Pesky leg veins? They can be treated!

PregnantWomanThe wear and tear that comes with time shows up on our skin.  For many of us, adulthood and various stages of life (eg pregnancy) come with skin changes.  I’ve recently had several patients ask me about pesky spider veins and varicose veins.

These are veins that become dilated or “loose” over time. They lose their elasticity and like old panty hose, become loose and wider.  They become more visible through the skin and this becomes a cosmetic concern for many.  Like leaky pipes, they also become functionally deficient.

So how can varicose veins and spider veins be treated?

A number of treatments exist for each type of dilated vein.  The varicose veins can be removed or “stripped” surgically, or a laser device can be inserted up the vein to destroy the vein.  Sometimes special solutions can be injected that will also lead to destruction of the vein, a procedure called sclerotherapy.  Sclerotherapy can also be done for spider veins.  Spider veins are called such because the appearance of the reddish or purplish veins can resemble legs of a spider.  A special laser can also be used to get rid of these spider veins, although this treatment is sometimes less effective than sclerotherapy.

If you are interested in removal, find a surgeon who is experienced in spider vein and varicose vein removal. Dermatologists often perform sclerotherapy and laser treatment for the smaller spider veins, whereas vascular surgeons or interventional radiologists often take care of varicose vein removal.

Additionally, ask your physician about compression stockings.  These are stockings that can be bought both off the shelf and are also available by prescription.  Your physician can determine how much compression is appropriate for you and prescribe these socks for you.  As someone who is on her feet a lot at work, I have found these compression stockings to be very helpful in preventing leg and foot fatigue and preventing the appearance of dilated veins.  During pregnancy, the legs often swell, and this becomes a time when women develop these dilated veins.  It would be a good idea to talk to your obstetrician about compression stockings if you are experiencing the swelling or dilated veins.

Split earlobe? Enlarging pierced ear hole? You can fix it!

Stretched ear piercing.
Stretched ear piercing.

Have your earlobes split?  Or is your pierced ear hole enlarging and you don’t like it?  Or did you purposefully stretch our your ear hole and now regret it?  Not to worry, you can get these issues fixed.

Earlobes can split if you’ve worn heavy earrings for a while, if someone pulls on an earring (ouch!), or if you’ve had an infection or rash around this earring area.  Big earring holes can happen with time from the weight of the earring or with trauma to the area.  If you opted for a larger gauge ear piercing in the past or purposefully stretched out your ear piercing with tunnels or plugs, this can be reversed as well.

So what can you do to fix a split earlobe or enlarged piercing hole?

Arrange for a consultation with a plastic surgeon or dermatologic surgeon who performs earlobe repairs.  These procedures are usually done under local anesthesia and you can go home afterwards.  The surgeon will fix the split earlobe or wide ear hole, cutting out a small part of skin that is affected and reassembling.  You will likely have small stitches after the procedure.  After the repair is completely healed, you can choose whether you want to re-pierce your ears.

Physician and layman perceptions on the preferred provider for skin surgery and cosmetic procedures

In a presentation at this year’s 2012 annual American Society for Dermatologic Surgery (ASDS) meeting, Dr. Omar Ibrahimi presented his Cutting Edge Research Grant project. Dr. Ibrahimi studied physician and layman perceptions on the most optimal provider for cutaneous surgery, Botox injections and filler injections.  He conducted two internet surveys: one assessing the lay public’s preference for providers of certain procedures and one assessing primary care residents’ (physicians in training) on their preference of providers for certain procedures. Choices of preferred provider included dermatologists, plastic surgeons, and non-physician  providers.

Dr. Ibrahimi found that for skin cancer surgery, both the lay public as well as the primary care physicians preferred dermatologists to perform the surgery.  For Botox botulinum toxin injection, the primary care physicians preferred dermatologists although the lay public preferred plastic surgeons.  For fillers, again the primary care physicians preferred dermatologists although the lay public’s preference for dermatologists and plastic surgeons was roughly equivalent.

Dermatologists receive in-depth training on cutaneous surgery, botulinum toxin injections and filler injections, and Dr. Ibrahimi concludes that it is important to make the public aware that dermatologists are the experts in skin cancer surgery and other cutaneous surgical procedures .

Are fillers right for you?

Don’t be scared away from fillers by that awful story of the fake doctor injecting patients with cement and tire sealant.  If you find a real doctor who does a lot of filler injections (with real filler material), this treatment may be right for you.

You might have heard of fillers such as Restylane, Perlane, Juvederm, Radiesse, Sculptra, Zyplast, Zyderm, ArteColl or ArteFill. The first three are probably the most popular fillers and they contain something called hyaluronic acid.

So what is the deal with these fillers?

They’re used to add volume where volume has been lost, usually in the aging process. As we age, our skin loses its plumpness and elasticity. Things start to sag, droop, and fold on itself. Lines start to appear. Fillers are used to try to counteract these effects of aging.

Where do people use fillers?

The most common areas are those diagonal lines between your nose and mouth — the “marionnette lines” (I know, sounds terrible!) A little bit of filler can go a long way and cause a visible difference.

Where should I go for my filler treatment?

Find a doctor who has plenty of experience doing these procedures. It’s your face after all!  Your doctor can talk to you about the different sorts of fillers.  Most fillers are not permanent and the effect does wear off.

What is a skin biopsy?

Histopathology of melanoma from the thigh
If you’ve been to a dermatologist, the issue of a skin biopsy may have come up. What is a skin biopsy? A skin biopsy allows the physician to make a diagnosis of a rash or a worrisome skin lesion (e.g. when your doctor suspects a skin cancer). It’s a procedure during which a small piece of skin is cut and then sent to a pathologist. A pathologist is a doctor that looks at the cells of the tissue and makes a diagnosis (when possible). A potential order of events is as follows:

1. Your physician explains the procedure and obtains your consent to do the procedure.
2. The area may be photographed.
3. The area is cleaned and numbed with an anesthetic medication. You will feel a prick and some stinging as the medication is injected into your skin.
4. A small piece of skin is obtained either by a scalpel, a special biopsy blade, or by a cookie cutter like device.
5. Depending on how much and how the skin is taken, stitches may be placed. If stitches aren’t placed, bleeding may be stopped by application of certain chemicals or via a cautery device.
6. The area is bandaged.
7. Wound care is reviewed.
8. The tissue is sent to a pathologist to help render a diagnosis.

Step 4 alludes to the different types of skin biopsies. A shave biopsy is usually done with a blade and do not require stitches. A punch biopsy uses a special cookie cutter device to obtain skin. Stitches frequently are placed when a punch biopsy is taken.