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Background and Treatment Options

Reaching seniority is inevitable, showing it… is optional!

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The Old Masters, “photographers” of times past, painted hands so beautifully that they not only added to the impact of the picture but were also a guide to the sitter’s age. This could, however, be depressing to the “cosmetically conscious” contemporary woman striving to keep looking young, dynamic and appealing. For quite some times by now, faces can be enhanced surgically or with injectables – or both; breast can be made larger, smaller or just firmed; hips, thighs, tummies, and buttocks, slimmed and/or firmed. Yet, beyond the fifth decade, those “veiny” hands may disclose a degree of unnecessary “esthetic vulnerability”. Indeed, “reaching maturity” is inescapable, showing it, however… is optional! Fortunately, excellent esthetic medico-surgical options for bulging hand veins became, quite recently, available too.

In both men and women, the existing normal sized dorsal hand veins become more visible at a later stage of life because of the physiologic atrophy of hand muscles as well as the supporting subcutaneous fatty tissues compounded also with a much, much thinner skin too. So, while the vein sizes have not changed much, with the passage of time they become more noticeable. The modern woman, interested in improving the looks of her hands, has today basically three available options:

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A. Injectable fillers such as own fatty tissue, Collagen, Restylane, Juvaderm, Sculptra, etc. etc. Since veins will not be affected, the perceived improvement is achieved by puffed up surrounding tissues. With possible one exception (injection of own fatty tissue harvested by liposuction) the filler treatment needs to be repeated usually at 6-8  months intervals, becoming quite expensive if the method is used for years. I have personally seen a patient treated with fat transfer and while the veins were less visible, the hand looked abnormally puffy as if one sustained a recent trauma.

Figure 3: Removal of veins, through 1-3 mm skin openings with help of small specially designed hooks.

B. Injection Sclerotherapy implies injection of a chemical/irritant solution that ideally causes an injury/wound to the inner lining of any injected vein. This chemical injury/wound will trigger the physiologic response of healing like any other type of possible injuries or wounds  (i.e. burned, pierced, stab, gunshot or cut wounds, etc.). The end result of any healing process is formation – in the veins -of only microscopically visible scar tissue which should trigger the closure of any injected veins, hand veins included. With vein(s) shut, blood is re-routed and the shrunk, shriveled, closed vein, not filled with 

Unfortunately, however, one has to put up with delayed results as multiple injection sessions will be required days and weeks apart. Moreover, swelling of the hand, frequent blood clot formation in the injected veins (needing evacuation of the clot), and occasional distant deep vein clotting such as axillary vein thrombosis  with or without signs of superficial phlebitis, has been reported, especially if a foamed sclerosing solution is used for injections rather than the usual liquid solution form. This could be a nasty complication able to degenerate in pulmonary emboli, a possible life-threatening condition that may necessitate hospitalization and blood thinning medications for at least six months. The possibility of residual brown pigmentation and relatively early recurrences are the similar complications observed in legs varicose veins treated with same injection sclerotherapy. See Fig.1 residual pigmentation after Sclerotherapy and compare with Fig. 2 by Ambulatory Phlebectomy, as we do it since 1995. I was then first time challenged by a patient, satisfied with the results of her leg veins, to help her out with her bulging hand veins too. The rest is history as they say…

dark venous blood, should become invisible. I say “should”  as each person may respond less well than physiologically expected yet, in well-experienced hands and with proper care (good compression) and proper healing upon which the practitioner has no role, the results could be quite – in certain cases – satisfactory.

C. The RejuvaHands procedure, is an offshoot of Ambulatory Phlebectomy first used for varicose veins of the legs and as such it is, at least in my hands, a much, much preferred minimally invasive method. Using only a 1-3 mm (1/8 -1/16 of an inch) skin entry points (basically puncture wounds) along the unwanted marked veins, are removed with specially designed hooks resembling a crochet hook* and using simple local anesthesia (Fig 3). Both hands are treated in the same office session that may last 1:30 – 2:30 hours. No stitches or butterfly (steristrips) are used and no downtime is required; indeed patients drive themselves away if they have not opted to receive a tranquilizer, in which case somebody else has to drive. The initially applied bulky dressing is exchanged 24 hours with only a simple 2-inch wide ace bandage suggested for an additional 3-4 days. Of course, weight lifting should be avoided for some time, as well as wetting the hands usually for the same period of time. Bruises and swelling are possible, usually lasting for 7-10 days. The reason I mainly prefer this procedure is that in sclerotherapy the practitioner has to certainly know what solution, what volume and concentration to use besides having a good technical command how to inject the squiggly hand veins. The buck, however, stops here as the end results are mainly dependent on the proper healing process of the vein’s chemical injury/wound. This, however, is not the same in each patient and we the practitioners, we do not have any magic “switch” to make the healing process slower, quicker, deeper or better… I always say to my patients, when using sclerotherapy for any vein type, that the results are mainly patient dependent and that my participation in the final results is only 50%. The second 50% if not more is patient dependent. Contrary, when using Ambulatory Phlebectomy for any type of unwanted veins, leg and hand veins included,  the practitioner will be vested and responsible for the results at least 95% of cases. Indeed we remove those unwanted veins and do not have to rely on the patient healing to make veins to possibly completely disappear. With Ambulatory Phlebectomy the patient has to heal only a few minute size and scattered skin openings, through which the veins were removed,  guaranteeing no scars left behind.

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These are THE much-desired difference in the favor of this fascinating minimally invasive surgical – in local anesthesia – approach, so simple and with so much better results and without any potential complications.

After personally and successfully using the method on leg varicose veins (in over hundreds of patients), I started offering the procedure for unwanted hand veins in 1995. Over 500 procedures of the kind have been performed during these 22  years, all in an office setting under strictly local anesthesia. Both hands are treated in the same single session and the results are visible in just days after the minimal bruising and swelling subside. Contrary to leg’s varicose veins, recurrences are non-existent, an unprecedented long-term success. A multi-layered bandage is worn for the first 24 hours after which, just for protection, a simple single layer 2-inch wide ace bandage will be applied directly on the skin for 3-4 additional days. No stitches are needed.

Needless to say, in my humble opinion, this cosmetic procedure easily, quickly and successfully rids women of their unwanted dorsal hand veins and for life, veins which otherwise might have betrayed their seniority.

*For anybody wondering what will happen to the venous circulation after removing the bulging veins, please note there are plenty left over deep and superficial veins needed to maintain a normal circulation in the hands.