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The Vein Institute of Toronto™ Technique
Description of Spider and Reticular Veins:
Telangiectasias are dilated superficial veins. They are often found on the face and legs. The thin veins on the legs termed “spider veins” usually appear on the thighs and ankles. The veins on the face generally appear on the nose, chin or cheek area and often occur in rosacea. These veins are purple, blue or red and usually appear in three basic shapes: linear, branch-like or spider-shaped, with a dark center point.
Branch-Like
Branch-Like
Linear
Linear
Spider-Shaped
Spider-Shaped
Symptoms:
Burning or itching are the most common symptoms of spider veins.
Incidence and Causes:
Nearly 70% of all women and 30% of men will develop some type of venous disorder. Spider veins result from reticular veins or truncal insufficiency. If the patient has pain or swelling, a duplex ultrasound is performed to make a complete diagnosis. If truncal (great or small saphenous vein) insufficiency is diagnosed, this condition should be treated prior to treating spider veins.
Contributing factors include:
  • Heredity
  • Pregnancy
  • Hormonal changes
  • Being overweight
  • Standing or sitting for prolonged of time
  • Advancing age
  • Trauma
  • Sun-exposure for veins on the face
Normal Vein
Abnormal Vein (Incompetent Valves)
Procedures:
Pre-Procedure Protocol:

At The Vein Institute of Toronto™, all patients will first undergo a complimentary physician consultation involving a focussed venous history, detailed venous physical examination and a duplex ultrasound to rule out truncal (Great saphenous or Small saphenous) venous insufficiency. We have developed a unique vein mapping technique to completely map out your spider and reticular veins and ensure a complete treatment plan. The initial consultation will allow us to develop a personalized treatment plan tailored to your schedule and goals.

Skin pigmentation can impact the effectiveness of any surface laser treatment. Therefore, the patient should have no sun exposure for four weeks prior to treatment to guard against blistering and scarring.
Procedure Protocol:
We utilize the Revolutionary Syris 300 T patented subsurface technology, which allows us to see approximately 1 mm below the skin's surface. This also allows us to have a more complete patient assessment and treatment, with reduced procedure times and improved outcomes.
We utilize the “Double Injury” method when treating spider veins on the leg. This technique treats the spider veins with our D940 FlexiPulse S Laser™, followed by an injection of sclerosing solution into the associated reticular or “feeder” vein. Laser energy is applied first through a hand piece that is extremely small and lightweight. The 5 Hertz system allows patients to be treated quickly and efficiently. The laser can be set to pulse or continuous mode. Spot sizes are easily interchangeable and come in 0.5, 1.0 and 1.5 mm sizes. Our D940 Flexipulse Laser has the smallest focal spot available. This allows precise treatment of fine spider vein networks. At The Vein Institute of Toronto™, the sole function of the D940 FlexiPulse Laser™ is the treatment of spider veins. We do not believe in multi-functional lasers, which are not tailored to one specific application. By injuring the veins with the laser first, the vein vasoconstricts and less sclerosant is required. The benefit of the “Double Injury” method over sclerotherapy alone is a quicker resolution and a significant decrease in the risk of staining or bruising. Staining appears as brownish discoloration on the skin.
Although discomfort with surface laser treatments is minimal, we utilize a Zimmer Cryo Cool 6™ air cooling device to increase the patient's comfort. The Zimmer Cryo Cool 6™ air cooler is designed both for comfort and safety. Cooling the skin during a laser treatment protects the outer layer of the skin (epidermis) from potential damage while making the treatments more comfortable for the patient. Because cooling the skin protects it from damage, the laser power can be increased to more effective levels, making each treatment maximally beneficial and minimizing the number of treatments. We are the first clinic in Canada to utilize a Zimmer Cryo Cool 6™ for surface laser spider vein treatments.
The duration and number of sessions will vary depending on the severity of the condition and the location. Many facial veins can be treated in one session. However, most conditions on the leg require three to five treatments to ensure all spider veins are treated. These treatments are spaced four to six weeks apart.
We perform sclerotherapy after surface laser therapy utilizing the Veinlite® technology. The Veinlite® patented Side-Transillumination provides uniform illumination and visualization of unprecedented clarity. Light generated by a halogen bulb travels through a high-quality fiber into the Veinlite® ring, where it is directed into the skin at an angle so that it is concentrated in a bright spot under the skin. The bright spot behaves like a virtual light source below the skin that transilluminates the open area within the ring. Superficial blood vessels are seen with high clarity and networks of varicose veins can be examined in detail. This technology allows us to completely map out the feeding veins and perform a complete treatment with decreased chance of recurrence.
Example
Before Laser Vein Therapy
Before Laser Vein Therapy
After Laser Vein Therapy
After Laser Vein Therapy
References
Thierry Passeron, et al. The New 940-Nanometer Diode Laser: An Effective Treatment for Leg Venulectasia, 2003.
P. Kaudewitz. Effective Treatment of Leg Vein Telangiectasia with the New 940-nm Diode Laser, 2001.
P. Kaudewitz. Treatment of Leg Vein Telangiectases: 1-Year Results with the New 940-nm Diode Laser, 2001.
E. Victor Ross et al. Laser Leg Vein Treatment: A Brief Overview, 2003.
Leslie Baumann, MD. Using the 940-nm Laser for Facial Indications, 2005.
Patient Procedure Instructions:
THE VEIN INSTITUTE OF TORONTO™
www.theveininstitute.com
416-929-0834

