Kenneth Janoff, MD (retired)

By just looking at your photo I would probably opt for a laser treatment using a 1064 nd yag.  However the success or failure of a single treatment has many variables that should be assessed and discussed on your first visit/consultation. Since we can only see a small portion of the leg it is impossible to know the entire situation. 
 
First is location and relative size of the vessels. Are there any deep feeder veins that are refluxing  creating pressure on the smaller veins. What is your level of activity? Do you run, jog or exercise where you place extreme pressure on your legs?  Does your job require you to stand or sit for longs periods of time?  Is there an activity or clothing that might be creating these vessels? How are your hormones?  Are you taking any medications that might be contraindicated for a procedure?

After we determine the answers to these questions then we decide what is the best treatment for you.  Are you a candidate for a quick laser treatment or do you really need sclerotherapy?  If you need sclerotherapy what solution is best for this size of vessel that will give the optimal result with the least amount of possible complications? (Sotradecol, Polidocanol, Glycerin, Hypertonic Saline, Foam)  Do you need to wear compression stockings after treatment and avoid high impact aerobic exercises or abdominal workouts or can we just use a temporary Co-Ban wrap?  Is one treatment going to do the trick or do you need multiple treatments?  

The next step is treatment.  Are we seeing either complete collapse of the vessels or a positive sign that the solution/heat used is creating inflammation in the internal walls of the treated vessels.  If no, is a stronger strength solution or laser setting needed? Do we need compression to keep the vessel closed, etc?  

If all of this is done then you should see an effective treatment and realize outstanding results.  

Yes, Ultherapy can yield some incredible non surgical results. If you are truly a surgical candidate then it won't take its place but it is a great alternative without the risks. 

Diony,

The cost per unit varies in the Portland Metro area depending on the office and their specialty.  I track pricing on a regular basis and it averages between $10-$12 per unit.  You can always find offices that offer it at deeper discounts or at much higher rates. Don't make your decision solely on price or if its being offered on Groupon. Do your research and find out who is doing the injections.  The Oregon Medical Board just recently changed the designation for Botox as the act of prescribing medicine so at your initial treatment you should receive an intake examination, treatment plan and photos that the physician signs off on and verifies.  Oregon however does not require any specific licensing for who is delegated the responsibility of preforming the injections so at any given office you may get an aesthetician,CNA, MA, RN, NP, PA or MD. It is all about training, years of experience and is the office/injector reputable.  If an adverse event occurs, who will be standing behind the service. Is the medical director/doctor on site? Is the company physician owned or has the medical director been hired and only comes on site to sign charts occasionally?  Hope this information helps and good luck to you on your search.  

Karen,  
We use Restylane  almost exclusively under the eyes because of its consistent results and if necessary reversibility. Other products that work well are Belotero and Juvederm Ultra.  Regardless, never should you feel pressured to buy a particular product.  

Often a client will come into our office and ask for a specific filler because of what they have heard or read.  With a few exceptions, a really good injector will be able to use any of the Hyaluronic Acid products and place them in the area for a good outcome.  It is my job to educate the client as to why I prefer a different product or why the product that they are asking for is not in their best interest with out making them feel pressured to purchase something else.  I would rather decline a treatment then to pressure someone or place a product that would not be optimal.  With that said however, I also never want price to be the reason why a client choses a certain product.  Get a second opinion or even a third. Don't do the treatment until you feel completely comfortable with the product, price and injector.  

Yes Vitrase (hyluronidase) will dissolve the Juvederm thus removing the tyndall effect.  My favorite filler for under eyes is Restylane, however it is more about the skill of injector than the product itself.  Overfilling or placing the product to high in the treatment zone creates a greater risk for complications.  I like to place the majority of my product under the muscle.  If I need to deposit filler above the muscle, I always thin the product allowing for a more precise, controlled injection.