Dr. Ly
Aesthetic Medical Artist & Instructor

Same Day Service!

Walk-ins Welcomed!

CLICK HERE to view Botox information from Aloha Dermatology and Laser Center.
89 Ho‘okele St. #101, Kahului
(behind Home Depot on your way to Walmart/Costco)

For those of you traveling from Makawao, Kula, Haiku, Wailea, Kihei, Lahaina, Kaanapali and Kapalua Click Here for Map of our location.

Varicose Veins …. A New Approach

By Dave Roberts

Varicose veins and spider veins are often mischaracterized as a cosmetic problem. Actually, they are a sign of an underlying disorder of the circulatory system called venous insufficiency. By age sixty, 70% of women will suffer from this condition. Left untreated, it can lead to a chronic, debilitating, and sometimes limb-threatening condition. Unfortunately this disease process is under-diagnosed and under-treated. Sadly, many patients opt for treatments that address only the superficial appearance of veins only to find that the veins reappear. Some superficial, skin deep treatments leave the veins worse than before treatment and cause the skin to appear blotchy or discolored. The underlying cause is never considered, diagnosed, or properly treated. Modern treatment of this age old problem can now be accomplished with an array of minimally invasive techniques in an outpatient setting.

Varicose vein disease afflicts women with twice the frequency as men. Many of my patients comment that the first veins became visible or worsened during the third trimester or in the peripartum. This is the result of being gravid and living with gravity. A woman’s blood volume will increase significantly during pregnancy. Veins act as the storage vessels for the extra blood volume. That extra blood late in pregnancy can overwhelm the veins below the heart, and damage the valves within the leg veins that normally function to protect the skin veins below. After delivery, some women are fortunate as these valves snap back and function properly; however in many others the valves continue to malfunction. The blood in the leg veins does not flow properly back to the heart. Instead, gravity pulls that blood downwards, and ultimately causes the skin veins to bulge.

Over time this unhealthy circulatory pattern can lead to tissue damage including swelling, dermatitis, and ulceration. As the blood is not flowing properly, the varicosities may clot, causing phlebitis, or they may rupture and bleed. Additional risks of untreated venous insufficiency include deep venous thrombosis and pulmonary embolism, a potentially fatal event. Patients with venous insufficiency may complain of aching, fatigue, itching or restless legs. Symptoms worsen at the end of the day. Relief is obtained with leg elevation, support stockings and pain medication. Because symptom onset is gradual, this disease may take decades to become apparent. All too often patients and physicians alike defer seeking care.

"Spider Veins" or telangiectasias may be an early sign of venous insufficiency that appear when tiny skin veins, previously invisible, become engorged and enlarge. We evaluate many patients who present for treatment of spider veins, who have had superficial injection treatments, only to see reappearance after 6-12 months. Worse still, some who opt for superficial laser treatments of leg spider veins exchange the veins for dark blotches in the skin. The underlying problem is never treated. A careful specialist ultrasound evaluation will usually show a deeper source vein.

A new outpatient treatment called the Closure? Procedure uses radio frequency energy to close the leaky source vein, and eliminate the major cause of varicose veins. With the Closure Procedure, a tiny catheter placed into the leaky source vein delivers a form of light energy to the vein wall. This energy causes collagen in the vein to change shape, closing the vein. This elegant procedure is completed in about an hour with minimal or no discomfort and a return to work or normal activity the same day.

Closure is covered by most all insurances and is performed in our outpatient surgienter devoted exclusively to vein care. Clinical studies have shown outstanding safety, efficacy, and patient satisfaction. Patients are delighted with symptom relief and cosmetic improvement, 98% of whom would recommend Closure for a friend.

Maryland Vein Professionals specializes in the treatment of varicose veins using the VNUS Closure Procedure, demonstrated to produce superior outcomes with literally no recovery time. Paid by insurance.

Varicose Veins …. A New Approach

Click to View Video

Christine McLaughlin hid a painful secret for 15 years: underneath her long dresses, black stockings or heavy support hose, McLaughlin’s legs were covered in large, bulging varicose veins.

A new procedure can remove the bulging veins in 15 minutes.

And, more than unsightly, her problem recently became unhealthy as well.

"There was a real sensation of throbbing," McLaughlin, 45, told "Good Morning America." "They’d just hurt. It was a heaviness, a density about the lower limbs."

Dr. Mark Adelman of New York University said varicose veins can cause engorgement, swelling and fatigue as well, "the same sensation you would get if you put a blood pressure cuff on your arm."

