Removal of periocular veins by sclerotherapy

Sclerotherapy in Aesthetic Medicine: Myths and Realities

BACKGROUND

Sclerotherapy is commonly performed for elimination of reticular and telangiectatic leg veins. There are several variations in practice, from the preparation to post-therapy directives.

OBJECTIVE

To critically examine the misconceptions of sclerotherapy for aesthetic indications.

MATERIALS AND METHODS

This review assesses evidence for and against each of the most common myths regarding sclerotherapy for aesthetic indications.

RESULTS

Sclerotherapy can be safely used to treat veins in areas other than the lower extremities, with the exception of the face. Laser therapy is not superior to sclerotherapy for the treatment of small telangiectatic veins on the lower extremities. The type of syringe used to produce foam sclerotherapy is an important procedural consideration. After sclerotherapy, graduated compression stocking usage is a vital part of the procedure. Detergent sclerotherapy agents are similar, but not equivalent. Touch-up treatments after sclerotherapy should not be performed for 2 months post-treatment. Foam sclerotherapy does not have a high risk for air emboli. It is not advisable to treat the leg veins in "sections." Finally, one cannot reliably treat the telangiectatic veins without treating the feeding reticular veins for a satisfactory result.

CONCLUSION

Many aspects of sclerotherapy have existing evidence to dictate best clinical practice.

Polidocanol: A Review of Off-Label Dermatologic Uses

BACKGROUND

Polidocanol is an FDA-approved treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, but numerous other off-label dermatological applications have been reported.

OBJECTIVE

To describe the various off-label dermatological clinical uses of polidocanol, as well as efficacy and adverse effects.

METHODS

The review of studies searchable on PubMed from 2004 to 2021 describing clinical uses of polidocanol to determine efficacy and adverse effects associated with various dermatologic applications.

RESULTS

Polidocanol has shown efficacy in the treatment of mucocele of minor salivary gland, hemangioma, upper extremity veins, reticular veins of the chest, facial veins, pyogenic granuloma, lymphangioma circumscriptum, digital mucous cyst, mixed skin ulcers, cutaneous focal mucinosis, seromas, glomuvenous malformations, acne cysts, lymphocele, and dissecting cellulitis. Commonly reported side effects include pain, erythema, swelling, ecchymosis, and ulceration. Most sources were case reports and small prospective studies, as such the strength of data supporting many uses is limited by small sample sizes and lack of controls.

CONCLUSION

Although polidocanol is currently only FDA approved for incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, the use of polidocanol has been selected for a variety of off-label clinical applications.

Updates and Best Practices in the Management of Facial Erythema

Facial erythema is a common dermatologic complaint. There are many medical and procedure-based treatments to help reduce the appearance of unwanted facial redness. The authors review a variety of treatment options and techniques to reduce facial erythema and prominent facial veins including topical medical therapies, a variety of lasers, light- and energy-based devices as well as the use of neuromodulators and sclerotherapy. The benefits and potential pitfalls of each procedure modality are also highlighted.

Vascular anomalies of the head and neck: diagnosis and treatment

Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.

A Dynamically Cooled, Variable Spot-Sized 1,064 nm Neodymium-doped Yttrium Aluminum Garnet Laser as a Treatment Option for Facial Reticular Veins

BACKGROUND

Facial reticular veins can be treated with laser therapy, sclerotherapy, or surgical removal. The use of a 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been reported to be successful in the treatment of facial reticular veins.

OBJECTIVE

To report a large retrospective study examining the efficacy, side effects, and satisfaction of a dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser for the treatment of facial reticular veins in the periorbital and temporal area.

PATIENTS AND METHODS

Contact was made with 100 patients from 2006 to 2019 who underwent treatment with a 1,064 nm Nd:YAG laser for facial reticular veins through office follow-up or telephone interviews. Percent resolution of veins, satisfaction, and adverse effects were evaluated.

RESULTS

Eighty-nine of the 100 patients ranked their satisfaction with the treatment as 3 or very satisfied. Most patients reported 75% to 100% improvement. The most commonly reported adverse event seen after treatment was mild edema. Sixty-eight percent of patients reported no adverse effects at all.

