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Sclerotherapy
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Sclerotherapy for Superficial Leg/Hand/Chest VeinsSuperficial leg veins, also known as spider veins, telangiectasia, or star burst blemishes are small, dilated
surface veins that can be pink, red, or purple and appear as lines or clusters on ankles, lower legs, or thighs.
What Causes These Vessels and Can They Be Prevented?Dysfunction
of the valves within veins contributes to spider veins, and several factors may play a prominent role in their development,
including heredity, pregnancy, hormone replacement therapy, oral contraceptives, obesity, and trauma. Although exercise, weight
loss, and support hose may limit the number of new vessels, it will not prevent their development. What is Sclerotherapy and How Do I prepare for the Treatments?Performed
on an outpatient basis, sclerotherapy involves the injection of a sclerosing solution, (such as hypertonic saline, glycerin
or Sotradecol) into the dilated vessels. This causes the lining of the vessels to swell and close, resulting in both a lighter
color and improvement in the appearance of the vessels. In many cases, the veins can be completely eliminated. Pre-Treatment Precautions- Do not take Vitamin E or non-steroidal
anti-inflammatory medications, such as Advil® or Motrin®, or aspirin at least one week prior to treatment. Tylenol
is a good substitute.
- You may also want to consider bringing comfortable shorts
to wear during treatment and/or loose-fitting pants or a long skirt to wear home.
What Can I Expect During Treatment?Most people experience mild discomfort
for about 15-30 seconds, similar to a mosquito bite. The injected veins completely disappear for a few minutes as blood is
pushed out by the solution, but they reappear when the blood flow returns. Since many vessels are interconnected, one injection
may eradicate several dozen vessels at once by washing over the cells lining the inner wall of the vessel, causing them to
shrink. They will slowly disappear, as your body's natural response to injury clears them. How Soon Will the Veins Disappear? Veins will fade over six to eight
weeks after treatment. Smaller vessels may disappear completely and large vessels should decrease in size. Are there Any Side Effects Associated with Sclerotherapy?Serious
side effects from this procedure are extremely rare; however, some temporary side effects may occur. - Local swelling and bruising may occur at the injection site and along the vessel. Swelling usually lasts
no more than 24 hours; bruising fades within several weeks. Brown discoloration may infrequently develop. This usually lasts
approximately three months, slowly fading away.
- Tenderness may occur at the
injection site and along the vessel, and may persist for a few days.
- Immediately
following injection, a hive-like reaction may develop at the site, usually lasting no longer than 30 minutes.
- Following injection of the ankle or calf, cramping similar to a "charley horse" may occur.
What are the Post-Treatment Instructions?Pressure gauze bandages
may be placed over the treated vein and remain overnight after treatment. You should avoid contact sports, aerobics, and use
of leg weights during this treatment. A 30-minute, moderately paced walk may be substituted for your regular workout. Thereafter, ace bandages or compression support hose (available at our office) must be worn continuously
(except to shower) for five days after treatment. Medium-weight compression support
hose are recommended for daytime wear during the one to two weeks following treatment; either Jobst sheer support pantyhose
or Sigvaris Delilah pantyhose. Both are nonprescription, fitted by height and weight and available in several colors. How Many Treatments will I need?Treatment will depend on number,
size and location of the veins as well as the level of cosmetic result you desire. Are
There Reasons Why I Should Not Have Sclerotherapy?Patients with a history of inflammation
of the veins (thrombophlebitis), blood clots in the legs, diabetes, arterial or other vascular problems, or previous leg ulcers
are not treated with sclerotherapy. Pregnant women are almost always advised to postpone treatment until six months after
delivery. Do Other Treatment Options
Exist?Yes! Sclerotherapy remains the treatment of choice for spider veins but
if sclerotherapy does not fade veins appreciably, if the veins are too small to be treated by sclerotherapy, or if you are
fearful of needles, lasers and light sources are highly effective treatment options. The pulsed dye laser (V-Beam), and the
long pulsed Nd:YAG laser (Lyra, Gemini, and GentleYAG) are effective in treating red, superficial, fine veins and also some
bigger, deeper blue veins. The options will be discussed during your consultation. Hand/Chest
VeinsFew patients are aware that unwanted hand and chest veins can be treated just as
effectively. The hands can be a telltale sign of aging. Over time, as the skin thins and muscle tissues and fat deposits in
the hands decrease, veins appear larger, making the hands appear aged or masculine. Likewise, a number of women tend to have
visible breast veins especially after breast augmentation surgery. If deemed unsightly, breast veins can easily be treated
with sclerotherapy. How is the treatment performed?Like treatment of leg veins, injection sclerotherapy offers a fast, simple, and virtually painless way to
eliminate unwanted hand veins and chest veins with no significant risks. The treatment is done in the office and requires
no anesthesia. It involves the injection of a solution into the vein with a fine needle. The solution causes the veins to
slowly collapse over time. Two hours after treatment, the patient can resume all activity without limitations. The results
are dramatic and long lasting. Is the treatment safe?The procedure is safe for healthy patients. Once the target veins are eliminated, blood flow is rerouted
to other existing veins without compromising circulation. Some mild bruising and swelling may occur after treatment, but quickly
resolves. Patients who have undergone radical mastectomy, those who have a dialysis shunt, or patients who have had any significant
trauma to the hands, arms, or chest are poor candicates for this procedure.
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Dear Friends Our goal at NYC Dermatology is to be the Tiffanys of Skin Care. I personally see every new patient who visits our office. I am not just
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and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with
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at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.” Best Regards, Dr. Rothfeld
Dr. Gary
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Dermatology by Board Certified Dermatologist Dr. Gary Rothfeld is a board certified NYC Dermatologist
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at NYC Dermatologist has over 20 years of experience with his beauty tips.
