Hand veins: Specialized phlebectomy technique improves appearance

Key Points

Montreal - Hand veins can be cosmetically improved with a minimally invasive technique that does not involve bleeding or disrupting the anatomy of the hand, according to a European dermatologist.

Speaking at the first Pan-American Congress on Aesthetic and Anti-Aging Medicine in early September, Eckart Haneke, M.D., Ph.D., professor of dermatology, department of dermatology, University of Berne, Switzerland, said patients can shave years off their appearance with cosmetic procedures, such as botulinum toxin injections or the use of soft-tissue fillers in various areas of the body.

With thinning of the skin over time due to factors such as chronic sun exposure, long-term medication use, age-related loss of fat on the backs of the hands and decreased skin tone, the appearance of the hands is likely to give away real age, particularly if an individual has very prominent hand veins, Dr. Haneke tells Dermatology Times.

Traditional teaching

Traditional teaching has discouraged clinicians from trying to treat prominent, seemingly enlarged hand veins, Dr. Haneke says. Only in specific instances were dorsal hand veins sacrificed. "It was like dogma," he adds.

If clinicians choose to remove veins, they have to have a very thorough knowledge of the anatomy, in particular the arterial and venous parts of the hand.

"It would be a catastrophe if we remove either the wrong vessels or would inadvertently remove nerves," he says.

Dr. Haneke adds that sclerotherapy in treating hand veins necessitates that patients wear compression gloves for two weeks.

Phlebectomy

A specialized type of phlebectomy developed by French vascular surgeon Dr. Marc Lefebvre-Vilardebo involves the placement of tiny incisions, Dr. Haneke says. Few scars are left after the procedure.

The technique also addresses the complex systems of the hand, which include a superficial venous system and a deep vein system that "communicate," he says.

During the procedure, a vein dissector is used to free veins from connective tissue and pull them out. The stumps of the veins are ligated.

Pre-operatively, clinicians use markings to indicate where they will make the incisions into the hand and where the prominent veins are.

"The procedure is one that does not compromise blood flow," Dr. Haneke says.

"It is a minimally invasive technique, and damage to adjacent structures like veins, nerves and arteries is absent or minimal," he adds.

Patients' experience with the procedure is a satisfactory one, and they typically see a visible improvement after about two weeks, Dr. Haneke says.

Fat injection

If one's hands are very skinny and hand veins are prominent, injection of fat is a method used to camouflage the hand veins.

"We do a number of passes, using microdroplet injections of fat to increase the graft take," Dr. Haneke says.

Clinicians must take care to avoid bleeding, for blood's oxidization process will interfere with graft take.

One of the new approaches to treatment of prominent hand veins is the use of hyaluronic acid, such as Perlane (Medicis), although there is scant documented experience in the medical literature with this soft tissue agent, Dr. Haneke says.