Yag Laser Treatment for Spider Veins on the Nose Reviews

Abstruse

Groundwork

Spider veins on the lower limbs are very common and take been reported to exist nowadays in 41% of women over fifty. Sclerotherapy equally a traditional treatment for spider veins has a low cost, though it may have adverse sequelae. Lasers have shown fewer but however substantial complications besides. Its lower efficacy relative to sclerotherapy has express laser application for the treatment of spider veins.

Objectives

To present a new alternative in management of spider veins which involves a depression voltage current delivered via an insulated micro needle with beveled tip.

Methods

Thirty female patients were treated with the "Given Needle." The technique utilizes a micro needle with an insulated shaft with an exposed beveled tip, which is inserted into a manus piece connected to a mono-polar electric generator. The needle is introduced through the peel into or on the spider vein. The current is then applied with obliteration of the vein.

Results

Twenty patients (66%) had more than a lxx% resolution. The most mutual complication was skin erythema, which developed in 15 patients, followed by bruising in xiii patients. Both of these complications resolved in 2-iii weeks.

Conclusions

A novel approach for the treatment of spider veins has been described. The evolution of an insulated micro needle with an exposed beveled tip utilizing low current has minimized side by side tissue damage and improved efficacy. The low cost, low level of complications, and comparable results offer a valuable alternative to sclerotherapy and laser treatment.

Level of Show

4 Therapeutic

Spider veins on the lower limbs are very common and accept been reported to exist present in 41% of women over the age of fifty years in the United States. ⁱ Spider veins occur in two-thirds of patients before the age of 25, and increase in incidence with historic period. They stand for an important aesthetic problem. ²

Almost cutaneous spider veins are abnormalities of the horizontal vascular skin plexus or capillary loops. ³ Spider leg veins are equanimous of a feeder vessel and ectatic venous sprouts in the reticular dermis. Their depth is between 180 µm and one mm in the skin. ^four The underlying pathophysiology is a matter of debate. Patients with college age and chronic venous insufficiency are at greater hazard. Hormonal factors and occupation play a role in the development of spider veins. ^{1 , five} In that location seems to be a potent genetic factor since 90% of patients has a positive family history of spider veins. ⁶

Spider veins may accept a bore that reaches several millimeters. This study involves the treatment of the virtually mutual type of spider veins, which are one mm or less in diameter.

The traditional treatment for spider veins has consisted of sclerotherapy, which involves injecting a pocket-sized amount of a sclerosing solution into the target vein. Notwithstanding, chemic agents cause harm in the vessel wall with subsequent fibrosis. ^seven Most chemicals capable of denaturing living tissue are likewise capable of producing uncontrolled thrombosis, unintended destruction of nontargeted vascular tissue, and a wide range of minor and occasional major complications. The most common complications include tissue necrosis, ulceration, scarring, hyperpigmentation, hypopigmentation, matting, and allergic reactions to the sclerosant. Many sclerosant agents have been used but a perfect sclerosant that is complexity free and 100% effective has not yet been developed. All sclerosants represent a compromise between efficacy and toxicity. ^{8 , ix}

There has been a longstanding interest in finding an effective, noninvasive alternative to sclerotherapy that would provide equivalent or better efficacy, with a higher level of safe and ease of operation. ^x Consequently, the introduction of lasers in this field was initially accepted with much enthusiasm. A wide diverseness of lasers has been employed with unlike levels of success. Notwithstanding, the higher price of lasers with lower efficacy relative to sclerotherapy and the significant complications such every bit hyperpigmentation, hypopigmentation, scarring, pain, and ulceration have resulted in limited laser popularity for the treatment of spider veins. Therefore, sclerotherapy has remained the preferred handling. ^{11 , 12}

Electrosurgery of blood vessels has been used since the 1920s and has profoundly improved the efficiency of operative procedures. Information technology employs high-frequency electrical current passing through the tissue, generating heat to deliver the desired clinical effect. This is different from electrocautery, in which electrical current heats an instrument and a clinical effect is achieved when the instrument is practical to the tissue. ^xiii

Nonetheless, thermal harm to adjacent tissue has express electrocautery'southward usefulness in the dermis. ^{iii , 12} Bollinger reported the germination of scar tissue after the use of electrocoagulation in the treatment of spider veins. ^xiv A new alternative in the management of spider veins, which involves a low voltage, delivered via an insulated micro needle with beveled tip, minimizing side by side tissue damage, is presented (Figure ane A).

