Total Body Surgical Blog

Winter time is vein time a wise man once said (that's me ya'll)!!

Why is winter time the time to worry about those pesky leg veins??  Well, it's because you are already wearing pants.  In spring and summer we want to wear shorts, or other more revealing clothing, it is then too late to conseal any ongoing treatment.  In winter, the healing process can take place under your clothing and people won't ask too many questions.  Now is the time to treat spider veins and larger varicose veins.

Spider veins are small areas that most of us get as we age.  These are pesky and ugly but usually do not indicate any major underlying problem with the larger venous system, although they can be an indicator.  They look like the skinny legs of a spider, thus the name.  They can also look like a bruised area that doesn't go away.  Spider veins progress with time and can be made worse by certain occupations..standing, etc.  They usually cause little concern except for their ugly appearance, however, they can become large enough to bleed if traumatized and an episode like this can be very frightening. 

What do we do for spider veins??  The best way to handle them is with sclerotherapy.  Now that may sound scary but really it is pretty simple.  We inject the veins with a chemical that causes them to stop working.  Sometimes a small clot forms in them and over time, your body resorbs the clot and vein eliminating the problem.  The process is fairly easy, quick, and causes minimal pain.  We have you wear a tight (compression) stocking for about two weeks after the injections and after that....nothing.  You may have some areas of pigmentation in the area for a few months and this usually resolves without further treatment.  Because this problem is superficial, most insurances consider this treatment Cosmetic and will not cover it under the usual policy.  We charge $350 per treatment and a treatment consists of two vials of the solution we use which is the safe amount at one sitting.  If more treatments are required, we usually wait about 6 weeks before re-treating.  Small areas usually require only one session.  Big, or multiple areas may require several sessions.

For a little larger veins we call reticular veins, we still use the sclerosing solution.  Sometimes it is used in a higher concentration and we use an instrument called a vein light. 

The vein lite allows me to see the larger veins under the skin that fill the small spider veins on the surface.  This instrument produces a very bright, circular light that produces no heat and is very good at showing reticular veins as you can see from the picture above.  I can then inject them with the sclorosing solution, stop the blood flow, and with time, the vein is eliminated by the body.  I usually try to find and eliminate any of these veins at the time I do the routine sclerotherapy.  Again, stockings should be worn for two weeks after the therapy and strenuous exercise is avoided for two weeks as well.  This helps in preventing future spider veins originating from this one source at least.  

Maintenance may be required when treating spider veins.  They usually sneak back into your life after a few years, even if all of them are eradicated along with the reticular veins.  I like to recommend that less is more....in other words, if we treat a large amount the first series of treatments, it is a lot easier to keep up by treating small areas as they arise.  Don't let them get out of hand again.

Varicose veins treated the modern way, with laser, require minimal down time and are done in the office.  It usually takes about 3 months to get insurance approval so you need to start now.  If you have varicose veins that are ugly, hurt, cause leg swelling, and create embarrassment....come see us to get started on effective, easy treatment today!!!

varicose veins.

Call 918-786-7780 or 1-877weight0.

Varicose Veins....an ugly term for an ugly and troublesome condition.  Almost everyone remembers a relative that had or has hideous looking legs.  When they show them, the kids run for the hills.  Today, I would like to discuss why the problem occurs and what can be done about it.  Also, a little history to show you how things have changed.....they are a whole lot better today!!

Varicose veins are a wastebasket term for chronic venous insufficiency.  Both are big descriptions for a complex problem.  The issue can range in severity from small spider veins, which most people have a smattering of, to the big ropey veins, to swelling in the lower legs, skin color changes and even leg ulcers that won't heal.

  A picture of spider veins.

  Picture of large varicose vein.

To be nice, I won't show an ulcer, they are ugly!!

The cause of these problems are usually hereditary, but can occur from leg injuries, clotting in the legs, and other factors.  They are made worse by working conditions, pregnancy, but usually not caused by them.  Of course, the human vascular system starts with the heart.  It pumps blood rich in oxygen to the rest of the body.  The blood travels around and exchanges oxygen for CO2 (the byproduct of the cells working), it then must get back to the lungs for the exchange of CO2 for new oxygen and the process repeats.  The veins don't have the heart to pump the blood, so, the musculature of the extremities compress the veins and make the blood move towards the chest and lungs.  In the normally functioning vein, there are valves present that allow the blood to only go towards the chest....up....against gravity that wants it to go down.  In the diseased vein, these valves don't work and the blood pools and stays in the leg or arm.  These pictures are a good visual for how this works.