. During your office consultation and examination you will be provided
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Sun ProtectionUltraviolet radiation is the major
cause of skin cancer, including melanoma. It is important for everyone to be aware of its damaging effects and take measures
to avoid overexposure. Although many people enjoy the appearance of tanned skin and think it looks "healthy,"
tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms
the cells. The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened
and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life. Ultraviolet
RadiationThe damaging part of sunlight is called ultraviolet radiation, or UV rays. It is categorized into three types: - UVC
rays (wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is the most likely
to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere. However, there
is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
- UVB rays (wavelengths
= 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface. It is the most common cause
of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and during the summer.
- UVA
rays (wavelengths = 320 nm to 400 nm) are the least powerful of the UV rays, but they are present all year and
can penetrate windows and clouds.
Sun ProtectionThe first and more effective way to avoid sun damage
is to stay out of tthe sun as much as possible. If you cannot avoid being exposed to sunlight, there are five basic
defenses that you should keep in mind when you go outdoors: - Avoid peak hours of sunlight
- Sunscreen
- Clothing
- Sunglasses
- Shade
Avoid
Peak Hours of Sunlight (UV Index)In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid
the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During
this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade. You
can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The
UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a
region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and
other factors. The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater
risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the
UV Index is moderate or greater. - 0 to 2 = Minimal
- 3 to 4 = Low
- 5 to 6 = Moderate
- 7 to 9
= High
- 10 or more = Very high
The UV Index can be found on our Website or in local papers, usually in
the weather section. SunscreenThere are several factors to consider when selecting the right sunscreen. (See
the Sunscreens handout for more information.) Sun protection actor (SPF) - Sunscreens are rated
by the amount of protection they provide from UVB, measured as the "sun protection factor" or SPF. Sunscreens with
higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 15. Broad-spectrum
sunscreens - It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called
"broad-spectrum" sunscreens. Most of the original sunscreens blocked only UVB, but increased awareness
of the damage caused by UVA has lead to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens
combine ingredients to provide a product with greater protection. Common sunscreen ingredients that provide protection
from UVB rays: - Cinnamates
- Octocrylene
- PABA (para-aminobenzoic acid)
- Padimate O and Padimate
A (Octyl Dimethyl PABA)
- Salicylates
Common sunscreen ingredients that provide protection from UVA
rays: - Avobenzone (Parsol 1789)
- Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)
Sunblocks -
"Physical" sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They
are particularly useful for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain
one or more of these ingredients: - Zinc oxide
- Titanium dioxide
- Iron oxide
Although past
formulations were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible
after being applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays. Water
resistance - Sunscreens are classified as "water-resistant" if they maintain their protection after
two 20-minute immersions in water. They are classified as "waterproof" if they maintain their protection after four
20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports,
such as swimming or water skiing, or will be actively sweating. However, independent testing has shown many products
do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently
if you are actively sweating. Using a SunscreenSunscreen should be applied evenly and liberally on all sun-exposed
skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after
being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating. Apply sunscreen generously
and reapply frequently at least every two hours. The chemicals may lose effectiveness over time, so it is important
to throw away sunscreen that is past its expiration date or is over two years old.
No sunscreen is 100% effective;
take additional measures to avoid the damaging effects of the sun's rays.
ClothingClothing can provide excellent
protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection
from UV rays. When selecting clothes for sun protection, consider the following: - Cover your head, shoulders, arms,
legs, and feet.
- Use a hat that is broad-brimmed (brim should be at least four inches wide).
- Wear fabrics that
are thicker or with a tight weave; these allow less sunlight to penetrate the skin.
- Wear darker-colored clothes that
absorb more UV rays.
- Wear clothing made from nylon or Dacron because it is more protective than cotton.
- Avoid
remaining in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
- Wash clothing with chemical
absorbers to increase their protectiveness.
- Some clothing comes with a UPF rating that stands for "Ultraviolet
Protection Factor." This measures the ability of the fabric to block UV radiation from penetrating to the skin. A fabric
with a UPF 15 allows only 1/15th (6.66%) of the UV radiation to penetrate your skin as compared to uncovered skin.
Garments
fall into 3 categories: - Good protection: UPF = 15 to 24
- Very good protection: UPF = 25 to 39
- Excellent
protection: UPF = 40 to 50+
Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a garment
will decrease over time as the fabric wears. SunglassesOverexposure to sunlight can cause cataracts and macular
degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of value. A darker
lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses
should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100%
of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm. ShadeIf possible,
remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because UV rays can
bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as
shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth, look
for a fabric that is thick, tightly woven, and dark-colored. Clear window glass provides protection from UVC and UVB,
but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which
prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use
of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but
this is illegal in some states. Summary- Avoid the sun when its UV rays are strongest,
between 10 a.m. and 4 p.m.
- Use a broad-spectrum sunscreen with SPF 15 or greater. Apply it 30 minutes prior to being
exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen if you will be active (sweating)
or in the water.
- Use a sunblock on your lips.
- Wear a broad-brimmed hat when outdoors.
- Wear sunglasses.
- Wear
tightly woven, dark clothing to cover your arms, legs, and feet.
- Stay in the shade when possible.
- Avoid reflective
surfaces, such as water or snow.
- Avoid sunbathing.
- Don't be fooled by cloudy days since damaging rays can
penetrate clouds.
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