Our Vein Care Practice
Vein Treatments in the Los Angeles Area
Using the comprehensive state-of-the-art resources of the Beverly Hills Vein Center, Dr. Gradman will diagnose your vein problem and plan treatment to meet your needs.
The foundation of treatment is to make an accurate assessment of the cause and extent of your problem. That is best done with a physician’s personal examination, and usually includes mapping your veins with Color Duplex Ultrasound. This is a painless test done at your first visit to the Vein Center.
Beverly Hills Vein Center, Los Angeles CA
Cosmetic Leg Vein Problems
Cosmetic leg vein problems fall into two broad categories (with plenty of overlap):
A large spider vein treatable with sclerotherapy
Varicose veins secondary to saphenous vein reflux starting in the groin. It is not enough to remove the varices; the reflux in the saphenous vein must also be eliminated, or new veins will quickly appear.
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Spider Veins (Telangiectasias)
Spider veins are small, highly colored red or blue veins easily seen on the surface of the skin. Blue reticular (net-like) veins lie just below the skin layer. Many spider vein complexes originate from an underlying reticular vein.
The most common question I’m asked is “What causes spider veins?”. Hereditary and female hormones are certainly contributing factors, but a myriad of others have been proposed. Spider veins are often associated with varicose veins, because the same factors that cause varicose veins (increased pressure) can result in varicose veins. That is why an ultrasound exam is often necessary to evaluate the origin of spider veins. For more on causes, see my recent blog.
Certainly Lasers have long been used to try to eliminate spider veins, but most experienced vein doctors find that lasers are ineffective, hurt way too much, and do nothing to prevent recurrences. At the Beverly Hills Vein Center, spider and reticular veins are treated almost exclusively with injections of a mild detergent medication (Sotradecol) which collapses the veins. An effective variation of treatment is to create foam from the basic liquid solution. The foam looks like shaving cream and sticks to the vein better than the plain liquid. This allows for a reduced concentration of medication and a more durable result, especially with the larger blue (reticular) veins.
Injections are remarkably safe. The chemical Sotradecol is given in very dilute strengths, and in contrast to most practitioners who make foam with air, I have gone the extra mile to eliminate the potential danger of introducing air into the circulation by switching to carbon dioxide which is absorbed within seconds of injecting it into the vein. In all the years I have been doing injections I have never seen a true allergic reaction to Sotradecol.
The VeinGogh™ thermocoagulation device is a clever device that delivers pin-point energy to veins that cannot be treated with sclerotherapy, such as tiny red veins on the face or the very smallest veins in the leg.
On its return path to the heart blood normally flows from the skin back into the large deeper veins of the leg. Varicose veins (the bulging kind) commonly arise from broken valves in the vein that connects the surface veins to the deep veins. No one really knows what causes varicose veins other than heredity and multiple pregnancies. This allows blood to spill out (reflux) from the deeper veins to the surface, usually into either the long saphenous vein (starting in the groin) or the short saphenous vein (starting behind the knee). The surface veins balloon out because of the constant barrage of high pressure from blood going the wrong way from inside out. Eliminating the varicose veins without eliminating the underlying source of the problem is an invitation for the varicose veins to return.
The foundation of treating varicose veins is to make an accurate assessment of the cause and extent of the underlying problem with Color Duplex Ultrasound. This painless test is done at your first visit to the Vein Center.
Treatment consists of two equally important steps:
- Eliminate all reflux between the deep and surface veins to prevent new varicose veins from coming back.
- Eliminate the varicose veins themselves.
1. Reflux in the Saphenous Vein
Laser closure of the saphenous vein (ELAS, EVLT or ELVeS) is one of two minimally invasive alternatives to stripping of the saphenous vein. A laser fiber is threaded up the vein to the source of the problem (usually to the groin.) As the fiber is withdrawn, laser energy heats the inside of the saphenous vein, causing it to collapse and seal shut. This procedure, usually done under local anesthesia, is readily combined with microphlebectomy. The combined treatment eliminates both the source of the vein problem and the veins themselves.
- The Covidien Company has introduced a greatly improved catheter called the ClosureFAST catheter for closure of the saphenous vein. The device uses radiofrequency (electrocautery). When an individual requires closure of the saphenous vein, I choose either the laser or ClosureFAST catheter based on the specific needs of that patient.
- Actual extraction of the saphenous vein, or surgical stripping, was the traditional treatment for reflux in the saphenous vein for over a hundred years. With today’s new technologies for closing the saphenous vein internally, stripping is no longer necessary.
2. Removing the varicose veins themselves
- Microphlebectomy (multiple small incisions) “tease” the varicose veins out of the leg. This is often the surest, quickest and most cosmetically gratifying way to remove large veins. The procedure is often done at the same time as closure of the saphenous vein. Veins removed this way result in three to four week bruising, but never staining.
- Small varicose veins may sometimes be treated with injections after the main saphenous vein problem is corrected. I am not a great fan of injections for large varicose veins, since the veins remain hard for months, I usually have to poke clots out of them anyway, and there is a real possibility for permanent skin staining.
Small red spider veins are often found adjacent to the nose. They may also extend onto the cheeks and chin. Some result from allergy, others from rosacea or too much sun. Some folks just get them. Lasers or V-beam can be effective for rosacea and very tiny veins, but I now prefer the VeinGogh thermocoagulation device which eliminates the larger thread veins and retards their tendency to re-form.
Blue veins around the eyes (to the side and under them) may be treated safely with injections with no greater risk to the eyes or brain than treating leg veins. Treating veins on the forehead should not be done. We have long experience in this important area of common cosmetic concern.
Women occasionally develop prominent veins on the upper chest and breasts. These veins sometimes first appear after breast augmentation or nursing. Unfortunately, they prevent wearing low-cut dresses (décolletage), which may be the very reason one underwent augmentation in the first place. Few plastic surgeons are aware that effective sclerotherapy of these veins is feasible and effective.
Hand veins can be distressingly prominent in thin women, athletes and older women whose grandchildren ask “What are those, grandma?” Others find them simply unattractive and/or unfeminine. I have never seen hand swelling as a consequence of treatment, although I counsel prudence when deciding how many of these veins to eliminate. All hand veins are game as well as most veins on the top and side of the forearm, but veins on the knuckles and underside of the forearm are best left alone. We bandage the hand overnight.
Radiesse, a filler designed specifically for the back of the hand, can complement and enhance the results of vein injections. The results of the combined treatment are quite impressive.