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As treatment of leg veins has become so successful and commonly performed, enlarged veins at sites other than the legs are becoming more of a concern for patients. Photoaged hands with ropey blue veins contrast with faces rejuvenated by lasers and injectables. Enlarged veins on the central chest are cosmetically disturbing.

Décolletage is the term used to describe the upper part of a woman’s torso the neck, shoulders, upper back, and chest. Revealing fashions motivate female patients to seek cosmetic improvement of enlarged veins, wrinkled skin, and blotchy pigmentation. After breast implants, veins can become enlarged on the central chest with obstruction of venous return from the skin due to physical pressure of the implants against skin and muscle. After medical etiologies such as portal vein hypertension or right-sided heart failure are not suspected, the cosmetic appearance may be treated. This chapter deals with the treatment of enlarged veins of the chest and hands.

Special Consent

Generally, non-leg sclerotherapy sites have a lower incidence of side effects, specially telangiectatic matting and hyperpigmentation. Some physicians may use a site-specific consent. Matting or hemosiderin staining may be more distressing to the patient when they occur at sites less covered than the legs; so, patients should be aware of the slight risks before such veins are treated. Care should be taken to ensure that the patient’s expectations are appropriate, and particular note should be made in the chart that the patient has been informed of the possibility of cosmetic complications. Patients should sign a consent form acknowledging this discussion before beginning the treatment. The sclerotherapy for leg veins consent can be used or modified for the specific area.

Limit Treatment to Cosmetic Regions

Because vessels in locations other than the lower extremities do not produce significant disturbance of venous circulation nor are they typically the result of reflux, treatment should be limited to the specific vessels that are of immediate cosmetic concern. Ideally, one can document the appearance of the vessels in pretreatment photographs. General principles are summarized in Table 16-1.

TABLE 16-1Treatment Options for Veins Other than Face or Legs

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