Effigy 1.

(A) Schematic drawing of Given Needle. (B) The Given Needle (C) Comparison of the Given Needle bottom left with a standard handle tip to a higher place. (D) The Given Needle inserted into a standard handle.

METHODS

The study was conducted in accord with the guidelines of the institutional review board and the tenets of the Declaration of Helsinki were followed. Informed consent was provided by all patients in the written report. Thirty patients who were treated with the Given Needle from July 2008 to Baronial 2009 were included in the study. Inclusion criteria were patients with spider veins of 1 mm or less in diameter. Exclusion criteria were patients with anticoagulation therapy and/or patients with a known history of keloids.

The technique utilizes a micro needle with an insulated shaft with a beveled tip (US Patent No. United states 7,125,406; US 7,628,790), which is inserted into a hand slice connected to a mono-polar electrical generator. The tungsten needle has a diameter of 0.01" with a biocompatible sheath with a thickness of 0.0002" (Effigy one B). The sheath of biocompatible material covers the entire portion of the needle except the beveled tip to forestall exposure of the shaft to next tissue and to minimize collateral damage (Figure one C). This study was approved by the Institutional Review Board at Georgia Regents University (Augusta, GA).

The innovation of this device is consummate insulation of the whole length of the needle except the beveled tip, which increases precision of ability delivery and decreases adjacent collateral impairment (Figure 2 ).

Figure 2.

Proper placement of needle in training for ablieration of vein.

The needle process is very simple. A render circuit pad is practical to the body extremities. The patient'due south skin is prepared with an antiseptic solution. The area is anesthetized with a topical or injectable anesthetic. The needle is inserted into a mitt slice, which is connected to a mono-polar generator (Figure 1 D). The generator is placed in the cutting mode with the wattage set at ii MHz (wattage will vary depending on the calibration of the generator). The needle is introduced through the skin into or on the spider vein (Figure ii ). The current is so practical with obliteration of the vein. The needle is withdrawn and boosted veins are then treated in a similar mode. To increase precision and efficacy and subtract collateral damage, magnification surgical loupes may be used. This technique presents a visible endpoint to destruction of the vein since 1 tin visualize the disappearance at the time the current is initiated. The risk of allergic reactions, thrombophlebitis, emboli, or nervus damage is low since the principal modality is heat limited to the vein wall. The utilise of loop magnification of 3.v or 4.v is recommended to increment the precision of needle tip placement.

Postoperatively, bacitracin ointment is practical to the treated area. Dry cold packs are recommended for 24 hours and Ace bandages for five to seven days.

RESULTS

Two graders were recruited from the section of plastic surgery past the senior author. The were blinded to the technique used. Grades were submitted anonymously and without consultation. The inferior author compiled and analyzed the grades. Thirty patients were treated with the Given Needle. All patients were female with ages ranging from 32 to 67 and an average age of 43 years. Patients had only one pass performed and had a hateful follow-up time of 6 months (range, 4-eighteen months). Typical clinical results are shown in Figures three-6 .

Figure 3.

(A) This 41-year old woman presented with untreated spider veins of the correct posterior of the calf. (B) 16 weeks after handling. (C) One year after treatment.

Figure four.

(A) This 41-year old woman presented with untreated spider veins of the left posterior upper thigh. (B) One calendar week subsequently treatment. (C) Five months after treatment.

Figure five.

(A) This 36-year old adult female presented with untreated spider veins of the left inner knee joint. (B) Ane week afterwards treatment. (C) Five months later treatment.

Figure vi.

(A) This 49-year old woman presented with untreated spider veins of the left anterior lateral leg. (B) Five weeks after treatment. (C) Three months after treatment.

