Once suspicion for venous reflux has been eliminated, cosmetic goals for treating spider veins and telangiectasia can then be addressed. Aesthetic improvement can be achieved using several techniques. Current treatment involves either single or multiple modalities depending on the spectrum of veins being treated. Sclerotherapy has a long history and is effective for treating spider veins and telangiectasia large enough for a small gauge needle insertion. Veins smaller than 0.3 millimeters are more challenging to treat because of access limitations. As small as these veins are, they are bothersome because of the large red or purple clusters they form with an appearance often mistaken for a bruise. Laser and intense pulse light (IPL) therapy have been used in the past, but are painful and often do not produce lasting results. The newest contribution to the treatment of spider veins and telangiectasia involves addressing these veins at the skin surface by a technique using radiofrequency energy commonly known as Veinwave™. At Hancock Vein & Surgical Center, Veinwave™ has been demonstrated to effectively treat these tiny spider veins with a rewarding degree of patient satisfaction. Veinwave™ and sclerotherapy are commonly used in combination to enhance treatment effectiveness. In many cases, Veinwave™ has proven to be an ideal complement to sclerotherapy.
 Sclerotherapy
Sclerotherapy has been a longstanding method used effectively to manage spider veins. Sclerotherapy involves injecting a chemical solution into the vein that injures the vein wall and triggers a cycle that causes the vein to collapse and reabsorb over a six week period. There is an immediate inflammatory response to sclerotherapy that causes the treated area to appear “angry” for several days. Continuous compression is recommended for 48 hours followed by two weeks of graduated compression stockings. Avoiding sun exposure is important following sclerotherapy to prevent hyperpigmentation or long term darkening of the skin in the area treated. Sclerotherapy is tolerated well by most patients and usually takes anywhere from 15 to 45 minutes. Asclera® (polidocanol) is an FDA approved sclerosant that causes less discomfort than traditional sclerotherapy agents and has a low risk profile. Treatments are limited by the amount of medication that can be safely used per session. A previously treated area should not be retreated within six weeks to avoid long-term hyperpigmentation effects. Effectiveness of sclerotherapy is variable and multiple treatments may be necessary as determined at interval follow-up.
Veinwave™
Veinwave™ is suitable for the treatment of tiny spider veins that remain after sclerotherapy and for primary treatment of spider veins too small for sclerotherapy. Veinwave™ has been available for over ten years in Europe where more than 1000 physicians have included it in their practice. Veinwave™ became FDA approved in the United States in 2009 for eliminating spider veins and telangiectasia of the lower extremities and face. Veinwave™ uses a revolutionary process called unipolar thermocoagulation (UTC). A unique high frequency energy is applied to the affected area transcutaneously which causes the vein walls to collapse and vanish. An ultra-fine insulated needle is used to trace the vein along the skin surface and a series of pulses are delivered. The pulses are precisely targeted avoiding any collateral skin damage.
 Patients tolerate treatments anywhere from 20 minutes up to 60 minutes with minor discomfort typically comparative to plucking hairs. An immediate skin reaction is common with the appearance of wheals similar to that of a bug bite or cat scratch that fade within hours to several days. Small microscabs appear and slough over the next couple weeks. At 30 days, the skin clears with the disappearance of all treatment effects. Follow-up at four to six weeks is scheduled for touch-ups as necessary. Veinwave™ is safe, effective, and permanent, a popular and advantageous addition to the treatment of spider veins and telangiectasia. There are no sun restrictions or requirement for compression stockings after the treatment and patients can resume their usual activities immediately without any downtime. Patients should avoid artificial tanning for several weeks prior to treatment. A test patch is usually performed at initial evaluation to allow patients to judge for themselves the effectiveness and tolerability of the treatment.
Despite there being an appreciation for the burning, tingling, itching, and throbbing that often exists in association with these veins, insurance companies insist that they represent a cosmetic issue and, therefore, any treatment addressing them does not constitute medical necessity.
In other words, these procedures are an out-of-pocket expense. For this reason, a consultation at Hancock Vein & Surgical Center includes a financial summary combined with treatment expectations to help balance individual cosmetic goals with sensitive budgetary considerations. | 
Susan Hancock, MD is board certified by the American College of Surgeons and has practiced as a Vascular Surgeon for three years since completing her Vascular Fellowship in 2007. She now has an independent practice in the Oyster Point area dedicated to the treatment of venous related disorders including varicose veins, ulcerations, dermatitis and infections, swelling, aching uncomfortable legs, and spider veins. She is experienced in vascular ultrasound, radiofrequency vein ablation with the VNUS Closure system, surgical excision of varicose veins, wound care, sclerotherapy, and radiofrequency treatment of spider veins.