Laser ablation of unwanted hand veins

Endovenous laser ablation vs phlebectomy of foot varicose veins

OBJECTIVE

The aim of this study was to compare the outcomes and complications of selected patients treated with endovenous laser ablation (EVLA) or ambulatory phlebectomy for foot varicose veins.

METHODS

From October 2016 to February 2022, selected patients undergoing EVLA (using 1470-nm with radial-slim or bare-tip fibers) or phlebectomy of foot varicose veins for cosmetic indications were analyzed, and the outcomes were compared. Patients were classified according to the Clinical, Etiologic, Anatomical, and Pathophysiological (CEAP) classification. Anatomic criteria provided the basis for the decision to perform EVLA or phlebectomy. Clinical and ultrasound assessments were performed on postoperative days 7, 30, and 90 for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep venous system. Disease severity was graded with the Venous Clinical Severity Score (VCSS), and quality of life was measured with the Aberdeen Varicose Vein Questionnaire (AVVQ) before and after treatment. Treatment outcomes were evaluated based on changes in VCSS and AVVQ scores. The groups were also compared for procedure-related complications. Data were statistically analyzed in SPSS v. 20.0 using the χ2, Student t test, Mann-Whitney test, Wilcoxon test, and analysis of variance. The results were presented as mean (standard deviation or median (interquartile range).

RESULTS

The study included 270 feet of 171 patients. Mean patient age was 52.3 (standard deviation, 13.1) years, ranging from 21 to 84 years; 133 (77.8%) were women. Of 270 feet, 113 (41.9%) were treated with EVLA and 157 (58.1%) with phlebectomy. The median preoperative CEAP class was 2 (interquartile range, 2-3) in the phlebectomy and EVLA groups, with no statistically significant difference between the groups (P = .507). Dysesthesia was the most common complication in both groups. Only transient induration was significantly different between EVLA (7.1%) and phlebectomy (0.0%) (P = .001). The two approaches had an equal impact on quality of life and disease severity.

CONCLUSIONS

Treatment complications were similar in phlebectomy and EVLA and to those previously described in the literature.

Dorsal Hand Rejuvenation: A Systematic Review of the Literature

BACKGROUND

Dorsal hand appearance undergoes changes with aging. Grading systems have been designed to provide numerical scores to dorsal hand appearance. Various modalities have been utilized to improve the aesthetic appearance and rejuvenate the dorsal hand.

METHODS

The MEDLINE database was searched for articles investigating dorsal hand rejuvenation. Studies were grouped by method including fat grafting, injectable filler, laser/light-based treatments and miscellaneous treatments. Treatment protocols and outcomes were compiled along with patient information and complications.

RESULTS

Forty-six articles were identified for inclusion. This included 9 studies of fat grafting procedures, 20 studies of injectable filler, 10 studies of laser/light-based treatments and 7 miscellaneous. Most studies showed overall good results with high patient satisfaction. Satisfaction rates were lower in laser/light-based treatments compared with the other modalities. The average patient age for included studies ranged from 41.5 to 69. Across all studies, 96.8% of patients were female and 3.2% male.

CONCLUSIONS

Procedures for dorsal hand rejuvenation in the literature include procedures to address volume atrophy and superficial wrinkling. These procedures are overall safe with most studies reporting no complications or only mild adverse events. With high satisfaction rates and anecdotal reports of increasing patient interest, these procedures represent a developing area in aesthetic surgery likely to continue increasing in popularity.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Review of Hand Feminization and Masculinization Techniques in Gender Affirming Therapy

INTRODUCTION

Anatomical characteristics that are incongruent with an individual's gender identity can cause significant gender dysphoria. Hands exhibit prominent dimorphic sexual features, but despite their visibility, there are limited studies examining gender affirming procedures for the hands. This review is intended to cover the anatomical features that define masculine and feminine hands, the surgical and non-surgical approaches for feminization and masculinization of the hand, and to adapt established aesthetic hand techniques for gender affirming care.

METHODS

The authors performed a comprehensive database search of PubMed, Embase OVID and SCOPUS to identify articles on the characterization of masculine or feminine hands, hand treatments related to gender affirmation, and articles related to techniques for hand masculinization and feminization in the non-transgender population.

RESULTS

From 656 possibly relevant articles, 42 met the inclusion criteria for the current literature search. There is currently no medical literature specifically exploring the surgical or non-surgical options for hand gender affirmation. The available techniques for gender affirming procedures discussed in this paper are appropriated from those more commonly used for hand rejuvenation.

CONCLUSION

There is a dearth of literature addressing the options for transgender individuals seeking gender affirming procedures of the hand. Though established procedures used for hand rejuvenation may be utilized in gender affirming care, further study is required to determine relative salience of various hand features to gender dysphoria in transgender patients of various identities, as well as development of novel techniques to meet these needs.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. .

Foam sclerotherapy for reticular veins of the dorsal hands: a retrospective review

BACKGROUND

Despite being the gold standard for lower extremity reticular vein treatment, few studies have yet evaluated foam sclerotherapy for hand veins.

OBJECTIVE

This retrospective study evaluates the safety and efficacy of foam sclerotherapy for reticular veins of the dorsal hands.

METHODS

A telephone-based questionnaire was used for patient self-assessment of overall improvement, satisfaction, prevalence of adverse events, and willingness for repeat treatment after foam sclerotherapy with sodium tetradecyl sulfate (STS). All patients had been treated with foam STS of 0.25% to 1.0% concentration using room air.