CONCLUSION

The dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins with minimal side effects. The results are usually immediate and, based on the long-term follow-up, tend to be long lasting.

Treatment of periocular and temporal reticular veins with 1064-nm Nd:YAG Laser

BACKGROUND

The periocular and temporal regions are important aspects of beauty. The presence of reticular veins in these areas is undesirable and can also interfere with injection of neurotoxins to treat squint lines. 1064-nm Nd:YAG laser shows promise as an effective treatment modality with long-lasting effects.

AIM

The aim of the study is to show that the long-pulsed, contact-cooled, variable spot-sized 1064-nm Nd:YAG laser is effective and safe, with good patient satisfaction and tolerability, and is able to achieve long-term results.

METHODS

A retrospective study of 35 consecutive patients seen over a 3-year period in a private cosmetic clinic affiliated to the University of Toronto for periocular and temporal reticular veins was conducted. They were all treated with 1064-nm Nd:YAG laser.

RESULTS

A total of 35 patients with an average age of 45.8 years old received treatment. 13 had lower eyelids treated, 9 had temples treated, 12 had both lower eyelids and temples treated, and 1 had both upper and lower eyelids treated. The first case of upper eyelid vein being treated with the 1064-nm Nd:YAG laser with great success after only 1 treatment is reported. 80% of the patients required only 1-2 treatment sessions. The average satisfaction score was 7.9 out of 10. The average pain score was 5.0 out of 10. 91% perceived the treatment outcome as excellent or good with the longest result lasting 33 months. There were 4 complications: 1 scabbing, 1 small burn, 1 skin darkening, and 1 teary eye.

CONCLUSION

The study showed that the use of the long-pulsed, contact-cooled, variable spot-sized 1064-nm Nd:YAG laser is effective and safe, with good patient satisfaction and tolerability, and is able to achieve long-term results.

Treatment of Facial Telangiectases With Glycerin Sclerotherapy

BACKGROUND

Sclerotherapy is used to treat varicosities and telangiectases. Glycerin is a sclerosing agent that has been used off-label for years with a favorable adverse effect profile. However, the treatment of facial telangiectases with sclerotherapy is controversial given the potential for necrosis and embolization in relation to the complex vascular anatomy of the face.

OBJECTIVE

To determine the safety and efficacy of glycerin sclerotherapy for the treatment of facial telangiectases.

MATERIALS AND METHODS

The authors report a series of 8 patients with facial telangiectases treated with glycerin sclerotherapy. Glycerin mixed with lidocaine and epinephrine was used. The telangiectases were measured and identified as targets for treatment.

RESULTS

The patients ranged in age from 45 to 88 years. Between 0.5 and 1 mL was used to treat telangiectases of the nose and malar cheek area per session. Five of the patients achieved satisfactory results after 1 treatment, whereas patients with more extensive telangiectases required up to 3 sessions with 4-week intervals between each session. Injection site pain was the only reported adverse effect, and no evidence of necrosis or blindness was observed.

CONCLUSION

Glycerin sclerotherapy seems to be a safe and effective modality for the treatment of facial telangiectases.

Sodium Tetradecyl Sulfate: A Review of Clinical Uses

BACKGROUND

Sodium tetradecyl sulfate (STS) is Food and Drug Administration approved for treatment of varicose veins, but numerous other off-label applications have been reported.

OBJECTIVE

To describe the clinical uses of STS, as well as efficacy and adverse effects.

METHODS

Review of studies searchable on PubMed from 1938 to 2016 describing clinical uses of STS to determine efficacy and adverse effects associated with various applications.

RESULTS

Sodium tetradecyl sulfate has shown efficacy in the treatment of varicose veins, telangiectasias, hemangioma, pyogenic granuloma, cherry angioma, Kaposi sarcoma, lymphangioma circumscriptum, digital mucous cyst, ganglion cyst, glomangioma, angiokeratoma of Fordyce, pseudocyst of the auricle, and verruca. Commonly reported side effects include pain, erythema, swelling, hyperpigmentation, telangiectatic matting, and ulceration. Serious side effects such as anaphylaxis, pulmonary embolism, stroke, and myocardial infarction have also been reported. Most sources were case reports and small prospective studies, as such the strength of data supporting many uses is limited by small sample sizes and lack of controls.

