Hi, Dr. Adam Goldman with the Metropolitan Vein and Aesthetic Center. I’m here to talk to you today about the topic of Varithena and hyperpigmentation. Varithena is a treatment for the superficial veins of the leg, as well as any communications that may be causing these veins. A common problem or side effect is hyperpigmentation or darkening of the skin, where the original veins were located.
Importance of Choosing a Specialist
When choosing a vein treatment center, it’s important to choose one that has vein treatment specialists and extensive experience. We at the Metropolitan Vein and Aesthetic Center have participated in some of the early trials of Varithena and have years of experience with this treatment. During that time, we have developed proprietary protocols to prevent any kind of complications and to give you the best clinical outcome possible.
Also, it’s important to note that there is very little information on the internet about Varithena and hyperpigmentation. So, I’m here today to give you an overview of that topic.
Causes of Hyperpigmentation
Inflammation and Melanin
The first thing I want to talk about are the causes of hyperpigmentation and any risk factors. The cause of hyperpigmentation after the treatment is poorly understood. One theory is that after we close the veins, the body tries to remove them, and this is done through inflammation. Secondary to this inflammation, the body reacts and produces a chemical protein called melanin. Melanin is what you see when you go out in the sun, and the body creates it to darken the skin to help prevent any further damage. However, in this case, that melanin may cause some darkening of the skin where the vein originally was located.
Trapped Blood and Hemosiderin
Another and more probable cause is that very often blood gets trapped in these veins that we treat. As the body removes that blood, the components of the blood, specifically iron or hemosiderin, are released. This is what can cause the darkening of the skin similar to a bruise. However, in this case, it is more permanent.
Risk Factors for Hyperpigmentation
There are some risk factors for hyperpigmentation that we can use to identify patients more at risk:
- Darker skin types
- If you’ve had hyperpigmentation from prior Varithena treatments, the likelihood is higher for the second or third time.
- The larger the veins, the greater the density of the veins, the more likely hyperpigmentation can occur.
Prevention of Hyperpigmentation
Treatment Strategies
The most important treatment of hyperpigmentation is the prevention of hyperpigmentation, and this is done in several ways:
Treat the Truncal Veins First: The greater saphenous vein, the lesser saphenous vein, and the anterior accessory veins can all be treated with endovascular techniques. Once the flow of blood has been interrupted, it gives an opportunity for the superficial veins to decrease in size and density.
Compression Stockings: Using compression stockings after treatment is also important.
Positioning and Injection Technique
Next, we use the same technique when you come to the clinic for the Varithena treatment. One may notice that when lying down, the veins often disappear because gravity is not allowing the veins to fill. We put you in what we call a reverse Trendelenburg position with the legs all the way up in the air and the head all the way down, and we leave you there for several minutes to help reduce the size and density of the veins.
The only caveat is if the veins are very dilated and the walls have become very stretched out, this technique is limited in its effect. However, it should always be attempted.
Slow Injection Technique
With injecting Varithena, a slow injection technique is important. By reducing the pressure of the injection, we reduce the risk of extravasation or the Varithena leaking out of the vein. The less Varithena that leaks out, the less inflammation and the less chance of hyperpigmentation.
Aftercare Protocols
Aftercare is very important. We use proprietary compression techniques after the procedure to help reduce the risk. The blood that becomes trapped in those veins can cause hyperpigmentation. It is very important when getting the treatment that you follow our instructions exactly, as it will reduce the risk of complications.
Follow-Up Appointment
Finally, when there are numerous veins or they are very large, we always ask the patient to come back for a routine follow-up in one to two weeks. During that time, we can assess the results of the treatment and the amount of closure, and more importantly, if there is any trapped blood. It gives us an opportunity to remove it, which will help reduce the risk of hyperpigmentation, decrease pain, and improve healing after the procedure.
Treatment of Hyperpigmentation
Time and Patience
The first and most important treatment is actually time. Often, when the hyperpigmented areas are not so dense or dark in color and the skin tone is lighter, it will fade on its own. Sometimes the process can take a long time, even up to two years, as the legs heal very slowly. However, if one notices that it is fading, I usually recommend waiting, and typically, we end up with a good clinical or cosmetic outcome.
Chemical Peels
The other thing that can be tried is medical-grade chemical peels. Often multiple treatments will be needed, but this can often achieve a good clinical outcome or cosmetic result with fading or reduction in the denser darkness of these hyperpigmented areas.
A chemical peel that can be attempted at home without a prescription is to mix apple cider vinegar (50%) with water, place it on a towel, and lay it over the darkened areas. You then rinse that off. This process should be repeated twice a day. If, however, you don’t see any results after one to two weeks, it’s unlikely it will make a significant change and that idea can be abandoned.
Q-Switch Laser
Finally, if there is no improvement, we recommend using the Q-switch laser. This is the same laser that is used for tattoo removal. It is a challenging way to treat it because the protocols developed for tattoo removal are not the same or applicable to this kind of problem. Another problem is that the darkened areas of skin are often close in color to the natural pigment of the skin. The challenge is removing the darkened area without affecting the underlying pigment, which could cause a white or lighter spot in that skin area.
In general, we start with very low energies and then we build them up slowly. This is a lengthy process. After the initial treatment, we assess the results and see if we need to increase or lower the energy, and hopefully, achieve a good cosmetic outcome.
Contact Our Specialists at Metropolitan Vein and Aesthetic Center
In conclusion, it is very important to be treated in a center with experience and specialists, as this will improve the outcome and reduce the risk of complications. If you have any questions or would like to schedule a consultation, please contact us. We are on the web at www.nymetrovein.com and on Instagram at @NYMetroVein. You can also reach us at either of our clinics, one in Manhattan and one in Corona, Queens. The phone numbers are listed below as well as on the website.
Thank you very much for watching.
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