INTRODUCTION:
Several years ago our business manager asked me if I could treat the enlarged veins on the backs of her hands. I hesitated because, to my knowledge, no one had done this before in a systematic way. However, I remembered that during my internship and residency these veins often disappeared following intravenous therapy without ill effects. At first these veins resisted treatment (1) but when I increased the strength of my solution I was pleasantly surprised to see how quickly the veins disappeared and how long lasting the results seemed to be. This brochure is aimed at answering questions you may have about this treatment.

DO I NEED THESE VEINS?:
Not usually. In active, healthy individuals, adequate blood flow is maintained without the presence of surface veins. However, it is always good to spare at least one large vein, perhaps somewhere on your arm, in case you do need emergency IV treatment.

WILL THE VEINS COME BACK?:
Recurrences are the rule but this usually takes several years. Generally, the veins that recur are never as large and unattractive as the ones which were first treated.

WILL INSURANCE PAY FOR THIS PROCEDURE?:
No, this is purely a cosmetic procedure; you should not expect your insurance company to pay for it.

HOW MANY TREATMENTS WILL BE REQUIRED?:
This is quite variable; between 1 and 6 treatments, it depends on how well you follow instructions and your individual response to treatment and the size of your veins. Patients who can continually keep their hands elevated (this can be done sitting down with your hands sitting on a pillow, chest height) and who use ice 15 minutes out of every hour, sometimes only require one treatment.

WHAT SHOULD I EXPECT OR DO DURING THE TREATMENT PERIOD?:
After the veins are injected, a dressing is applied temporarily. Keep the dressing on when you are busy and you must be using your hands. Take it off as soon as possible, sit down, elevate your hands and begin using ice bags on them. Open and close your hands as often as possible to increase circulation. Replace your dressings when you must be using your hands. Elevation is the single best method of caring for your hands. At about 24 to 48 hours you may notice moderate swelling, bruising and aching. These problems are minimized with hand elevation. You should also expect to see unattractive, hard lumps (clots) which are harmless (they will not break loose).
One and a half to two hours before returning for follow-up, apply Emla Cream, very thick, over the treated veins, put Saran Wrap over it and wrap these areas with Ace bandages. This permits us to drain these clots without discomfort. Smaller clots are routine at 1-2 week intervals after treatment. Do not hesitate to call us if you have any concerns. Most of these phone calls have to do with the presence of these hard clots which is really part of the normal healing process.

WHAT ACTIVITIES SHOULD I AVOID?:
Avoid bone crushing handshakes and applause. Shortly after the first treatment, former Miss America MC'd a beauty show and clapped continually through three Broadway plays. She had a great deal of swelling and discomfort. No applause, please, for at least two weeks. Patients who baby their hands for about a week have played tennis ten days after treatment.

ARE THERE PATIENTS WHO SHOULD NOT BE TREATED?:
Yes; elderly, inactive patients, those with infections on the hands, those with severe circulatory disease (diabetic arterial disease), patients in generally bad health who may require regular infections of IV medications, those with collagen vascular disease (lupus, scleroderma) and those taking certain drugs.

CAN VERY LARGE VEINS BE TREATED?:
Yes. Veins up to 1cm in size (about 1/2 inch) can be treated quite satisfactorily. These often require more treatments using higher concentrations of sclerosants.

HOW OFTEN DOES THIS TREATMENT FAIL?:
About 2-3% of treated patients simply do not respond to multiple treatments.

HOW MUCH WILL THIS COST?:
This depends on the number of treatments and the number of follow-ups visits where a procedure is carried out. It ranges between $400 and $900.

CAN YOU DO ANYTHING FOR THE BROWN SPOTS THAT SEEM TO LOOK WORSE ONCE THE VEINS ARE GONE?:
We certainly can. These involve fruit acids and electrocautery or lasers and in the case of certain types of spots (actinic keratosis, premalignancies), your insurance may pay for this.

1. Duffy, David M., Sclerotherapy: Broader Horizons, J Cutaneous Aging & Cosmetic Dermatology, Vol 1, Number 4, 263-268, 1991.