Figure vii.

Frontal (A) and side (B) views of a 59-year old human (not part of the original report) who presented with untreated spider veins to the dorsum of the right nose. (C) Five days after treatment. Frontal (D) and side (E) views five months afterward treatment.

Fourteen patients had 75%-100% clearance. Seven patients had a clearance of l%-75%. Five patients had a clearance of 25%-50% and four patients had 0%-25% clearance (Tabular array 1 ). Grading was performed by experienced contained plastic surgeons. Success of treatment was graded on pct of consummate resolution of treated areas.

Table 1.

Showing Number of Patients With Percentage of Clearance After Unmarried Handling With Needle

ane=	0%-25%	4
two=	25%-l%	5
3=	50%-75%	7
4=	75%-100%	fourteen
Total		thirty

In social club to place treated areas, marking and preoperative photographs were used. The initial follow-up revealed differences between the treated and adjacent non-treated areas. Adjacent not-treated vessels were used every bit a reference to frame the treated vessels. Precise anatomic description with measurements was utilized. (e.chiliad., 5 cm in a higher place superior border of patella and 7 cm lateral from ASIS lateral edge of patella line.)

The most common complication was skin erythema, which developed in 15 patients, followed by bruising in 13 patients. Both of these complications resolved in ii-3 weeks and there were no permanent sequelae. Needle stick hurting was a complaint in 14 patients, which resolved within 3 days. There were no serious complications such equally major vessel thrombosis, serious allergic reactions, hypopigmentation, hyperpigmentation, ulceration, scar formation, or prolonged pain at the handling site every bit sometimes seen with sclerotherapy or lasers.

DISCUSSION

Currently, there are ii widely used methods for the management of spider veins.

The older method using sclerosing agents is well established amidst physicians. A new method using lasers is becoming more than common with variable success depending on vessel size, body region, and laser type. Both methods treat these lesions with a variable success rate.

In order to effectively sclerose veins, the sclerosant must cause total endothelial destruction, which produces thrombosis, eventual fibroses, and vessel disappearance. ^fourteen Each grade of sclerosants produces this effect with different and highly variable patterns of efficacy, potency, and complications. ^xv All sclerosants represent a compromise between efficacy and toxicity.

Despite 150 years of unregulated human experimentation encompassing an enormous range of more or less toxic agents, the "perfect sclerosant," complication free and 100% constructive, has non been discovered.

With sclerotherapy, clearance after i treatment varies from 50% to 84% in 70%-fourscore% of patients. ^xvi In order to achieve total clearance, up to six treatments may be needed. ¹⁷ In that location are numerous complications and adverse reactions associated with both sclerosants and lasers.

Hurting may be very pronounced with a sclerosant if it is injected into perivascular tissue. ¹⁸ Extravasation necrosis after the use of commonly recommended concentrations represents a leading disadvantage associated with sclerosant use. ⁸ Neovascularization (matting) and treatment failures probably occur at the same rate in all type of sclerosants with equal potency. Hyperpigmentation is reported to be a major drawback occurring in up to 30% of patients. ¹⁹ Allergies and anaphylaxis varies between 0.01% and 0.9%. Deep venous thromboses and pulmonary emboli are rare, occurring most ofttimes in patients who are not ambulatory and receive inappropriate pinch or have hypercoagulable states. There have been 5 reported cases of anaphylactic daze leading to death. ²⁰

Recent developments in laser technology allow a more selective and ameliorate-tolerated therapy. Lasers have shown more than success in treatment of facial spider veins. However, laser treatment of lower extremities presents a greater therapeutic claiming. Clinical response depends upon wavelength, fluency, pulse width, pulse elapsing, cooling, and the diameter and color of the spider leg veins.

