Total Body Surgical Blog

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!

Last week the discussion was all about the causes of venous problems that occur in over half the population.  This week the discussion will be about treating the problem and some of the common hurdles faced when attempting to encourage payment from our wonderful insurance carriers.  The good thing is that if criteria are met, insurance will usually pay for treatment.  What are the criteria??  Well, they are somewhat variable.  First, there must be symptoms.  Pain, swelling, skin discoloration, aching, restless legs, and at the worst, ulceration and chronic changes.  Second, there must be ultrasound documentation of the problem.  This includes dilation of the veins or vein, and reflux of blood which demonstrates the absence of proper valve function.  Third, many require failure of conservative therapy with compression stockings for varied lengths of time....in some cases for up to six months.  Of course, treatment of spider veins is NOT covered as it is considered cosmetic.  A great deal of the time, however, these pesky spider veins are caused by an underlying bigger problem with the larger veins and this is covered.  The reason that's good is that after treating the larger veins, getting rid of the spider veins usually is much more permanent and they don't come back!!

The way it works at Total Body Surgical, we see you for a consultation and examine the problem.  If it is obviously a venous issue, I will give you stockings to start your time requirement, if present, and schedule an ultrasound.  At the ultrasound, we will discover what the extent of the problem is and how many veins are involved.  At that point we will figure out the treatment plan.  The important part of the ultrasound is measuring how much and where the reflux is located and document this.  Once all of your insurance criteria are met, your procedure, or procedures are scheduled.  At the procedure we use sedation for your comfort.  We use the cooltouch laser and tumescent local.  The laser fiber is inserted into the vein, the tumescent local is injected around the vein and the fiber is activated and pulled back the length of the vein to heat seal it.  This redirects the flow of venous blood to the deeper system where it is supposed to go anyway.  Sometimes, depending on how many veins are diseased, this may require more than one treatment.

Pictured above is the laser fiber itself and a rendition of what happens inside the vein when it is inserted, activated and retrieved.

Next week we will talk about removing the large varicosities that branch off of the veins that are closed by the laser.  This is known as European microphlebectomy.

We are approaching the final week of the breast augmentation special and don't forget our lap band introductory offer.

New special for fall to be announced next week!!!

Thank you for visiting!

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. 

COOL TOUCH LASER ABLATION

 At INTEGRIS Total Body Surgical, we provide the latest in total vein therapy.  When I first started in surgery many years ago vein stripping was the norm.  It usually required multiple incisions and a fair amount of blood loss.  The procedure was done under general anesthesia and required a prolonged recovery and left unsightly scarring.   The success rate was about 60=70%.  We know that this condition, known as chronic venous insufficiency, is inherited and aggravated by long periods on our feet and pregnancy.  It can also be caused by trauma, deep vein thrombosis and other abnormal clotting states.  The symptoms are caused by malfunctioning of the valves in the venous system.  Because of this, the venous blood pools in the lower leg causing pain, swelling, spider and varicose veins, skin color and texture changes, and possible ulceration.  It can cause restless leg syndrome, and makes them look bad.  Many people no longer wear dresses, skirts, shorts, or any other attire that shows leg because of embarrassment.  Others spend their life in hot and uncomfortable stockings with their legs elevated at night to deal with the discomfort. 

More later in the week on treatments.

  At INTEGRIS Total Body Surgical, Through July, we are offering $150.00 off of one sclerotherapy session if you screen and qualify for laser vein closure. See the link below for sign up and more details!!! Or call 918-786-7780 Today....don't miss out!!

http://www.totalbodysurgical.net/love-your-legsagain/

Video on how it is done.