The condition affects about 20 million

Aging can lead to varicose veins, typically in the legs, by causing the vessels to become less elastic, allowing them to stretch and pool blood. High blood pressure, such as the kind that comes with pregnancy, can also push the walls of the veins outward.

Initially wary of painful treatment, McLaughlin heard about the newest treatment for varicose veins called the VNUS ClosureFAST procedure.

No Recovery Time With New Treatment

The treatment involves threading a long electrode up the vein and then using radio frequency waves to heat the vein until it collapses and closes. The procedure is done without anesthesia and there is little to no pain or painful recovery. The treatment takes about 15 minutes.

"Typically, patients feel better right away, almost," Adelman said. "As they walk out, they feel lighter, that they no longer have that heavy pressure inside the veins."

The procedure is the cutting edge of a treatment that started nearly a decade ago when the U.S. Food and Drug Administration approved the original closure catheter, Adelman said. But, back then, the treatment still required general anesthesia and a much longer session.

‘Walking in Gratitude

"The procedure itself has evolved," Adelman said. "Now, we’re not doing it in the hospital under general anesthesia. We’re doing them in small procedure rooms in the office, without any IVs, without keeping the patient without food beforehand, and you can see the procedure takes 15 to 20 minutes."

Closing blood vessels, at first blush, would seem to be dangerous but, Adelman said, these varicose veins are "superficial."

"The veins that are necessary for normal circulation are deep inside the muscles," he said.

After the procedure, McLaughlin could not believe the relief she felt.

"Oh, words can’t describe," she said. "I mean, what was really shocking to me was that there’s no recovery period. That, as soon as the doctor was finished, his wonderful assistant, his surgery assistant, Wendy, literally wrapped up my leg, gave me a series of instructions and told me, ‘You’re walking out of here.’"

Now, without fear of shorts and skirts and in great health, McLaughlin said she’s "walking in gratitude."

New Treatment For Unsightly, Unhealthy Varicose Veins – ABC News

A varicose vein treatment that can be done in a doctor’s office in 15 minutes that really works—it may sound too good to be true, but the millions of people who suffer from the unsightly bulging veins in their legs will be glad to know it’s for real. The technique is called venus closure, or more specifically, the VNUS Closure procedure, and there are many doctors in the Los Angeles area who perform this quick and easy out-patient surgery that in most cases requires only a local anesthetic.

The veins are the blood vessels that return blood to the heart and lungs. When the veins and their valves are weak the blood pools, causing unsightly bulging blue veins. It’s estimated that two-thirds of women over the age of 60 have varicose veins, but millions of older men also suffer from them.

Varicose veins aren’t just unsightly, they can also be uncomfortable, causing swelling, aching, a feeling of heaviness and fatigue. In some women they can eventually cause blood clots, inflammation and skin ulcers. Varicose veins tend to run in families, but can also be caused by being overweight, sitting or standing for long periods of time, straining caused by constipation, and the hormonal changes that come with menopause.

In the VNUS Closure procedure, the doctor makes a very small incision into the bulging vein and then threads a catheter up the vein. Radio frequency waves in short bursts heat the vein and shrink or collapse it. The body quickly reroutes the venus blood through other veins. It takes a day or two to recover, and the treated vein is absorbed over time.

To locate a doctor in the Los Angeles area who does the VNUS Closure procedure, and for more detailed information on the treatment, please visit the VNUS website .

For more info: Medline Plus varicose veins info

Women’s Health.gov FAQs about varicose veins

Varicose vein treatment is quick and effective

Varicose veins afflict as many as 40 million Americans. (Kyle Stalder/KTUU-DT)

ANCHORAGE, Alaska — As many as 40 million Americans suffer from severe varicose veins, which cause pain, swelling and disfigurement of the legs.

Until recently, patients seeking treatment for varicose veins underwent what is called stripping. But there is a new catheter device that uses heat to treat varicose veins.

It’s a minimally invasive procedure and patients are able to walk out right after the surgery.

For years, Connie Stafford has suffered from severe varicose veins.

"They ache, they get tired, they itch, they’re very unsightly, very ugly," she said.

Varicose veins develop because of faulty valves in the veins or because of weakened vein walls.

Dr. Robert Artwohl, a surgeon at the Alaska Vein Clinic (Kyle Stalder/KTUU-DT)

Stafford came to the clinic seeking a new type of treatment called closure for her varicose veins.

"I’m just hoping that the ugliness, the color and the bulging and the aching goes away," she said.