If the valves do not work properly, pressure builds.  This is reflected in the branches of the larger veins and they enlarge over time creating the large varicose veins we have all seen.  These become painful as they stretch the surrounding connective tissue and the pressure, combined with the lack of flow causes the iron from the blood to break down in the skin.  This can lead to rust colored changes in the skin, rashes, and eventually skin breakdown. 

Treating this problem has changed significantly in the last decade or so.  Since the problem is usually the saphenous vein (kind of an intermediate vein in the leg), we used to remove it surgically and called it stripping.  Many have heard horror stories about removing these veins, having general anesthesia and the recovery time required.  With modern ultrasound and laser technology we can now remove this vein from the circulation without stripping, without general anesthesia, and without a long recovery time......great news!!  We do them in the office, patients walk, in then walk out. There is almost no down time...if any.

For the large, tortuous, ugly branches, we remove them through tiny incisions, as small as the end of a pen.  Because we have stopped the flow into this vein by lasering the saphenous vein there is very little blood loss and again, almost no down time.  The little incisions heal nicely and are not noticed after a few months.

Most of the time, if you are having symptoms of pain, swelling, skin color changes and have a visible varicose vein, insurance will pay for the procedure...after jumping through a few hoops.  Spider veins are considered cosmetic and are not covered though we can treat them with injections or laser.

So if you have vein issues, come see us today at Total Body Surgical where we can help.  Our goal is to try to make your legs look and feel as normal as possible. Call 918-786-7780 today!!

What does Christmas have to do with Cosmetic Surgery??? Well let's talk about it. 

Christmas is rapidly approaching believe it or not, it is only a few weeks away.  Now is the time to start thinking about gifts and what can be done for the new year.  Many don't think about anything Cosmetic, but let me help you change your mind.  Instead of that sweater, tie, or other gift that will be worn on Christmas day and then never seen again, how about giving something that can be seen every day!! There are a number of things that are affordable and can make you or your loved ones look and feel better.....much more useful than a sweater!!

First:  Laser hair removal.  We have pricing on laser hair removal that are the best in the country.  If you have young ladies in your life, this is a great gift.  At $50 per area per treatment you can give the gift that keeps on giving for about $300 per area.  No more razors, always ready for summer wear...what a gift.  For guys, we must bring this up carefully but if you listen well, the opening usually comes up so pay attention.  We can remove hair on the face, bikini area, and under the arms on women and for men, chest and back hair removal is all the rage.  Call the office at 918-786-7780 and we can get you a nice gift certificate to put under the tree!

Second:  Botox or dermal fillers.  Everyone has heard of Botox and many of us use it regularly.  It is a great help in reducing wrinkles in the face, stopping excessive sweating, and relieving headaches.  In many cases our loved ones are already using it so why not pre buy and save some money!!  We have special pricing on pre-bought Botox at $9 per unit.  If you figure the average number of units at 30, that is $270 per treatment....very affordable.  The treatments take about twenty minutes and last up to 6 months.  You can take care of his or her whole year with one gift certificate.  Dermal fillers like Radiesse or Juvederm can also be pre purchased at a special price.  These are used to fill nasolabial folds (the wrinkles between the base of the nose and the mouth) and marionette lines (wrinkles from the side of the mouth).  They last about a year.  We also do the so called liquid face lift that fills the cheek area getting rid of lines under the eyes and in the cheek.  This is very rejeuvenating and less traumatic than the real thing.  We are offering a syringe of filler for $400 (usual price $500) and if you purchase more we will lower the price on multiple syringes.  Either of these gifts will get you big kisses.  Call us at 918-786-7780 and we will get you a nice certificate.

Third:  Venous sclerotherapy.  This is the time to get rid of those ugly spider veins before we are back in shorts.  These treatments are done in the office and are fairly quick.  Normally we charge $350 per session but for Christmas, we will lower that price to $300.  What a nice gift to give....getting your legs back, being able to wear shorts again without embarassment.  For a nice gift certificate, call 918-786-7780.

