If It Sounds Too Good To Be True… Evaluating Consumer Health and Cosmetic Surgery Claims:

Percutaneous sclerotherapy of peripheral venous malformations in pediatric patients

PURPOSE

To report the efficacy of percutaneous puncture and sclerosis using polidocanol in the treatment of venous malformations (VMs) in pediatric patients.

PATIENTS/METHODS

Between March 2007 and February 2011, a series of 19 patients with VMs on the upper and lower extremities had undergone a total of 89 sessions of intralesional sclerotherapy using polidocanol. All the procedures were performed in an angiographic suite under general anesthesia in order to maintain sedation for facilitating the procedure. For each injection, approximately 1 ml of 2% polidocanol was injected for each centimeter of the diameter of the lesion, with a maximum of 6 ml. Injection of the sclerosant was guided by real-time sonography and fluoroscopy.

RESULTS

After the treatment, the symptoms completely resolved in four patients (21%). Clinical symptoms, such as bulging and pain were improved in 12 out of 19 patients (63%). They remained unchanged in three patients (16%). During the procedures, no major complications were encountered. The minor complications (65%) encountered were swelling and pain after treatment which were resolved by taking NSAID within a few days.

CONCLUSION

In pediatric patients, sonographically guided percutaneous puncture and fluoroscopically guided sclerosis using 2% polidocanol is effective, less invasive and safe for the treatment of VMs, with a high success rate and minimal complications.

Rejuvenation of the aging hand

This article reviews aging of the hand and the treatment options for cosmetic rejuvenation. Options available for cutaneous rejuvenation include microdermabrasion, chemical peeling, intense light sources, and laser therapy, including pigment lasers, ablative resurfacing, and noninvasive rejuvenation. Protuberant veins of the aging hand can be treated effectively with sclerotherapy. The soft tissue atrophy of the aging hand is best treated with fat augmentation. The article concludes with a mention of new fillers that are just beginning to be used for soft tissue atrophy of the hand.

Lipoaugmentation for aging hands: a comparison of the longevity and aesthetic results of centrifuged versus noncentrifuged fat

BACKGROUND

Fat augmentation has long been utilized by cosmetic surgeons for volume restoration of the face and hands. However, it is not clear which methods of fat preparation optimize survival and aesthetic results. The need for centrifugation of the fat prior to augmentation has been debated in the literature.

OBJECTIVE

To evaluate the long-term efficacy of fat transplantation to the hands using centrifuged versus noncentrifuged fat.

METHODS

Fourteen patients underwent fat augmentation to the hands utilizing 10 ml of centrifuged fat in one hand and 10 ml of noncentrifuged fat in the contralateral hand in a randomized, double-blind comparison study. Evaluation intervals were at 1, 3, and 5 months at which time aesthetic results, vein prominence, and depth of metacarpal space were evaluated.

RESULTS

At 1 month the subjective and objective preference was the hand with the noncentrifuged fat in 75% of patients, even though vein prominence and depth of metacarpal space were higher in that group. By 3 months the preferred result was centrifuged fat in 62.5% of patients; 25% had equal results and 12.5% preferred the noncentrifuged fat. By 5 months the subjective and objective preference was for the centrifuged fat in 100% of patients. This preference was supported by a lower score in vein prominence and depth of metacarpal space in that group.

CONCLUSION

This preliminary study supports the use of centrifuged fat compared to noncentrifuged fat for longevity and improved aesthetic results at 3 and 5 months for fat augmentation of the aging hands.

Sclerotherapy of reticular and telangiectatic veins of the face, hands, and chest

BACKGROUND

Prominent tortuous veins of the face and hands may result from the process of aging and constitute a source of distress for many patients. Marked telangiectases of the chest and face are similarly distressing to some patients.

OBJECTIVE

To determine the safety and efficacy of sclerotherapy for telangiectatic veins of the face and chest and varicose veins of the hands.

METHODS

Twenty facial telangiectases and tortuous veins in 14 patients and 20 total facial sites were treated with sclerotherapy. Patients did not suffer from collagen vascular diseases, had no chronic illnesses, and were thoroughly informed of the strictly cosmetic nature of the procedure. A hyperosmolar sclerosant was used in 16 of 20 sites and the remaining 4 sites were treated with a detergent sclerosant (polidocanol 0.5-0.75%). The follow-up period ranged from 9 months to 15 years. Similarly the varicose veins of 14 hands in seven patients were treated with sclerotherapy using a detergent sclerosant [sodium tetradecyl sulfate (STS)] at various concentrations (1-3%). The follow-up period ranged from 1 to 6.5 years. Tortuous veins and telangiectases on the chest of three patients were treated with either STS 0.25-0.50% or polidocanol 0.75% with a follow-up of 2-9 years.

RESULTS

Tortuous facial veins and telangiectases had a mean improvement of 70%, with 11 of 20 sites showing a 90-100% improvement. Hand varicosities had a mean improvement of 97.8%, and all sites showed a 90-100% resolution of varicosities. Finally, the tortuous veins and telangiectases of the chest improved by 50-100% with sclerotherapy. Only minimal to moderate telangiectatic matting was observed in two patients (one in the lateral canthal area and one near the treatment site of chest reticular veins). No ulceration or hyperpigmentation occurred long term in facial or hand veins. One patient developed an arterial ulceration on the left lateral breast.

CONCLUSION

Sclerotherapy of varicose and telangiectatic veins of the face, hands, and chest can be safe and effective. Care must be given to sclerotherapy in the chest area, particularly the breast.

Removal of periocular veins by sclerotherapy

PURPOSE

Prominent periocular veins, especially of the lower eyelid, are not uncommon and patients often seek their removal. Sclerotherapy is a procedure that has been successfully used to permanently remove varicose and telangiectatic veins of the lower extremity and less frequently at other sites. Although it has been successfully used to remove dilated facial veins, it is seldom performed and often not recommended in the periocular region for fear of complications occurring in adjacent structures. The purpose of this study was to determine whether sclerotherapy could safely and effectively eradicate prominent periocular veins.

DESIGN

Noncomparative case series.

PARTICIPANTS

Fifty adult female patients with prominent periocular veins in the lower eyelid were treated unilaterally.

PATIENTS AND METHODS

Sclerotherapy was performed with a 0.75% solution of sodium tetradecyl sulfate. All patients were followed for at least 12 months after treatment.

MAIN OUTCOME MEASURES

Complete clinical disappearance of the treated vein was the criterion for success.

RESULTS

All 50 patients were successfully treated with uneventful resorption of their ectatic periocular veins. No patient required a second treatment and there was no evidence of treatment failure at 12 months. No new veins developed at the treated sites and no patient experienced any ophthalmologic or neurologic side effects or complications.

CONCLUSIONS

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