Dr Mimi Lee is wonderful. I have seen her for spider vein treatment, Botox and filler. She puts you at ease and is very sweet. She listens to your concerns and is helpful. I trust her completely and with confidence.
I have performed sclerotherapy for more than 15 years. There are a few considerations in achieving good results from this treatment. I like to use Asclera or polidocanol because it is gentle (unless the solution went outside the vein, then it will burn). The results are highly dependent on the injector. So be sure to do your research as who performs the actual treatment and if they have had complications. Most patients require 2-3 treatment sessions so don't expect the veins to be gone with one treatment. Thorough treatment will lead to better longer term results (lasting years instead of weeks or months) but results are not permanent since the treatment does not address underlying cause of these veins, mostly genetics. Darker veins have more blood flow and will bruise more. The treated veins will look worse because of the bruising, then it will fade over a few weeks or couple months (depending on the extent of bruising), and you will see final results. So I recommend planning ahead if you have special plans to show off your legs. Larger veins can get blood trapped in the vein and may form small knots at the area, they are harmless but if it's tender, you should notify the physician. I always ask patients to show me the areas that they want me to prioritize and I draw an arrow by the area so I make sure those are treated first. Certain patients skin type are at high risk for postinflammatory pigmentation, including Asian, Hispanic, African-American. Those patients will likely develop brown discoloration over the treated veins which will take several months or 1-2 years to fade, regardless of treatment method (injection or laser). So I typically offer those patients a small test treatment to make sure they are comfortable with the extent of discoloration (which will take a long time to fade) prior to doing large treatment areas. Certain medications can cause pigmentation and should be avoided during sclerotherapy treatments including minocycline, doxycycline. Compression stockings help to minimize veins from refilling and bring faster and better results. One last but most important factor would be physical inspection of the legs with patient standing to look for bulging varicose veins. Patients with bulging varicose veins often have underlying blood flow issue with the veins known as venous reflux. If the venous reflux is not treated, the surface veins treatment with sclerotherapy will be less effective or not work at all. Seek a qualified vein specialist who treats venous reflux if you have bulging ropy varicose veins. Treatment of venous reflux are mostly covered by insurance.
Skin discoloration can occur after sclerotherapy treatment in some patients as result of how the skin heals. Some skin types react strongly to inflammation and develops Post Inflammatory Hyperpigmentation (PIH). We can develop inflammation from a mosquito bite or a scratch or procedure (whether it is laser or vein injection). Asians, Hispanic, and African-American skin types are at high risk for PIH. It can take several months to couple years for the discoloration to fade. For my patients at high risk for PIH, I usually offer them a test treatment so they can fully understand what to expect and if they are comfortable with the extent of the discoloration, then we will proceed to full treatment sessions. Because spider and varicose veins will spread without treatment, I still recommend high risk patients to have treatment but they should be informed that the results will be delayed until discoloration fades. I prescribe bleaching cream in some cases. Patient should also avoid certain medication that may cause unwanted pigmentation including some antibiotics (minocycline, doxycycline), antiarrhythmics, and antimalarial drugs.
Imagine our face as a piece of paper. If you fold the paper many times, a deep crease will form. Eventually this crease is permanent even if the paper is not folded. Botox helps to relax the underlying muscles that causes the facial wrinkles. Botox can be used in various amount to achieve different degree of relaxation (we can put enough to allow the paper to bend or put more to completely flatten it). Dermal filler can be used to "iron out" the deep set wrinkle but it works better if you keep the underlying muscle relaxed with Botox so the wrinkle will not reform as quickly. Botox essentially will keep "new" wrinkles away and minimizing aging related to animation although gravity and collagen loss still play important role in aging.
Bruising may occur with some patients and also depending on how much is done. The more work needs to be done, the greater the risk of bruising. Patients should avoid alcohol beverages, ibuprofen, aspirin, Vitamin E, omega fish oil use before treatment. Arnica montana which is a herbal supplement can be taken before treatment and can also be used after treatment to reduce bruising and speeds up recovery. I also like to put nude color paper tape on under eye treatment area to restrict bruising and swelling. Blunt cannula can also reduce bruising associated with dermal filler injection.
Cost of treatment varies region by region. In the Midwest cost run from $250-400 per treatment.