In a study performed on 46 female patients afterward treatment with loftier energy long pulse NdYAG laser, the author demonstrated favorable results in the treatment of leg veins. In patients with veins less than i mm in bore, sixty% had greater than 50% clearance after one treatment and 80% had greater than fifty% clearance after two treatments, whereas 1-2 mm diameter showed greater than 50% clearance in 39% of patients after one laissez passer and 67% showed greater than 50% clearance after 2 sessions. ²¹

Q-switched Nd: YAG laser has shown favorable results in a written report of 62 sites in fifty patients with spider veins of the legs. Greater than 50% improvement has been demonstrated in 73% of patients following one handling session. Still, multiple passes and overlapping pulses were by and large required to attain clinical endpoints of vessel disappearance. ²²

In a clinical investigation evaluating 72 patients with lower extremity spider veins treated by an intense pulse light source, Green reported significant adverse furnishings with pain being present in 74% of patients. Hyperpigmentation was observed in 50% of patients and hypopigmentation in 20%. Scarring and textural changes occurred in 21% of patients. ²³

A major problem with lasers is the associated discomfort. Because of the pain, patients chose sclerotherapy over the light amplification by stimulated emission of radiation. Topical anesthesia was minimally constructive. Pain was mitigated by decreasing the spot size, which despite higher energy reduced the hurting. ²⁴

In studies done by Levy et al and Munia et al, the authors concluded that lower extremity spider veins may be equally treated using Nd: YAG 1064-nm light amplification by stimulated emission of radiation or conventional sclerotherapy. ^{25 , 26} However, Munia gave advantage to sclerotherapy due to its lower cost, less hurting, and faster improvement. The light amplification by stimulated emission of radiation is recommended for patients with matting, needle phobia, or allergic reactions to sclerosant. ²⁶ A like decision was found by Lupton et al that despite contempo advances in laser applied science, sclerotherapy continues to offer superior clinical event. As in the Munia study, the authors recommended the laser in leg vein treatment in patients with matting, needle phobia, or sclerosant allergy. ²⁷ Levy suggested the combination of both methods with a sequence of sclerotherapy followed past laser, which provided college clearance. ²⁵

The platonic laser has yet to exist invented. Laser engineering science for treating spider veins is better than e'er but still far from perfect. Lower efficacy relative to sclerotherapy and significant complications such as hyperpigmentation, scarring, pain, and ulceration have limited laser popularity. Sclerotherapy remains the preferred treatment among the majority of physicians involved in the treatment of spider leg veins. ^26-28

This report of the Given Needle has shown a meticulous and precise approach with clearance of more than than 70% achieved in l% of patients after the outset pass. The results are comparable with sclerotherapy and laser, and represents an effective alternative handling. There has been a low level of side effects.

Local anesthesia may or may not be necessary, depending on the patient'southward sensitivity to pain and physician preference. A few patients preferred no local anesthesia subsequently the initial trial. No difference was noted in the requirement for additional energy to achieve the same event of vessel obliteration when lidocaine was used.

With all three methods, the therapeutic finish indicate is vessel obliteration. Sclerosant action is not well controlled since the sclerosant may spread beyond the expanse of treatment causing complications as previously described. Still, thrombosis seen with the needle is well controlled since the energy commitment is precise.

Cost

The treatment cost per session is $30 with the needle. Sclerosing agents average $80 per session. The amortized price of light amplification by stimulated emission of radiation treatment per session is between $250-$400 (Table 2 ).

Table two.

Comparison Efficacy, Complications and Cost of Sclerotherapy, Laser and Given Needle

	Sclerotherapy	Laser	Given Needle
Price	$eighty-100	$240-400	$30
Efficacy	50%-lxx% clearance in 50%-70% of patients/1 laissez passer	50%-60%clearance in 50%-60% of patients/1 pass	50%-70%clearance in fifty%-lxx% of patients/1 laissez passer
Complexity	Moderate potentially fatal thrombosis or allergic reactions	Low to moderate	Low

	Sclerotherapy	Light amplification by stimulated emission of radiation	Given Needle
Cost	$80-100	$240-400	$xxx
Efficacy	50%-70% clearance in 50%-seventy% of patients/1 laissez passer	50%-60%clearance in 50%-sixty% of patients/1 pass	50%-70%clearance in 50%-70% of patients/i pass
Complication	Moderate potentially fatal thrombosis or allergic reactions	Low to moderate	Depression

Tabular array 2.

