I visited a local laser clinic to treat the unsightly spider veins on my legs.

The dermatologist offered her laser treatment for the veins (Yag).

I've been researching and there are many testimonials that laser treatments work, however, Sclerotherapy seems to be a better option.

1. What is the success rate of laser treatments in removing spider veins?

2. My sources also cited that Yag can remover hair. Is this true and do you recommend it?

Please enlighten me.

Sclerotherapy doesn't hurt. Works great for small varicosities, venulectasias, and most telangiectasias. I reserve laser for the smallest spider veins, that I just can't access with a 30g needle.

JB,

I agree with Vernice MD. For the superficial spider veins the laser will have about a 50% kill rate and the sclero will have closer to an 80% kill rate on the vein. The lasers work better on facial veins than they do on spider veins on the legs.

Lornell E. Hansen II, M.D.
www.PhysiciansVeinClinics.com

I prefer sclero for spider veins- easier, cheaper and works better.

Yes, the laser treatment does work for the smaller veins. You have to turn it up really high. It is not very comfortable, so I use a very strong topical and ice before the laser. Then compression for about 24 hours and light activity to give the veins time to start sclerosing.

(OK, it hurts like hell without a topical - or I am a wimp because my spiders are on my gouty ankles).

Patients tend to make more spiders, so they are good customers. And it can be the same laser as the hair removal one.

Post-laser patients I've seen traded their spider veins for lines of little white scars. They weren't happy. Are the newer lasers less destructive to superficial skin?

I find it "scary" that UNLICENSED LASER "wand wavers" are willing to tackle such serious procedures with virtually no training at all (40 hours is ridiculous, if they have that much. Who decided on that?). Those who do these procedures do not seem to know or care about the facts. In EVERY STATE IN THIS COUNTRY, IT IS AGAINST THE LAW to practice medicine without a license. Thank God for that because I have to see a doctor occasionally, as do you and your family, These professionals are licensed by the state to protect the citizens. We can not conceive of how difficult it is to graduate from medical school and then start training all over again to become proficient in a "specialty" so that doctors can provide us with the skills needed to keep us going to a ripe old age (I know 2 who are 102 yrs old and many who are 80s and 90s). That is the reason for licensing. It is to protect us by making sure those who have a license have met the qualifications to perform the life saving procedures we need. WHY DON'T THE REST OF YOU UNDERSTAND YOU KNOW VIRTUALLY NOTHING ABOUT THE COMPLICATIONS THAT ACCOMPANY ALL SURGERY. Even NPs, RNs, PAs, THINK they are equipped to do SURGERY BUT THEY ARE NOT. YES... laser procedures are ALL SURGERY. They were invented by doctors and everybody thinks they can do anything a doctor does. Just watching a few cases does NOT qualify you to do that same procedure to a real LIVE person. NO NEW LAWS ARE NEEDED BECAUSE EXISTING LAW IS ADEQUATE IF THOSE IN AUTHORITY DO THEIR JOB.

SURGERY is defined as, ANY PROCEDURE THAT ALTERS THE STRUCTURE OR FUNCTION OF THE AREA BEING TREATED. In order to perform the procedures done with lasers TISSUE HAS TO BE DESTROYED AND/OR ALTERED SO THAT IT CANNOT PRODUCE ANY MORE HAIR. IF YOU CAN, LEGALLY, DO IT THAT IS SURGERY. IF YOU CANNOT DO IT....THAT IS ILLEGAL WITH SEVERE PENALTIES..

LASERS ARE "INVASIVE" because the GOAL IS TO ALTER TISSUE UNDER THE SKIN OR WITHIN THE SKIN. For those of you who know.... the very top layer is STRATIFIED SQUAMOUS EPITHELIAL TISSUE. IT IS "DEAD" and will soon be cast off. ANYTHING BELOW THAT IS LIVE TISSUE THAT HAS A SPECIFIC FUNCTION, ERGO, IT IS SURGERY. ALL SURGERY IS INVASIVE BY THE VERY NATURE OF THE PROCEDURE AND THE GOAL, Andy Rooney, the popular person on "60 Minutes TV" for years, recently died as a result of complications following MINOR SURGERY by Board Certified doctors. This is an example of how serious MINOR SURGERY CAN BE. You heard of it because he was well known. How many more cases like that happen every year?

Why do you insist on BOARD CERTIFIED DOCTORS for yourself, yet, you are willing to "TREAT" people who trust you because you have a "white jacket" and a shingle. The white jacket, when PROPERLY "EARNED" AND LICENSED signifies an EXTRA LEVEL OF TRAINING AND KNOWLEDGE....... all to protect you. Aren't your clients entitled to the same care you want for yourself and family?

ALL STATES REQUIRE LICENSING FOR DOCTORS. If you are doing surgery without a license you are violating the laws designed to protect you too. If you are an aesthetician you have a license to do specific things that DO NOT INCLUDE SURGERY.THE SAME HOLDS TRUE FOR NPs, RNs, PAs. Lawsuits against laser operators are increasing. More and more USED LASERS are available for sale as owners give up using them.There would be more if lawyers took every case that came before them but there is no malpractice insurance for breaking the law, consequently, the legal costs exceed the amount that can be recovered so a lawyer will not take every case.

Anyone else seen white scars like what NVS posted? Overall, sounds like the laser would be at least a good short term option!

Are white scars a common or rare side effect, NVS?

The treatment would depend on many factors. If the right procedure is done for the correct indication you should improve. Not every treatment is applicable. Would start with an evaluation for DVT and a consult with a vascular surgeon who does vein work.

Laser is a good treatment option for other conditions--but not for leg veins. I gave up on using lasers. Sclerotx is more efficient and cost effective.

has anybody tried Asclera?

I still do sclerotx with 23% saline for isolated varicosities and the ocassional excision in symptomatic varicosities.

Asclera is very effective for leg veins. Can be used aa liquid or as foam. Nearly painless and more forgiving then other agents.

As we know, the spider veins on legs represent a different problem than facial veins for many reasons.
For facial veins I use quite different technique. I use a CO2 laser. CO2 laser with the incisional hand-piece that delivers a 200-micron beam. The effect is immediate, no chance for scarring, and very minimal re-occurrence rate. The only significant risk is a re-activation of HSV infection in patients with history of symptomatic infection.

A quick survey: which do you prefer to use to treat spider veins? Laser, IPL or electrolysis?

I used to offer spider vein removal services in my clinic. Choices ranged from laser, sclero and vein stripping. Unfortunately, I decided to stop performing all these services. Lasers are (obviously) very expensive and high maintenance. Patients would often complain of hypopigmentation post laser. Overall, I'm glad with my decision. Not regretting a thing.

I have seen a fair amount of white scarring from laser from referred patients. I have laser in my clinic but rarely use it for leg veins. I exclusively perform sclerotherapy, it is less painful than laser and works better.

Do not treat leg veins with any laser in your practice unless you are also proficient with sclerotherapy. You will have far more unhappy patients with lasers than sclerotherapy. Laser is painful, expensive, time-consuming, inefficient and risky when treating leg veins. My advice: Use it sparingly.

Do you perform an Asclera test injection before scheduling a treatment?

We have been using Asclera for several years now and we never encountered a case of anaphylaxis. We use varied strengths for different indications and often foam the product, resulting to increased efficacy and decreased risk.

I suggest you look into Thermavein. Thermavein uses a microcurrent of heat to seal vein walls in a process called thermocoagulation, after which the veins vanish for good with no risk of skin pigmentation issues (after IPL or laser treatment, skin is extra-sensitive to ultraviolet light, so sunscreen is obligatory).