Sclerotherapy or Laser ablation for prominent hand veins? (photos)

Question

I have enquired with a few surgeons regarding removing these veins and while some say laser ablation has a higher success rate than sclerotherapy, others say a staged approach of separate sessions using hypertonic saline sclerotherapy is better? The laser ablation ismore expensive, but if the sclerotherapy does not work, maybe laser is the answer? Also, is 'recanalisation' a risk with either procedure? In hot weather i get discomfort/swelling in my hands due to the blood pooling in the veins.

Jason Emer, MD · Answer

You can rejuvenate the hands very well with fillers, I suggest that first before removing the veins with sclerotherapy.  Best, Dr. Emer.

Hratch Karamanoukian, MD, FACS · Answer

Thank you for your question. The hand veins you show are quite large and the best treatment would be microphlebectomy.BestDr. Karamanoukian

John W. Chang, MD · Answer

I treat unsightly hand veins routinely with foamed sclerotherapy using Asclera/polidocanol/sotradechol.  The foam makes the medication "sticky" and localizes its effect so it does not travel up the arm.  I have had 100% results with this simple technique. I can not imagine hypertonic saline being strong enough to treat hand veins which are much larger than typical spider veins.  I have not heard of EVLT being used for hand veins.  I would worry about the effects of heat on nearby nerves as well as damage to the overlying thin skin. Also, the cost may be prohibitive.As far as worries about less venous access in the ER or hospital by removing dorsal hand veins,  IV's are not supposed to be placed in the hand unless absolutely necessary as they tend to blow after 24-48 hours.  Hand IV access is supposed to be discouraged and converted to arm IV's as soon as possible as they usually can not handle many medications or lots of high flow.  In reality, unfortunately, hand veins are used all the time for IV access.  Ironically, this proves that it is not dangerous to treat dorsal hand veins as they routinely "blow" from hand IV's.Hope this helps.  Take care.Dr Chang

Samir Shureih, MD · Answer

The veins over the dorsum of the hand is normal anatomy. They become more prominent because of loss of fat of the dorsum of the hand. Fat graft will soften the look but does not disturb the normal venous system of the hand. Just because there is a procedure to take them away does not mean it should or is safe without complications.

John Landi, MD · Answer

I treat hand veins with a combination of laser and sclerotherapy.  The larger veins are treated with a laser and the smaller ones with sclerotherapy.  I do the combination of treatments on the first treatment session and the follow up sessions consists of only sclerotherapy and evacuations (releasing of any clotted blood in the treated veins).  Hand vein treatment is a process but the results are very good. Over time, as with any other veins, some veins may recur but they can easily be treated by follow up sclerotherapy.

Sclerotherapy or Laser ablation for prominent hand veins? (photos)

Answers (5)