RESULTS

Twenty-one of 45 patients were successfully contacted, with a total of 54 treatment sessions performed on 38 hands. Overall, patients reported scores of 2.55 ± 0.56 for overall improvement (0 = none, 1= mild, 2 = moderate, and 3 = complete resolution) and 1.79 ± 0.41 for satisfaction with results (0 = not satisfied at all, 1 = mildly satisfied, and 2 = very satisfied), with few significant treatment-related adverse events. Most patients stated they would undergo another treatment if needed.

CONCLUSION

This single-center experience found that foam sclerotherapy with STS is a safe and effective treatment for reticular veins of the dorsal hands with excellent long-term patient satisfaction.

A prospective, noninterventional study of the treatment of the aging hand with Juvéderm Ultra® 3 and Juvéderm ® Hydrate

BACKGROUND

Hand rejuvenation aims to restore volume and produce smooth, elastic skin. A combined treatment has been proposed: Juvéderm Ultra® 3 for filling and smoothing the skin and Juvéderm® Hydrate to rehydrate and restore skin quality.

METHODS

Twenty physicians enrolled 99 subjects (i.e., 198 hands). At the first visit, hands were injected with Juvéderm Ultra® 3. At the second visit (day 15) hands were treated with Juvéderm® Hydrate. A final assessment was made at day 30.

RESULTS

Ninety-eight percent of subjects were female (mean age=60.3 years). Mean volumes injected were 1.02 ml Juvéderm Ultra® 3 per hand at day 0 and 0.91 ml Juvéderm® Hydrate per hand at day 15. Mean grading on the Hand Aging Scale was 3.18 preinjection, which decreased to 1.73 on study completion (p<0.0001). Injections were rated as "very easy/easy" in 99.4 and 98.9% of cases for Juvéderm Ultra® 3 and Juvéderm® Hydrate, respectively. Most physicians found both products "very easy/easy" to massage. Physician evaluation based on the Global Aesthetic Improvement Scale (GAIS) showed that the proportion of "very much/much improved" was significantly higher at days 15 and 30 compared to baseline (63.7 and 70.3 vs. 41.8%). Patient GAIS scores showed that the proportion of "much improved" was significantly higher at day 30 than at day 15 (53.1 vs. 43.9%). Over 94% of physicians and approximately 90% of subjects would recommend treatment. The adverse event rate was 8.2 %, including edema, hematoma, redness, and pain.

CONCLUSION

Combined Juvéderm Ultra® 3 and Juvéderm® Hydrate treatment is effective and safe for rejuvenating the aging hand.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Hand rejuvenation: a review and our experience

BACKGROUND

The aged hand is characterized by cutaneous and dermal atrophy, with deep intermetacarpal spaces, prominent bones and tendons, and bulging reticular veins. Epidermal changes include solar lentigines, seborrheic keratoses, actinic keratoses, skin laxity, rhytides, tactile roughness, and telangiectasia.

STUDY DESIGN

A Medline search was performed on hand rejuvenation from 1989 to 2011, and results are summarized. Practical applications of these procedures are also discussed.

RESULTS

Reports of injectable hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, autologous fat transfer, vein treatment, and chemical peels, along with lasers and light sources such as Q-switched laser, intense pulsed light, photodynamic therapy, nonablative resurfacing lasers, and ablative resurfacing lasers, in the rejuvenation of hands were found.

CONCLUSION

Review of the literature revealed options for minimally invasive treatment for rejuvenation of the skin and volume restoration of the dorsal hand. These treatments include injectables and fat transfer for volume restoration; sclerotherapy or vein ablation for dorsal hand vein treatment; and chemical peels, lasers, light, and energies for the treatment of epidermal and dermal changes.

Minimal-scar handlift: a new surgical approach

BACKGROUND

Removal of excess skin from the aging hand can cause scarring in one of the body's most visible areas, which is highly undesirable for patients. A minimal-scar approach to tightening this skin, in conjunction with the rejuvenating effects of minimally-invasive procedures, is therefore needed.

OBJECTIVES

The authors describe a new technique for limiting scar size and visibility by locating the incision in a unique position on the ulnar side of the dorsum of the hand.

METHODS

Eleven patients were treated with the authors' method between March and September 2009. Both hands were treated for each patient, but these procedures occurred separately, at an interval of two to four months. The surgical approach included skin flap advancement and rotation, and the procedure took place under local anesthesia and sedation. The resultant scar was S-shaped. Changes in postoperative stress ratio were visualized.

RESULTS

Patients reported being highly satisfied with this procedure with regard to scar size, quality, and location. No major complications were observed, such as infection, flap necrosis, and nerve damage. All minor complications were treated conservatively. Patients with Fitzpatrick skin types I-III profited from less scar visibility in their outcomes. All patients experienced quick recovery with minimal downtime, independent of skin type.

CONCLUSIONS

The minimal-scar handlift technique is an effective surgical approach to rejuvenating the hand and can be implemented concurrently with minimally-invasive techniques for volume restoration. The complication rate is low, and patient/surgeon satisfaction with outcomes is high.

Treatment of the aged hand with injectable poly-l-lactic acid

We report the use of injectable poly-l-lactic acid (PLLA) for volume restoration in a 45-year-old white female who was concerned about the appearance of her hands. The patient expressed a desire for long-term restoration, and selected injectable PLLA because of its known 2-year duration of effect, although she was informed that injectable PLLA is not FDA-approved for use in the hands. After reconstitution with 8 ml of diluent plus lidocaine, 0.1-0.2-ml aliquots of injectable PLLA were injected into selected sites, up to 5 ml per hand. The patient underwent three identical treatments, followed by postinjection use of moisturizing cream and massage; improvement in appearance was noted by the patient between the second and third treatments. Correction was maintained for at least 18 months, with no adverse events. We have also briefly reviewed the literature on the use of injectable PLLA for volume restoration in the hand.