In addition to the face, neck, chest, and hands, the aesthetic appearance of the legs is a significant area of concern to patients. In 2005, according to statistics gathered by the American Society for Aesthetic Plastic Surgery, sclerotherapy ranked as the sixth most common nonsurgical cosmetic procedure.1 In order to maximize the successful treatment of leg veins with sclerotherapy, a thorough understanding of venous pathology, specifically venous hypertension and chronic venous insufficiency, is crucial for practitioners.
The aim of this chapter is to familiarize the reader with the underlying pathology, the diagnosis, and the treatment of venous hypertension, and to help the reader differentiate between the medical and the cosmetic sclerotherapy patient. In keeping with the theme of this textbook, the treatment section of this chapter will focus on sclerotherapy as it pertains to the cosmetic patient, specifically regarding the treatment of leg telangiectasias, venulectasias, and reticular veins. Treatment options for patients with clinically relevant venous disease will be briefly mentioned.
THE VENOUS SYSTEM AND VARICOSE VEINS
The venous system is a low-pressure system and a blood reservoir. Unlike arteries, which carry oxygenated blood and have a thick elastic muscular lining designed to withstand high pressures, veins carry deoxygenated blood, are thin-walled, and easily distend with increased pressure. The map of venous circulation is more variable than that of arterial circulation, and anastomoses between veins commonly occur. This multiplicity allows for surgical repair of the venous system as there are several routes for deoxygenated blood to return to the heart. Veins rely on the heart as well as skeletal muscle contraction for circulation. Contraction of skeletal muscle compresses the veins within them and helps to propel blood back to the heart. This is particularly important in the lower extremities where the force of gravity must be overcome to maintain proper circulation. The contractile action of the skeletal muscles, primarily the calf muscles, helps to transport blood upward.
The Venous System of the Leg
The venous system of the leg consists of both a superficial and a deep component. The superficial component is located above the fascia, and the deep component is located below the fascia. The principal superficial veins are the lesser saphenous vein, which runs from the ankle to the knee, and the greater saphenous vein, which runs from the ankle to the groin. The superficial veins of the leg connect and empty into the deep veins via perforating veins, which pierce through the fascia separating the compartments of the leg. The skin surface of the leg may consist of superficial pink telangiectasias found in the papillary dermis that empty into blue-appearing reticular veins found in the reticular dermis, which empty into the superficial venous system located above the fascia. These superficial veins drain into the deep venous system that is located below the fascia and within the muscle. Besides ...