Which treatment for veins and telangiectatic matting of my ankles and feet? (Photo)

Question

Wondering what treatment might most help improve the appearance of my ankles. Laser or IPL? What about high frequency radio waves? There is a local Dr. who uses this for the face and I am wondering if it could work well for this? I understand there may be reflux (a previous ultrasound did reveal some, but very mild, according to the Dr.) but I am not able or ready to do anything like EVLT at this time. Is a dermatologist sufficiently qualified for these procedures, or must it be a vein Dr.?

Raffy Karamanoukian, MD, FACS · Answer

It’s important to distinguish between varicose veins and spider veins when choosing between laser therapy, sclerotherapy, and vein surgery. With two board certified vein specialists, our center uses a combination of visual examination, functional flow measurements, ultrasound, transillumination, and infrared light to map out vein networks prior to therapy. Lasers can be used to treat deep varicose vein insufficiency, vein perforators, and varicose veins. Sclerotherapy is ideal for spider veins and reticular veins. Whereas surgery is reserved for severely incompetent varicose vein segments. 
Dr. Karamanoukian
Realself100 Surgeon

Susan Fox, DO, RPVI · Answer

There are veins in the feet and ankles that are unsightly.  Usually the back flow and increased pressure caused by this continue to cause these.  The increased pressure makes it hard to get these veins to go away without treating the source of the problem.  This would be done by treating the insufficeincy or reflux in the vein.  After that is treated the pressure goes down and the veins are more receptive to scleotheraoy and they tend to go away better.  I would recommend this path for them to go away correctly.

David T. Jacobs, MD · Answer

This is a common reaction after sclerotherapy treatment. These tiny veins ("matting") can be treated with continued sessions of sclerotherapy. However, the truly tiniest of these veins - the ones that are too small for even a skilled practitioner to access with a needle - can be treated with a treatment known as ohmic thermolysis (brand name VeinGogh). This treatment uses tiny needles to apply a burst of radiofrequency energy to the vein (and surrounding tissues). This causes the vein to close and eventually it is resorbed. The advantages of VeinGogh are the ability to treat the tiniest of vessels, and the ability to treat a wide area. The treatment feels like a tiny sting (which can be lessened with the application of topical anesthetic prior to the procedure). Most tolerate the procedure very well and see great results in a few weeks. Multiple treatments are necessary.

Ali Golshan, MD · Answer

The condition you are describing is extremely common. The appropriate therapy is sclerotherapy. The injection of these tiny but unpleasant veins with a liquid medication that reduces or eliminates their appearance. But if you do truly have insufficiency or reflux in your underlying veins you are only treating the surface of the problem. Veins are like trees. There is a trunk which is the root of the issue when it is not working appropriately and the branches which are the part of the condition that you see at the surface. See a board certified vascular specialist (interventional radiologist or vascular surgeon) that focuses specifically on the treatment of varicose veins. Get a through ultrasound evaluation which should be done in part with you standing upright. And get treated for the entirety of your condition. It may take a little time and effort but with patience you will have excellent results.

Michael Nguyen, MD · Answer

It is common that treated areas with sclerotherapy may cause micro veins to appear, a side effect known as matting, like you mentioned. If this happens, it can also be treated with another sclerotherapy session for more adequate temporary cosmetic results. If reflux is present, consider medical treatment as well. I recommend you see a vein specialist board certified in Venous and Lymphatic Medicine. All the best,

Stephen M. Davis, MD, FACS · Answer

Thanks for writing,Your photos suggest you have a bigger problem then spider veins. They suggest venous reflux. That is: the larger veins going up your leg have valve problems and the blood is falling down your leg and pooling in the area of your ankles. The veins are forming because the body is always trying to move blood back to the heart. You need a venous reflux study with ultrasound. This study will answer the question. Based on this study a definitive treatment can be tailored for you. Find someone who does venous reflux  surgery and get studied before you spend money on sclerotherapy that might not work. Good LuckStephen M. Davis, MD, FACS

Manu B. Aggarwal, MD · Answer

There are two main methods to treat spider veins. They are sclerotherapy and surface laser treatments using an Nd:Yag laser (1064nm). There have been studies that have shown that both of these modalities are effective and safe in the correct hands. The only two FDA approved medications to use to help treat spider veins is Polidocanol (Asclera) and Sodium Tetradecyl Sulfate (Sotradecol). The first step is to make sure there are no underlying feeding veins that can be causing the spider veins. Otherwise your treatments (sclerotherapy or laser) may not be as effective. Sclerotherapy and laser treatments can be combined to treat the spider veins. At the same time. There again are studies that have shown that this is effective as well. It has actually been shows to be more effective in combination that with one type of treatment alone. I would recommend going to an IAC Vein Accredited facility. These facilities have gone through rigorous scrutiny with their policies and procedures to provide effective and consistent care. Good luck.

John Landi, MD · Answer

I would treat these veins with sclerotherapy.  I use foam sclerotherapy in this area with good results and sometimes I may use glycerine.  I would not use IPL or laser.  I would recommend seeing a vein specialist.

Brian Heeringa, MD, FACS · Answer

The treatment of choice for the veins shown is sclerotherapy.  Spider veins are caused by cutaneous venous hypertension and given the dependent nature of ankle veins, the pressure is often higher there than for similar veins higher on the leg. Without an ultrasound I don't know if you would need an ablation or not, given the distribution I would expect more proximal venous reflux but it could very well be a pre-tibial perforator which could be treated with ultrasound guided foam sclerotherapy. I would recommend getting treated by someone who has experience in successfully treating veins of this nature.  If your dermatologist has a passion for treating veins then they will likely be able to do this for you but I would not have those treated by someone who just dabbles in veins.

Rodolfo Farhy, MD · Answer

Those changes near the ankles are indication of advanced vein disease. That condition should not be treated by a dermatologist with local therapy. You must have more than mild venous reflux and unless you have elimination of the venous reflux you will not have satisfactory results with local treatment. You should consult a qualified vein specialist that is able to diagnosed ALL the possible sources of reflux (not just of the saphenous veins).

Which treatment for veins and telangiectatic matting of my ankles and feet? (Photo)

Answers (11)

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