Fourth:  Liposuction.  This can be a little more of a touchy subject but if your significant other is continually complaining about belly fat, saddle bags, love handles, muffin top, fat arms, any other area or combination of areas, they are asking for liposuction but don't know how to say it.  Smaller areas are perfect for liposuction with short recovery time and amazing results.  We have all the specialized equipment too.  Laser liposuction is amazing at helping tighten up the skin after removing the fat.  We will give you a 10% discount on the first area and a 20% discount on a second area.  That is up to a 30% discount on two areas of liposuction.  That means that you can give a gift that will change those complaints into complements.

Fifth:  Breast augmentation.  College students, wives, and girlfriends are always talking about having breast implants to improve self image by improving appearance.  What better gift to give.  We have the best pricing on silicone and saline implants right here in Grove.  Christmas is a great time to schedule and take advantage of the winter to heal up and be ready for summer. 

There you have it...some great ideas for Christmas gift that I guarantee will be appreciated.  Dr Miller and I or our nurses are also ready to help if you have questions about what is appropriate.  Call us today at 918-786-7780 and GET YOUR SHOPPING DONE early for once!!!!

Winter time is vein time a wise man once said (that's me ya'll)!!

Why is winter time the time to worry about those pesky leg veins??  Well, it's because you are already wearing pants.  In spring and summer we want to wear shorts, or other more revealing clothing, it is then too late to conseal any ongoing treatment.  In winter, the healing process can take place under your clothing and people won't ask too many questions.  Now is the time to treat spider veins and larger varicose veins.

Spider veins are small areas that most of us get as we age.  These are pesky and ugly but usually do not indicate any major underlying problem with the larger venous system, although they can be an indicator.  They look like the skinny legs of a spider, thus the name.  They can also look like a bruised area that doesn't go away.  Spider veins progress with time and can be made worse by certain occupations..standing, etc.  They usually cause little concern except for their ugly appearance, however, they can become large enough to bleed if traumatized and an episode like this can be very frightening. 

What do we do for spider veins??  The best way to handle them is with sclerotherapy.  Now that may sound scary but really it is pretty simple.  We inject the veins with a chemical that causes them to stop working.  Sometimes a small clot forms in them and over time, your body resorbs the clot and vein eliminating the problem.  The process is fairly easy, quick, and causes minimal pain.  We have you wear a tight (compression) stocking for about two weeks after the injections and after that....nothing.  You may have some areas of pigmentation in the area for a few months and this usually resolves without further treatment.  Because this problem is superficial, most insurances consider this treatment Cosmetic and will not cover it under the usual policy.  We charge $350 per treatment and a treatment consists of two vials of the solution we use which is the safe amount at one sitting.  If more treatments are required, we usually wait about 6 weeks before re-treating.  Small areas usually require only one session.  Big, or multiple areas may require several sessions.

For a little larger veins we call reticular veins, we still use the sclerosing solution.  Sometimes it is used in a higher concentration and we use an instrument called a vein light. 

The vein lite allows me to see the larger veins under the skin that fill the small spider veins on the surface.  This instrument produces a very bright, circular light that produces no heat and is very good at showing reticular veins as you can see from the picture above.  I can then inject them with the sclorosing solution, stop the blood flow, and with time, the vein is eliminated by the body.  I usually try to find and eliminate any of these veins at the time I do the routine sclerotherapy.  Again, stockings should be worn for two weeks after the therapy and strenuous exercise is avoided for two weeks as well.  This helps in preventing future spider veins originating from this one source at least.  

Maintenance may be required when treating spider veins.  They usually sneak back into your life after a few years, even if all of them are eradicated along with the reticular veins.  I like to recommend that less is more....in other words, if we treat a large amount the first series of treatments, it is a lot easier to keep up by treating small areas as they arise.  Don't let them get out of hand again. 

More about varicose veins next time.  Don't forget our special pricing and come meet Dr. Miller, he knows veins too!!!

Legs are often overlooked in Cosmetic Surgery.  However, think about how much of your "person" is legs???  We all want to work on our faces, abdomens, and breasts but often forget about one of the larger parts of our body.  What can be done??

Here are the common problems:

1.  Lost tone and shape of the butt.

2.  Saddle bags or outer thigh enlargement.

3.  Inner thighs becoming large and "rubbing" together.

4.  Weight gain in the anterior or front of the thigh and knees.

5.  Spider veins.

6.  Varicose veins.

These are the most common complaints I hear from day to day.  These complaints are due to hormonal changes and the process of getting older.  Also, genetics can play a role in how we all gain weight.

