Show off your Legs

Dr. Douglas A. Hill was intrigued by varicose veins and when he completed his training in phlebology in 1989, he dedicated his time to assessing and treating venous disease.  Since then his accreditations extend to being an executive member of the Canadian Society of Phlebology, a Fellow of the American College of Phlebology and a member of the American Venous Forum.

But two of his greatest accomplish-ments were participating in pioneering the use of ultrasound-guided sclero-therapy in Canada and, in 2002, introducing endovenous laser therapy to the country. When he practised as a student, he was taken aback by the process of old vein-stripping techniques and wanted to come up with a new method of treatment. Endovenous laser was able to treat larger veins as an alternative to surgery, and that’s why he brought it to Canada and incorporated the treatment into his clinic.

You can meet with Hill and his staff at his Calgary clinic, the Vein Treatment and Therapeutic Skin Care Centre, where they treat venous disease with the endovenous techniques he introduced eight years ago as well as other cosmetic procedures.

ABOUT VARICOSE VEINS
Varicose veins are enlarged and deformed veins, in which the blood flow is reversed or slow. As a result of this, they are visible on a person’s body and as they get larger, they become more prominent. The disease results from the stretching of the vein walls and malfunction of the valves that normally direct blood back to the heart. The smallest varicose veins are commonly called spider veins.

A person’s lifestyle may be partly to blame for the condition. If one is not active, or stands on his or her feet for long periods of time, blood tends to pool in the veins and puts stress on the vein walls. Other contributing factors that are out of one’s hands are genetics, aging, hormones and pregnancy.

Varicose veins generally occur on the legs, in 20-25% of women and 10-15% of men. The earliest signs appear in one’s early twenties, but they become more prominent once the person is in their thirties. “The first sign for many people is when you see discoloured or enlarged veins on your legs.” says Hill. “Often when they’re appearing you can get some discomfort.”

TREATMENT
For people whose jobs involve sitting or standing for long periods of time, they can help prevent their veins from functioning improperly and forming new varicosities by wearing medical compression stockings.

However, if the venous disease has already formed on your body, there are three treatment options to consider:
Sclerotherapy is the least invasive method out of the three options. Medicine is injected into veins that are both on the surface and deeper under the skin. For the veins they can’t see under the surface, Hill will use ultrasound to image the veins and then inject with a tiny needle.  It will close the vein up, which will then be gradually re-absorbed by the body.

The second treatment uses an endovenous laser or radiofrequency-generated heat to treat larger veins, deep under the skin.  The endovenous laser method involves using a laser fibre (a long, thin catheter), which is inserted into the vein guided by ultrasound. Once inside, the catheter heats the portion of the vein it’s close to and it is slowly withdrawn so the laser energy is distributed along the vein wall, also sealing it up.

Radiofrequency also uses the catheter positioned in the vein but uses radiofrequency energy to heat the catheter, which heats the portion of the vein wall adjacent to the catheter. So, it uses heat generated by radiofrequency rather than laser light to heat the vein. But both are proving to have higher success rates and fewer complications than any other procedure for treating large veins.

The final treatment is surgery and it is the most invasive. It is traditionally a stripping and tying procedure where the surgeon makes at least two small incisions on the leg. He finds the top of the vein where it joins with the deep vein and cuts then ties off the vein. A minimum of one more incision is made lower on the leg to cut and tie off the lower end of the vein. The vein is then pulled out between the two incisions.

While these procedures are geared towards larger veins that occur from the groin down, there is laser treatment for smaller veins that appear on the face (generally the nose and cheek areas). “It’s a different laser than the one that’s used for treating the varicose veins,” says Hill. This is because these veins are not necessarily connected to deeper veins in the same way and so there is not as much pressure on their walls as there is on the veins that appear on legs.

RECOVERY AND SUCCESS
The non-surgical procedures generally take 15 to 20 minutes to do, but it does depend on how much is being done. After each procedure, there will be some initial bruising, swelling and tenderness. However, most patients can get back to light daily activities the next day, keeping in mind that they should do no prolonged standing or strenuous exercise for about a week.

“Effects will take several weeks, but each has a really good initial success rate,” says Hill. However, he also says that while the veins treated are completely gone and will not reappear, there is a tendency for people to form new varicose veins. More invasive treatment like surgery, for instance, can sometimes stimulate the body to form new veins.

THE RIGHT TREATMENT
But which one is the right treatment for you? Hill says it is only through a thorough assessment, which includes an ultrasound, that they can acquire the information to determine which treatment might work for the patient.

“Usually all three are an option, but sometimes if the vein is too small or too twisted, we can’t get the catheter inside the vein to do the endovenous catheter-based procedure,” explains Hill. “In these cases sclerotherapy is often the way to go but it depends on the anatomy of the vein more than anything.” However, if the patient has received surgery before, more surgery may not a viable option because it can be difficult to go back and perform more surgery due to scarring and unpredictable anatomy. •

Botox with
Dr. Hill

WHAT IS BOTOX?
Botox prevents and reduces signs of wrinkles, which form with facial expressions over time. It can also be used for medical conditions like migraine headaches, tooth grinding and excessive sweating. However, Dr. Hill says the main reason people seek Botox at his clinic is to manage developed lines on prominent areas around their face.

WHERE CAN IT BE USED?
These areas include the crow’s feet, between the eyebrows and forehead wrinkles. It is also effective for lifting and sculpting the eyebrows, treating vertical neck bands, and correcting lines around the lips and chin and down-turned corners of the mouth.

PROCEDURE
Hill will initially analyze the strength of the muscle, which is creating the lines. “Those are the muscles we’re injecting the Botox into — that’s our target,” explains Hill.

He will then mark off the spots and determine the amount of Botox medication that is needed for each area. He administers the injections point by point through a tiny needle.  The procedure only takes a few minutes.

RECOVERY AND RECOMMENDATIONS
“After it is injected, we usually ask them to perform the facial expression they wanted to get rid of to help the medication absorb into the muscle,” says Hill. Patients should expect slight redness and swelling for the next hour. The Botox generally takes about five days to show its effectiveness and for the maximum benefit, the patient is recommended to have repeat injections every three to six months.

http://www.veintreatmentcentre.com/