CONCLUSION

Although not always the most effective method of treatment in off-label usage, use of STS has been frequently selected for a variety of applications for reasons of simplicity, low cost, lack of availability of technologically advanced equipment, and intricacies related to anatomic location.

Periorbital rejuvenation: reticular vein treatment

The safety profile of certain techniques, such as sclerotherapy, is questionable in a region as precarious as the periorbital region, where complications related to vision would be catastrophic. Other safe techniques such as phlebectomy can be performed with successful outcomes but are operator dependent, require a reasonable degree of technical ability, and can result in scarring and other complications. The aim of this article is to explore newer, laser-based treatment of these periorbital veins, discuss the physiology and the therapeutic efficacy, and better delineate the safety profile and evolution of the technique that has led to the present treatment paradigm.

Treatment of facial reticular veins with dynamically cooled, variable spot-sized 1064 nm Nd:YAG laser

BACKGROUND

Facial reticular veins are often seen on the temple and periorbital areas in patients with genetic predisposition or after facial cosmetic surgery.

AIM

The purpose of this study was to evaluate the efficacy and safety of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser in the treatment of facial reticular veins.

PATIENTS/METHODS

This is a retrospective study. Twenty patients with facial reticular veins who underwent treatment with dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were evaluated. Patients were followed up 1 month to 2 years after the procedure.

RESULTS

Objective and subjective improvement scores after one or two treatments of dynamically cooled, variable spot sized 1064 nm Nd:YAG laser were nearly 100% when appropriate parameters were used.

CONCLUSION

Dynamically cooled, variable spot sized 1064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins. Most patients responded to one treatment and experienced no significant side effects other than tolerable pain associated with the procedure.

Optimal management of facial telangiectasia

Telangiectasia can be treated with many different modalities. Electrosurgery is effective but dependent on technique. Sclerotherapy can be used on larger blue telangiectasia but may be complicated from inadvertent injection into arterioles. Surgical phlebectomy can be used on reticular veins but is technically difficult. Many different laser wavelengths can be successfully used to minimize and/or eliminate vascular lesions on the face. Each type of laser has advantages unique to its profile of wavelength, pulse duration, spot size and cutaneous cooling. The benefits of using 532-595 nm lasers are the multiple applications of these lasers on treating not only telangiectasia, but also pigmentation and even fine wrinkles. Newer methods of cutaneous cooling and lengthening of pulse duration make these lasers less painful with fewer adverse effects (purpura) than previous lasers. The benefit in using a 1064 nm laser is that its longer wavelength can penetrate more deeply, allowing effective thermosclerosis of vessels up to 3-4 mm in diameter. In addition, the 1064 nm wavelength permits treatment of patients of skin types I-VI with or without a tan, since melanin absorption is minimal.

Removal of blue periocular lower eyelid veins by ambulatory phlebectomy

BACKGROUND

Prominent periocular veins, primarily of the lower eyelid, are a relatively frequent cosmetic problem. Reported treatment techniques have included electrosurgical, sclerotherapy, and longer-wavelength lasers.

OBJECTIVE

Ambulatory phlebectomy can be performed on reticular veins of the leg. This technique has been applied over the past few years to periocular reticular veins in order to observe the results and side effects.

METHODS

Using a hook specifically designed for reticular veins, we treated 10 patients who had larger reticular periocular eyelid veins. One or several punctures with an 18-gauge needle were made in the center of the targeted length of vein. The reticular vein was then gently dissected by undermining with the stem of the Ramelet phlebectomy hook.

RESULTS

All 10 patients tolerated the procedure well. In 8 of 10 patients there was complete elimination with a single procedure. Surprisingly, no significant hematoma was seen in any patient, although two patients had a small hematoma lasting less than 1 week. Two patients had only partial success, as a small segment of vein was difficult to extract. This was eliminated with a second phlebectomy performed 2 months later in both cases. Edema that is usually seen after sclerotherapy was not noted in any of these patients.

CONCLUSIONS

Ambulatory phlebectomy appears to be a safe and effective means of permanently eradicating periocular veins.