Regional Approach to Aesthetic Rejuvenation in Visual Studio .NET

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| Regional Approach to Aesthetic Rejuvenation
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patient will experience repeated recurrences Previously, the only treatment option for these patients with varicose veins from saphenous insuf ciency was surgical ligation and stripping of the vessels under general anesthesia This procedure resulted in signi cant postoperative downtime with surgical scars, swelling, bruising, and pain The expense of a hospital stay and missed work, along with an unacceptable rate of recurrence has decreased the popularity of this procedure While RF-mediated elimination started the noninvasive varicose vein trend, endovenous obliteration with lasers has revolutionized varicose vein treatment Radiofrequency This method involves the placement of a catheter within the varicose vein through a small puncture or incision The catheter is threaded up to the saphenofemoral junction typically under duplex ultrasound guidance Critical to the safety and success of the technique is the placement of tumescent local anesthesia, which involves rst in ltrating the tissue under the skin including the thigh muscles to push the saphenous vein further away from the skin and then creating a space between the fascia and the saphenous vein so as to hydrodissect the vein away from structures such as nerves and arteries Once this hydrodissection has been performed with high volume and low concentration of local anesthetic (01% lidocaine), energy is applied as the catheter is slowly withdrawn This results in heat being directly applied to the vein wall via a computercontrolled thermocouple feedback loop, which leads to a collagen shrinkage accompanied by complete vein wall occlusion The ef cacy for RF elimination of re ux is 90% at 2 years and 80% at 5 years27,28 Recent advances in the delivery of the RF energy to the vein will hopefully increase the ef cacy of this procedure Lasers with hemoglobin-predominant absorption (810 nm, 940 nm, 980 nm) Endovenous laser treatment with these wavelengths are similar to RF in that both devices produce endothelial and vein wall shrinkage by nonspeci c heating of the vessel The target for lasers with wavelengths of 810, 940, and 980 nm is the intravascular red blood cell The success of these lasers is highly dependent on correct placement of tumescent local anesthesia to have a thin layer of blood surrounding the laser ber while having enough anesthesia to protect the surrounding nerves and muscles from injury Direct thermal effects on the vein wall without the presence of blood probably do not occur Consistent results may be hard to duplicate given that these lasers are dependent on so
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VARICOSE VEINS Patient Selection
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More then 24 million people are affected by varicose veins and the incidence of varicose veins increases with each decade of life With an increasing life span within the United States, the rate of varicose veins is on the rise While 41% of women in the fth decade have varicose veins, this number rises to 72% in the seventh decade25 Statistics for men are similar with 24% incidence in the fourth decade, increasing to 43% by the seventh decade Pregnancy, increased body mass, and family history increase the risk of varicose vein development It is estimated that 6 million workdays per year may be lost in the United States due to complications of varicose veins26 Obviously, varicose veins are not just cosmetically dis guring, they may also cause signi cant morbidity including chronic stasis dermatitis, ankle edema, spontaneous bleeding, super cial thrombophlebitis, recurrent cellulitis, lipodermatosclerosis, and skin ulceration on the ankle and foot
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When a patient presents with bulging varicosities, complains of leg pain or swelling, has a previous history of vein surgery, has a strong family history of varicose veins, and an abundance of veins in the area served by the saphenous veins, a duplex ultrasound is indicated Duplex ultrasound is the gold standard of noninvasive examination of the venous system It allows direct visualization of the veins and identi cation of ow through venous valves The Duplex examination may also help to delineate re ux sources when patients experience poor results from sclerotherapy If venous insuf ciency is found in the saphenous system, dermatologic surgeons can employ endovenous occlusion of the vessel by radiofrequency (RF) or laser, and then address the remaining veins depending on their size and location by ambulatory phlebectomy (AP) and duplex-guided or standard sclerotherapy
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