Telangiectasias, venulectasias, dilated reticular veins, and torturous varicose veins are common age-related manifestations of chronic venous hypertension and valvular incompetence. A multifactorial pathogenesis is implicated in the development of lower extremity venous disease, including hereditary, hormonal, gravitational, thrombotic, and sedentary factors.
Sclerosing agents produce their clinical effect through the permanent fibrosis and destruction of the vessel wall. Treatment guidelines include utilization of both the smallest quantity and lowest concentration of sclerosing agent to produce venous wall fibrosis and the treatment of larger, proximal veins before the treatment of smaller, distal veins.
Common complications following sclerotherapy include hyperpigmentation, telangiectatic matting, and cutaneous ulceration and necrosis. Implementation of graduated compression for 2–3 weeks after sclerotherapy is essential to reduce the risk of complications and endovascular recanalization.
Cosmetic treatment of superficial leg veins with sclerotherapy is an effective, safe, and satisfying treatment modality. Proper assessment, utilization of duplex ultrasonography, and knowledge of both sclerosing agents and injection techniques are critical to a successful outcome.
Sclerotherapy combined with laser treatment has demonstrated enhanced clinical outcomes.
Duplex ultrasonography is a helpful resource to provide real-time guidance of sclerotherapy for the treatment of deep leg veins with a foamed sclerosant.
Novel endovenous ablation devices and sclerosants are potential future advancements in the treatment of medical and cosmetic venous disease.
In addition to the face, neck, chest, and hands, the aesthetic appearance of the legs is a significant area of concern to patients. In 2018, according to statistics gathered by the American Society of Plastic Surgeons, sclerotherapy ranked as the 11th most common minimally invasive 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. 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. Treatment of varicosities, while technically within the purview of the cosmetic dermatologist, will not be discussed in detail. And finally though much progress has been made in the use of sclerotherapy for the treatment of lymphatic malformations of the head and neck, this chapter will not discuss this novel procedure.
THE VENOUS SYSTEM AND VARICOSE VEINS
The venous system is a low-pressure system that functions as a blood reservoir and an avenue to return deoxygenated blood to the heart. Unlike arteries, which carry oxygenated blood and have a thick elastic muscular lining designed to withstand high pressures, veins carry deoxygenated blood, are ...