"The closure procedure eliminates the saphenous vein from circulation," Artwohl said. "This procedure replaces the saphenous vein stripping that we used to do for varicose veins."

A catheter is threaded into the varicose vein to cut off circulation. (Courtesy image)

The closure procedure uses radiofrequency, or laser, heat placed directly into the wall of the vein, causing it to contract and collapse, cutting off the source of blood.

"Like when you put bacon on a griddle, the proteins in the bacon contract and get smaller, same thing happens here in the vein," Artwohl said.

Once the diseased vein is closed, healthy veins take over and normal blood flow returns to the legs, allowing the swelling, pain and discoloration to improve.

The procedure is about as invasive as getting your blood drawn and it only takes about 20 minutes to treat each leg.

"The nice thing about this procedure is that number one, we do it right here in the office, they don’t have to go in the operating room, they don’t have to prepare for surgery the night before," Artwohl said.

Plus, patients do not have to have anesthesia. They actually stay awake during the entire procedure, but are given relaxant.

"If they’re relaxed, their adrenaline won’t surge and their veins won’t go into spasm, and it makes it easier for us to get into the vein," Artwohl said.

And they are able to walk out right after their procedure.

"We’ve had people have this procedure done on Friday and Saturday morning they’ve flown down to Park City (Utah) and they’re skiing, so there’s really very little downtime for this procedure," Artwohl said.

Most health insurance providers and Medicaid do cover this procedure for patients diagnosed with severe varicose veins.

Contact Lori Tipton at ltipton@ktuu.com

New procedure trims treatment time for varicose veins – KTUU.com | Alaska’s news and information source |

Tired, Painful, or Unsightly Legs…?

4 June 2009
By: Samuel M. Wilson, M.D., FACS

If you are among the estimated 20 to 40 million men or women who suffer from venous insufficiency, you may have venous reflux disease. You may feel that your legs are aching or uncomfortable and may note that they swell up, especially as the day goes on. Your legs may feel heavy. Other symptoms include painful varicose veins, seen as protruding veins of various sizes.

Over time this may lead to discoloration of the lower leg above the ankles or even open sores in the same area, known as venous leg ulcers.

Certain jobs or activities which require prolonged standing may make you more likely to have these problems. They are also seen in pregnancy. Other risk factors include a family history of varicose veins, overweight, and increasing age.

The diagnosis may be simply made with a short, non invasive (no needles) procedure using an ultrasound machine combined with a physical exam.

Many of the most basic cases can be treated with venous compression stocking and elevation. If this is not sufficient or more definitive treatment is required, a minimally invasive outpatient office procedure may be done, often with cure.

When indicated, one of the newest and most effective outpatient procedures, which is done in the office, is the VNUS Closure Procedure. A catheter is inserted in a superficial vein and the diseased vein is closed by radiofrequency (RF) energy. This causes blood to be returned by other normal veins.

The procedure takes about one half hour to one hour with only local anesthesia required. There is minimal discomfort. Normal activities are usually resumed in one day.

Samuel M. Wilson, M.D., FACS and his Board Certified partners, Thomas P. Barnett, M.D., FACS and Cristobal G. Alvarado, M.D., FACS of Surgical Associates at Eden Hill have been successfully performing the VNUS Closure Procedure since 2005.

If you are experiencing the signs and symptoms of varicose veins and venous reflux disease, the physicians of Surgical Associates at Eden Hill are available for help. Call (302) 674-0600 for a consultation.

Testimonials:

“I was surprised at how quick it took, and really pain free and that’s not an exaggeration it was pain free.”
~Kate S., Dover, DE

“I had torturous veins. Now they’re really flat… The appearance is much better.” ~Joan L., Viola, DE

“I tell anyone who has these not to put off treatment. Literally, the next day, it was like a miracle.”
~Jim W., Smyrna, DE

“I was shocked at how quickly I recovered. I was on the phone with my office as soon as I got home from the hospital. I’ve had more discomfort after a dental appointment than I had after this procedure.”
~John D., Elkton, MD

Dr. Samuel Wilson has been practicing general and vascular surgery since 1986 and has been in Dover since 1996. He graduated from Swarthmore College in 1972 and earned his medical degree from Temple University School of Medicine. He completed his surgical residency at Temple University Hospital followed by a two-year vascular fellowship at Presbyterian University of Pennsylvania Medical Center in Philadelphia. He was Chief of Surgery at Kent General Hospital from January 2005 through December 2007. A surgeon who is published in the general, vascular, and trauma literature, he is a member of the Delaware Valley Vascular Society, the Eastern Vascular Society, the Vascular Access Society of the Americas (VASA),  the American Society of Breast Surgeons, the American Medical Association, the Medical Society of Delaware, and the Southeastern Surgical Congress. Dr. Wilson is Board Certified in Surgery and is a Fellow of the American College of Surgeons. He is listed in the Who’s Who in Medicine and Healthcare and is a Delaware Today “Top Doc.