First, the butt.  What can you do when the shape of the area is lost?  The most common problem is not that the shape is lost, it has become hidden.  Most of us gain weight in the hip or love handle area (the muffin top) and in the outer thigh or saddle bag area.  When these areas enlarge, the but area becomes smaller in comparison.  So how can this be fixed??  What I usually recommend is liposuction.  Liposuction of the outer thigh and hip area makes them smaller and the secondary result is a more shapely butt.  We can also take the fat from these areas (which is usually high quality) and transplant it into the butt.  This will increase the volume of the buttocks and after liposuction of the surrounding areas, you can have the shape you are looking for.  In this photo, you can see the improved shape of the buttocks after liposuction.  It looks bigger because the surrounding areas are smaller.

Second, the Saddle Bag.  These are the areas that not only "shrink" the butt, but also create a problem when trying to get into jeans and dresses.  I hear it all the time, "I cannot buy jeans that fit my waist and thighs at the same time"!!  Liposuction is what I use to attack these areas.  It can be an amazing transition when you can drop 2-3 pant sizes with one in office procedure.  Other procedures that are advertised may or may not work for you...this one is guaranteed.  You can see from this photo that indeed, you can drop a significant number of pant sizes and regain your shape.

Third is the inner thigh area.  I hear it all the time...."I hate that my thighs rub together".  We can actually lump three and four together, the inner thigh, anterior thigh, and knee areas.  Again, what we use is liposuction.  These areas are fairly easily done and the recovery time is short.  All of the areas can be done together to re-shape the entire upper leg.  Small incisions about the size of the end of a pen are used in the groin area and in the fold at the base of the buttocks.  Within a few weeks the difference will become visible and you will need to find some new pants...but don't, because, it will continue to get smaller for 4-6 weeks.

The next complaints are of veins.  Spider veins and varicose veins are ugly.  They are also, sadly, very common.  Caused by heredity, trauma, child birth, and life style, they come and stay.  They trap many people in long pants making it embarassing to wear anything else.  Spider veins are considered a cosmetic problem.  They are the small, blue veins that are very close to the surface of the skin.  Treating them requires professional evaluation to make sure no other bigger problems with the veins exist.  Once other venous problems are ruled out, they are treated by injecting small amounts of a substance to obliterate the vein.  It does cause some inflammation and this procedure, called sclerotherapy, is best done in the fall and winter....NOW!  It may take several treatments to get rid of them all, and may require maintenance.  We charge $300 per session, very competitive.  Varicose veins are a different story.  They require more extensive evaluation and treatment.  Much less than in the past however.  Getting rid of these veins, when symptomatic, is done as an office procedure and is usually covered by insurance.

Come see us NOW to get ready for next summer....remember your legs....they need attention too!

Remember our specials...

For the last installment on veins in this series let's discuss the pesky spider vein.  These veins are very common and can be unsightly.  I probably hear more complaints about spider veins than any other vein problems.  They can occur in young women, old women, and every age in between.  The cause of these veins which occur superficially in the skin is usually hereditary and they are aggravated by standing for long periods.  They can occur alone or may be associated with a bigger underlying vein issue.  The reason they enlarge and become visible is increased venous pressure.  Good news is, when these veins occur, they can be treated. At Total Body Surgical, we have a number of methods for treatment.  First, if the problem is extensive, we go out of our way to ensure that the cause is not just a symptom of an underlying bigger vein problem.  At the Total Body Surgical Vein Center we use ultrasound to make sure the larger veins are healthy.  If the spider veins are limited, or if the larger venous system is healthy, we then focus on the cosmetic treatment of the spider veins themselves.  Dr Swetnam usually uses sclerotherapy to eliminate them.  This is a minor procedure that is performed in the office.  It is fairly quick and with minimal discomfort.  A solution is injected into the spider vein that causes inflammation of the lining of the vein, eventually causing your body to remove it so that it can no longer function, or be seen.   This may take a few treatments and requires the wearing of compression stockings for about 2 weeks after injection and avoidance of strenuous exercise and hot tubs for that time as well.  In some instances, some brownish discoloration can occur around the site that usually resolves.  Some ulceration of the skin can also occur which heals well but can cause some minor scarring.  If the larger veins are diseased and the spider veins are injected, they will recur.  If we do a diagnostic ultrasound that shows the larger veins are not functioning, we treat those first with laser closure.  This stops the pressure and then allows us to treat the smaller veins with sclerotherapy successfully.I also use the Vein Light to isolate the "reticular" or connecting veins that feed the spider vein.  This allows me to see what is feeding the group of spider veins and inject it as well. 

