Will my legs look like they did when I was 20, if I fix my veins?
You were promised the moon, your friend had vein treatment done and his/her legs looked better than they ever did. You are hoping to get back to where you were twenty years ago. Let’s face it, vein treatment can provide both symptomatic and cosmetic improvement but it’s not a fountain of youth and anyone who tells you that, has a bridge to sell also.
Results of varicose vein treatment will depend on how much disease you have to start with, how compliant you are with recommended therapy, how aggressive you treat the current disease, and finally how progressive or recurrent the disease is in your particular case.
Genetics affect not only our risk for heart disease and cancer but also whether we may develop venous insufficiency and varicose veins. Some families are predisposed to venous reflux. Individuals in those families many times develop varicose veins earlier and with greater severity. Many of my patients in the Glastonbury and South Windsor CT offices remind me that their parents or brothers and sisters have lived with varicose veins for years. However, some patients state that their mother’s legs looked great but they got “unlucky” after their first child. So, there is a hereditary element to venous disease but it also appears sporadically and is affected by our lifestyle and work habits.
No matter how you get them, some people have worse varicose veins than others at the same age. This can happen because venous valve failure can occur at the deep level, such as after a DVT or clot. It can also occur at the superficial level after a focal injury and it can occur in any number of these combinations. Depending on how many levels of reflux are present determines how much venous disease and ultimately varicose veins one may see and feel. Thus the more vein disease one starts with, the further one has to go fix the problem and the longer it may take to achieve the same results in symptoms and appearance as someone who starts with less.
So, if we are born with a given probability of vein disease and it is worsened depending on our jobs and activities, why do members of the same family doing similar jobs get different results? The answer lies partly in our individual participation with treatment. In my practice I ask my patients to wear a 30-40mHg thigh high compression stocking every day, all day, for two weeks. Obviously if a patient is working at night then the hours of stocking usage would change to reflect use during waking hours. Many practitioners suggest less time for stocking use acknowledging that the benefit of wearing stockings wanes as time passes after the procedure. The idea is that the external compression applied from the stocking assists the vein in closing in a tight constricted fashion resulting in less trapped blood and less chance of re-opening.
After about 14 days the treated vein is going to be as small and as scarred as it gets. The scarred vein will continue to remodel but there is limited use for that degree of compression after two weeks and most patients are glad to get a break. Stockings can be uncomfortable. I have seen many patients who know they are supposed to wear stockings, but, “left them in the car” or “will use them when I get home”. I cringe knowing that these ‘white lies’ reflect an inability or unwillingness to participate in achieving optimal results. Partial efforts with post procedure stocking use results in more trapped blood, more discomfort, and more hemosiderin staining. In addition to stocking use, heaving lifting or straining with a valsalva maneuver can exacerbate reflux and push more blood back into the vein that was just treated. Yes, you can exercise and lift at the gym, just don’t do it in the first two weeks while the vein is healing. So, patient compliance with post procedure recommendations truly affects the results that they get both in how they feel and how they look.
The third element that affects the results that you achieve with vein treatment is the degree to which you treat the disease. Injecting superficial spider veins alone when there are large varicose veins below the surface and significant venous reflux in the axial veins running down the leg is unlikely to affect the desired result. The spider veins might disappear or abate for a short time but likely will reoccur. You need to treat the source of course, start with the root of the problem first. A vein ultrasound can evaluate and diagnose if there is a problem below the surface that needs to be treated prior to clearing up visible spider veins. A venous ultrasound should be done prior to any vein treatment. Failure to do this would be like replastering and repainting a wall damaged by water without trying to find and fix the leaking pipe that caused the surface damage. How do you find a specialist who knows to do an ultrasound, what to look for, and will treat it appropriately? Vascular surgeons are “medical plumbers'' trained in diagnosing and treating the body’s plumbing. You should look for a physician specifically trained in treating these issues and do not dabble in it part time. Treatment of vein disease in its varied forms and presentations is all we do in my practice. While you could ask a general contractor to do some plumbing, and the results probably would be ok, why would you risk it?
Finally the results that you achieve both in symptoms and appearance with vein treatment are dependent on how fast the disease recurs or progresses. Normal veins should not be treated prophylactically, but short of wearing tight compression hose stockings every day forever, there is little to stop the progression of venous valve failure and gravity. There is nothing to stop normal veins from wearing out and resulting in reflux and varicosities. We live on earth and have to live with the effects, our bodies wear out and tissue fails. The veins we have will get worse with time, but that doesn’t mean we can’t treat and make them better today. We can make them better, we can improve symptoms by treating the right veins with the right procedures in a timely fashion. We can treat your veins and relieve the discomfort you have with minimal downtime. You can have the desired improvement in symptoms and improved appearance with a clear understanding of what to expect from your treatment and over what period of time
Call for an appointment today 240-965-3915 in the Glastonbury or South Windsor offices. Please let a specialist in vein disease, a vascular surgeon, take care of your legs.
Dr. Christopher Bulger, MD, FACS, is board-certified in vascular surgery and general surgery and is a diplomate of the American Board of Venous and Lymphatic Medicine (ABVLM). He has been working in the field since 2005.
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