Sclerotherapy and Surface Laser Therapy Protocol
WHAT SHOULD I DO BEFORE MY TREATMENT?
  1. Do not shave your legs or apply cream for one day prior to and the day of your treatment. No tanning within two weeks preceding treatment date. Do not take Tetracycline or Minocin 10 days before or after treatment.
WHAT SHOULD I DO AFTER MY TREATMENT?
  1. After the treatment you may wear 20 to 30 mmHg or 30-40 mm Hg compression stockings for 72 hours continuously to improve treatment results and reduce pigmentation. We suggest no baths, tanning, hot tub, Jacuzzi or sauna for two weeks after treatment. You can resume normal day to day activities today and aerobic exercises the day after treatment. Walking a minimum of 30 minutes per day is recommended for the first 72 hours after treatment.
  2. Bruising, pigmentation, local swelling, lumpiness, redness and some tenderness are normal at sites of treatment.
    • If there is swelling, wrap ice in a cloth or obtain a gel pack from our clinic and apply to the affected area for a minimum of 5 days after treatment.
    • For areas of lumpiness or “bumps” after 7 days, please apply a warm compress to the area 2-3 times a day.
    • Bruising/discoloration at a site of sclerotherapy may last greater than 2 weeks in some patients.
    • To decrease persistent bruising/ discoloration we suggest:
      From the day of the treatment, please have 5 pellets of Arnica™, 3 times per day, and one 500 mg Bromelain tablet twice per day for 11 days after the procedure. Also, drink at least 2 liters of water per day to promote healing, reduce bruising/pigmentation and prevent discoloration.
    • To accelerate the healing of bruising, discoloration or pigmentation we suggest applying a small amount of Hiruval™(available at our clinic) to the area of discoloration, 2-4 times a day at the sites of discoloration or pigmentation, until you see improvement.
  3. Avoid sun exposure for two weeks after treatment if possible to prevent persistent discoloration. We suggest applying sunblock with a 50 SPF or greater rating to sites of treatment or bruising for at least 4 weeks following a treatment (or until bruising and pigmentation resolves) in the event of any sun exposure.
  4. You will not notice an immediate improvement. Healing usually occurs over a 2-6 week period and in some cases may take beyond 10 weeks. There may only be a partial response after the first one or two treatments with the veins looking a darker red or worse than before the treatments were started. This is part of the normal healing response. It may take three to five treatments for a specific area to demonstrate an adequate response or improvement in appearance.
Call 416-929-0834 for a physician consultation (Referral letter required from a physician)
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Branch-Like
Branch-Like
Linear
Linear
Spider-Shaped
Spider-Shaped
before
after
Before
After