For much smaller areas I sometimes will use the YAG laser to close them.  This is relatively quick.  I also use the laser when treating facial veins.  These commonly occur around the base of the nose, on the cheeks and chin.  They are very common in people with rosacea. 

Treatment of spider veins is an ongoing process and should be maintained.  Most people with significant spider veins will eventually meet criteria for treatment of the larger veins that are the root of the problem.  Patients with facial veins will also need maintenance.

Next week....fungus amungus.....the newest treatment for toe nail fungus!!!

Keep an eye out for new specials for fall!!!!

Come see us at Total Body Surgical for Obagi products, Skinceuticals, Botox, Juvederm, and all laser services.  Coming soon....laser tattoo removal!!

918-786-7780

Sorry everyone!! An Internet crash at the Grove address forced me to delay writing this installment.  The double edged sword of modern technology. 

This week I want to discuss removing the large varicose veins.  This was once done with larger incisions that left unsightly scarring.  We now perform what is called the European Micro phlebectomy.  What that means is that the veins are removed using a technique developed in Europe.  The difference is that this technique leaves very little scarring and is much more Cosmetically appealing than the old way.

The large varicosities that we see in the leg is usually not the actual disease.  As discussed in previous blogs, this disease is from incompetent valves in the saphenous system in most cases.  These big and ropey veins develope in response to the increased pressure in veins deeper in the leg.  Once closed with the laser, the deeper veins no longer feed these enlarged "branches" or varicosities.  When this happens a number of problems can occur, they can become painful, they can clot and cause phlebitis, they can cause skin color changes.  These problems will usually resolve with time but can be miserable. 

How is the procedure done??  After closing the system that is feeding the visible varicose vein, the large ropey veins are marked with a marker with the patient standing.  Local anesthesia is injected into the areas to be removed and in our office, IV sedation is given.  Once the local has taken effect, very small incisions are made and small instruments are used to grab the vein, elevate it, and tease it out from under the skin.  It is completely removed if possible.  The incisions are no more than a couple of millimeters in size (less than an eighth of an inch).  No stitches are placed, and a compression dressing is applied with Coban to hold pressure.  Some minor bruising may occur that lasts for a few days, the wounds may leak minimally for about 24 hr or so.  We have patients walk out of the office and most experience very little discomfort after.  The wounds heal very well and usually go unnoticed after 6 months or so.  Once removed, the painful and ugly source of embarassment is gone.

Next week....Cosmetic sclerotherapy and how to get rid of spider veins.

Call Total Body Surgical today for YOUR vein evaluation 918-786-7780!

Since there have been no requests about special interests, I get to choose!!  The next few weeks I will address veins and what to do about them.

The reason Cosmetic Surgery and Vein Surgery are so intimately associated is quite simple.  I can liposuction, augment, and tuck everything to make the body look great, and yet, if your legs look like this.....

it makes it hard to wear a dress, shorts, a swimming suit, or any other attire. 

Vein disease or chronic venous insufficiency, is a common problem.  It is thought to effect at least half of the population to varying degrees.  It is thought that the problem is hereditary, but can have other causes such as trauma or thrombosis (clotting).  The veins causing the problem have valves in them that no longer work properly.  The muscles of the lower leg act as a pump to move blood up the veins as they contract.  The valves are supposed to allow the blood to travel towards the heart but not let it return down the leg.This picture illustrates normal valve activity.The second image shows a comparison of normal with abnormal function.  When these valves are defective, the blood is allowed to return down the leg, increasing pressure and causing tributaries to dilate and become tortuous.  Spider veins also develope as the pressure causes enlargement of smaller veins in the skin.  The disease is not limited to appearance either.  This process causes cramping, restless leg syndrome, skin discoloration, rashes, ulceration with secondary infection, swelling, and ultimately, disability. 

The reason that these problems happen is multifactorial.  Pressure, low oxygen tension in venous blood, and the leaching of iron products from the hemoglobin in the blood and into the skin.  Depending on the severity of the reflux these symptoms may occur early or late in life.  

I hope this discussion helps shed light on why venous problems develope.  Over the next few weeks we will dive into the diagnosis and treatment of chronic venous disease.