go to a vein clinic instead of a hospital for varicose vein treatment?
A: Hospitals have come a long way since the 1600s when the print below was made, but the answer is simple. Today all modern vein treatments are done mainly in vein clinics (sometimes called vein centers). Not only is it less complicated to go there than to a hospital–you don’t have to be “admitted” and you won’t have to pay hospital overhead charges–but you’ll still have a fully qualified physician performing or overseeing your procedure with all the latest equipment and instruments.
You’ll be covered by insurance the same as if you were in a hospital. And often it’s easier to get to a vein clinic than to a hospital. Why go to a vein clinic instead of a hospital for varicose vein treatment? Hospitals have come a long way since the 1600s when this print was made, but the answer is simple. Today all modern vein treatments are done mainly in vein clinics (sometimes called vein centers). Not only is it less complicated to go there than to a hospital–you don’t have to be “admitted” and you won’t have to pay hospital overhead charges–but you’ll still have a fully qualified physician performing or overseeing your procedure with all the latest equipment and instruments. You’ll be covered by insurance the same as if you were in a hospital. And often it’s easier to get to a vein clinic than to a hospital.
When you have varicose veins you don’t need to go to a hospital to get the most advanced diagnosis and treatment options. Vein specialists generally do all their diagnostic work and perform all their procedures right in their vein clinics. Treatment options at reputable vein clinics may include sclerotherapy, endovenous radiofrequency [VNUS] or laser closure, ambulatory phlebectomy, and vein stripping (rarely done today).
Worried about your varicose veins? When you go to a vein doctor who is certified specifically in vein treatments, you’ll have the same–and sometimes more–treatment options and the same protection against any potential risk for complications. Find a reputable vein clinic in your area and get some answers. Why continue to live with a life-long problem when you might find relief?
- Dr. Wright
Q: I had laser light therapy for facial redness and veins showing on my face due to Rosacea. The veins now appear darker and more visible than they were before. Is this normal if this procedure was done 2 days ago? if so when will the redness go away for the desired result?
A: Yes, exaggerated coloration may take up to a week to 10 days to disappear, depending on how severe your rosacea was. It almost always looks worse before it looks better. Discuss your concerns with your doctor, but know that in general, you will have some differences in coloration shortly after your treatment which should dissipate and leave behind a better result.
- Dr. Wright
Q: How long after Sclerotherapy can you get in the sun?
A: The more you wait the better but the minimum is 6 weeks.
You should wait for the acute inflammation to go away, usually in 4-6 weeks, depending on the solution used, the size of the vein treated and you skin complexion. (Olive skin or dark skin color may be more predisposed to darker discoloration than fair skin.)
The main concern here is not to stimulate the melanin (skin pigment) producing skin cells and thus minimize the undesirable skin discoloration that may happen in the treated areas. A compromise may be to venture out with shorts and skirts with sunblock on at most, and certainly no sun tanning. In time, you may resume normal activities with normal sun exposure.
- Dr. Wright
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