What is a LASER?  A laser is a medical device that uses a focused beam of light to target specific structures in the skin.  By definition a laser has a single wavelength of light.  The wavelength we use is a 1064nm NdYag laser – called the Cutera Xeo Cool Glide.  Why is this important?  The higher the number (up to about 1300nm), the longer the wavelength and the deeper the laser light penetrates in the skin.  Only a 1064nm laser effectively penetrates to the deeper layers of the skin where a number of the blood vessels lie.  In contrast, an intense pulsed light device (which we also have in the office but we do not use for larger vein removal) contains many wavelengths of light between 560nm and 1200nm.  This type of device is generally less effective for larger veins.  Many things are marketed as a “laser”.  It is important to understand the above information to evaluate laser treatment options in an educated manner.

How does Laser treatment of veins work?  In laser vein removal, the laser light targets the pigment in the red blood cells that are in the blood that courses through the veins.   The interaction between the laser and the pigment in the blood generates energy, best described as heat.  This energy is transferred from the blood to the blood vessel wall.  By damaging the blood vessel wall, the blood vessel is no longer a good conduit for blood flow. Using this technology,  laser vein treatments enable removal of unwanted facial veins, without needles or cautery, in a few treatments. We use our knowledge of anatomy and plan treatments carefully to ensure the most effective and best cosmetic outcome. We use a similar technique to treat facial veins as well.

What happens to the veins after the treatment?  Although we can visually see the veins responding during the treatment session, the veins are not “vaporized” by the laser.  The laser damages the blood vessel making it less conducive to blood flow.  As blood flow ceases, the blood vessel loses its nutrients and dies. However the blood vessel “pipe” remains even though it is empty.  Then in the weeks following the treatment the body breaks down the blood vessel “pipe” and removes it.  Until this removal process occurs the veins often may look darker and more visible. We like to allow six weeks between treatments to see the full effect of the treatment.  Even after the treatment, continual improvement can occur.  As larger veins “rivers” are shut down, often smaller veins “creeks” dry up as well.

Who is a candidate for leg laser vein removal?
A candidate for treatment is anyone who has leg veins that are less than 5mm in size, that understands the risks, costs and time necessary to achieve the full benefit of the procedure, and who has realistic expectations of the ultimate outcome.  If you are pregnant, take aspirin or other blood thinning medications, or have a medical condition that prevents your blood from clotting properly, the treatments may be less effective. 

What is Laser Vein Removal like?
Prior to the treatment you will be asked to wash the area to be treated in the office.  We use cold aloe vera gel on the area being treated. The gel allows the laser cooling to conduct more effectively.  The laser is then applied in "pulses" to veins. Depending on the extent of the veins, each treatment takes between 15 and 30 minutes. Subsequent treatments are performed at 6 to 8 week intervals.  You will need to wear goggles during the entire treatment to protect your eyes from the laser.

What desired results can be expected?
If a vein goes completely away with treatment, it should not return, but occasionally the body reopens the vessel before it is completely reabsorbed or the vessel only partially responds. Because of this, we find that most people need 2-4 treatments that are 6-8 weeks apart. Also, the factors that contributed to the development of the veins, including incompetent valves in the veins and larger varicose veins, may not change, and therefore, new veins tend to form over time. . Also, the factors that contributed to the enlarged leg veins such as standing for long periods of time, female hormones, pregnancy, being overweight, or a family history of varicose veins may not change, and therefore, new veins tend to form over time.  Thus it is important to try to prevent the development of new leg veins by wearing compression stockings before and after the treatment.

Why does it take multiple treatments?  Some veins respond less well and may need multiple treatments.  More importantly, I like to use this analogy…. “If you say to me ...Beth, go clear off all the trees on that mountain over there. I follow your request and remove all of the poplar, oaks and large trees.  This is great, but now you say… what about the scrub pine trees, rhododendrons and hollies?  You couldn’t even see these at the start, but as the larger trees (Veins) are removed, now you see more things than you did before.”

Are there any negatives?
There is some discomfort with this procedure, but it is usually tolerable and short-lived. When you leave the office after the procedure, you should not be in any pain. The veins treated will usually look darker and a bit swollen after the procedure. The entire treated area may be red for a few hours after the treatment, mainly from the body’s response to the cooling.  When we treat larger veins it is possible that a small amount of blood can “leak” out of the vessel before it is heat-sealed resulting in a bruise or discoloration of the skin. Bruises are temporary and resolve in 1-2 weeks. The risk increases if you take aspirin products or are on blood thinners. Because blood contains iron, it is possible for a brownish discoloration to result after the bruise fades. This is temporary and will resolve in 1-2 months. To decrease the risk of bruising and discoloration as well as increase the effectiveness of the treatment, we ask that you wear prescription strength compression stocking for at least 7 days after the procedure. 

Uncommonly, a skin wound such as superficial blisters and scabs can occur, which heal within 2 days to 14 days. Use of antibiotic ointment on a regular basis usually results in uneventful healing. There is a <0.5% possibility of a skin wound leaving behind a permanent scar. It is also rare for an infection to occur since the skin is usually not broken.

What happens after Laser Vein Removal?
You may go directly back to work or your regular activities after a procedure. You should avoid strenuous exercise, alcohol, and aspirin products for at least 48 hours following the procedure.  To decrease the risk of bruising and discoloration as well as increase the effectiveness of the treatment, we ask that you wear prescription strength compression stocking for at least 7 days after the procedure. 

Is there another way to get the same effect?
Alternatives to laser treatment of leg veins include sclerotherapy, cautery, leg vein stripping  and no treatment.  There are no needles or injections involved in a laser treatment as there are in sclerotherapy. We are also able to effectively treat small vessels which can sometimes be difficult to do with sclerotherapy. We are also able to address the underlying larger veins and source of spider veins with laser that leads to a more permanent result. There are other types of lasers that have been used to treat leg veins, but those are generally less effective and more likely to cause bruising.

Can this be combined with other treatments?
Laser Vein treatments may be combined with any of our other cosmetic services. 

What is the cost of Laser Vein Removal?
The fee for Laser Vein treatments depends on the extent of your leg veins. Please call our office to schedule a consultation exam.  At that time Dr Rosenberger will give you an estimate of the number of treatments needed and the cost of each treatment.