The Womens Journal » Blog Archive » Tired, Painful, or Unsightly Legs…?

Twisted rope-like veins bulge out of the legs of 50 percent of women in the United States, according to the American Academy of Dermatology.

Varicose veins can be more than just plain ugly. The unsightly veins can cause pain, swelling or itching severe enough to drive many sufferers to seek medical help.

Over the years, several procedures for treatment have surfaced, but most have been somewhat invasive.

A relatively new procedure that’s being used in about 100 doctors’ offices around the country is said to be far less invasive, painful and time-consuming than the current most popular procedure, known as vein stripping.

Seeking Closure

Mark Adelman, director of vascular surgery at Bellevue Hospital in New York City, says a procedure known as VNUS, or "closure," is a great option for patients who’ve been putting off a varicose vein procedure because of the pain and recovery time traditionally involved.

"The procedure itself is not painful at all and after the surgery the patients resume the normal day-to-day activities without pain," Adelman said on ABCNEWS’ Good Morning America.

VNUS, which uses a radio frequency to close the troublesome vein, can be done while patients are under localized anesthesia, and patients usually recover completely in one to two days, Adelman said.

Varicose or "enlarged" veins that sit just under the skin of the leg have numerous causes. The most common cause is a valvular dysfunction of the main vein on the leg. That vein should allow blood to pass through the leg to the heart and close so blood doesn’t pass back. When it’s dysfunctional, the blood can pass back, causing the enlargement.

More women suffer from varicose veins than men because it’s worsened by estrogen stimulation and by anything that puts pressure on the abdomen, like obesity or pregnancy. Only 20 percent of American men suffer from varicose veins.

Throbbing Pain

Lynette McCollum has been trying to cope with her own varicose veins for five years. The 38-year-old Broadway performer and mother of two said she’s tried every trick in the book to try and relieve the pain of the veins — but support hose and dieting hasn’t helped. "It’s painful, the throbbing and the heaviness of the leg," she said.

McCollum hasn’t been willing try traditional varicose vein removal procedures because they seemed too invasive to her. Vein stripping, the most commonly used procedure, is very effective, according to Adelman, but recovery can be difficult, he said. It entails two incisions on the leg — one at the ankle and one at the groin.

A wire is then passed through that main vein, which is pulled out. Once it’s removed, several smaller incisions are made that remove the small branches of blood vessels off the main vein. The trauma of the tearing causes recovery to be uncomfortable, with bruising and an irritation of the nerves that could cause numbness, Adelman said.

With VNUS, there is only one incision at the ankle. A small catheter the size of a piece of spaghetti is passed through the vein and travels to the groin where a trigger is pulled. That opens prongs on the catheter, which contact a wall of the vein. The radio frequency is then turned on and the heat closes the vein.

Becoming Invisible

Since no blood remains in the vein, it becomes invisible, and not in position to feed the smaller branches. According to Adelman, there’s no bruising and very little swelling or numbness associated with this treatment, but it takes about two to three weeks for the vein to completely disappear.

About 10,000 VNUS (www.vnus.com) treatments have been carried out since the Food and Drug Administration approved its use in 1999.

The cost of the procedure is comparable to vein stripping, which ranges from $2,000 to $4,000 per leg. Closure usually costs around $2,000 to $2,500. Some insurers cover it interchangeably with vein stripping as a medical necessity, not just a cosmetic procedure, but some insurers are just becoming aware of it, said Adelman

Other varicose vein removal procedures include sclerotherapy, which treats both spider and varicose veins. It consists of injecting a solution into the vein and bandaging the area tightly for about 24 hours. A yellow-brown discoloration can sometimes appear in the treated area. This may take weeks or sometimes months to fade.

Laser therapy also may be used to treat spider veins. Sometimes more than one treatment is needed.

While high-tech treatments have become available, experts say there are ways to ease the discomfort associated with varicose veins. Support hose and tight-fitting elastic stockings can help prevent blood from pooling in the legs and increasing pressure on veins with damaged valves.

Elevating the legs to help gravity drain blood out of the leg veins is often recommended as well.

New Treatment for Varicose Veins – ABC News