Comparing Efficacy, Complications and Cost of Sclerotherapy, Light amplification by stimulated emission of radiation and Given Needle

	Sclerotherapy	Laser	Given Needle
Toll	$fourscore-100	$240-400	$30
Efficacy	fifty%-seventy% clearance in fifty%-70% of patients/i laissez passer	50%-60%clearance in 50%-threescore% of patients/1 pass	fifty%-70%clearance in 50%-seventy% of patients/ane laissez passer
Complication	Moderate potentially fatal thrombosis or allergic reactions	Depression to moderate	Low

	Sclerotherapy	Laser	Given Needle
Cost	$80-100	$240-400	$30
Efficacy	50%-70% clearance in 50%-70% of patients/1 pass	fifty%-60%clearance in l%-threescore% of patients/one pass	50%-70%clearance in 50%-seventy% of patients/1 pass
Complexity	Moderate potentially fatal thrombosis or allergic reactions	Low to moderate	Low

Burns

There were no skin burns in this study. The use of low power, precise insertion, and power commitment at less than a 2d mitigates this complication.

Although information technology is possible to deliver enough energy to obliterate all vessels in one pass, doing then would increase the chance of burning next tissue. Therefore, more than one pass with lower level of free energy of 2-3 watts and shorter duration of delivery from ½ to one 2nd is safer.

Several patients have been treated with facial spider veins. Preliminary results have been very successful. (A video showing treatment of a patient with facial spider veins is available at www.aestheticsurgeryjournal.com .) Due to the lack of feeder veins, the recurrence charge per unit was depression. Complications such as bruising and needle stick pain may be more pronounced due to differences in facia vascularization and innervation (Effigy 7 ).

Successful long-term handling of spider veins of the legs requires the emptying of feeder veins. Spider leg veins, unlike facial-caused spider veins, are connected to the deeper vessel ecstasies. Therefore, a failure to completely clear spider leg veins of the leg is more than common, unless the underlying varicose or feeder veins have been treated previously. Successful treatment of spider veins is best achieved by first treating the underlying venous insufficiency. In situations with varicosities, phlebosurgery should be performed first to ensure an optimal outcome in the management of spider leg veins. ²⁹ The patients in this study were not screened for venous insufficiency and were not previously treated. Even so, this method conspicuously demonstrates that spider veins can exist successfully obliterated with electrocautery, although new spider veins may occur.

Limitations of this written report include a short follow-up time of vi months, subjectivity of consequence assessment, and a depression number of patients. A thorough knowledge of the diverse devices and their risk do good are necessary prior to treatment. The Given Needle offers a cost-effective alternative with a low level of complications.

FDA blessing has been received for treatment of spider veins 1 mm or less in bore. The potential for employ on larger veins volition require further evaluation and testing.

CONCLUSIONS

A novel approach for the treatment of spider veins has been introduced and described. The development of an insulated micro needle with beveled tip utilizes low current to minimize adjacent tissue damage. The depression cost and small-scale complications offer a valuable alternative to sclerotherapy and laser treatment.

Supplementary Fabric

This article contains supplementary cloth located online atwww.aestheticsurgeryjournal.com .

Disclosures

Drs Mujadzic and Ritter declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Dr Given is President of Spider Vein Solutions, Inc. (Augusta, GA), which owns the patent and markets the needle.

Funding

The authors received no fiscal support for the research, authorship, and publication of this commodity.

Acknowledgements

The authors thank Dr Kirit Bhatt and Carol Callahan for assistance with chart review and editing/data entry.

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Yag Laser Treatment for Spider Veins on the Nose Reviews

Abstruse

METHODS

RESULTS

DISCUSSION

Cost

Burns

CONCLUSIONS

Supplementary Fabric

Disclosures

Funding

Acknowledgements

REFERENCES

Menu Halaman Statis

1=	0%-25%	4
2=	25%-fifty%	v
3=	fifty%-75%	7
four=	75%-100%	14
Total		xxx