Contemporary cosmetic surgeons need one eye on trends

MANCHESTER, ENGLAND, UNITED KINGDOM – Coming to America, most likely by the end of the year, is Veinwave™ – a new high-frequency modality to treat spider veins, telangectasia, rosacea and other small vascular blemishes. The European distributor of Veinwave, Medical Innovations, is ready to partner with a major U.S. distributor, according to British consultant surgeon and general vascular surgeon Brian Newman, M.D., F.R.C.S. who developed and popularized the technique.

Due to contractual agreements, Dr. Newman was unable to divulge specifics of the device's availability in the U.S. but did say he was scheduled to be in America for several large-group training sessions this fall. He developed the Veinwave system primarily for use on the face and legs, "in response to a failure of available procedures to permanently eliminate thread veins," states Dr. Newman's Web site ( http://www.drnewmansclinic.co.uk/).

The Veinwave system, which has a pen-like shape and single-use needle probe at the end, operates with a microwave function to heat microblood vessels at a depth of no more than 2 mm. The high frequency energy (4 Mhz) results in thermo-coagulation, leading to the collapse and disappearance of unsightly spider veins, without damage to surrounding tissues.

Veinwave is being used in more than 1,000 European medical centers, according to Dr. Newman's estimates. Of those centers, he says 350 are in the United Kingdom, and medical personnel were trained under his instruction. Dr. Newman has used Veinwave since 2001 and estimates that he performs 80 Veinwave treatments per week. About 60 percent of his patients are referred for treatments to the face, while 40 percent require leg vein treatment.

Veinwave can be used on any size of vessels in the face, but leg vessels must be 0.3 mm or smaller. To treat the larger blue leg veins or vascular flares, Dr. Newman typically administers microsclerotherapy after first using Veinwave to first slow down blood flow. This reduces the risk of vascular matting, which can occur in about 20 to 30 percent of patients around the main vein and result in undesirable pink skin discoloration.

"If you can get a needle into it, then get a needle into it. If not, then Veinwave it," he summarizes, adding that any vascular surgeon doing sclerotherapy could benefit from adding Veinwave to his or her armamentarium of vein treatments. Veinwave offers the benefit of treating leg areas that are otherwise inaccessible, such as the ankle and behind the knee.

To go above and beyond vein clearance as it appears to the naked eye, Dr. Newman uses cross-polarized lighting during Veinwave procedures. This allows him to see microblood vessels and microcirculation that are not visible under traditional lighting so he can direct the device appropriately. He also uses cross-polarized lighting for annual "tune ups" of any new veins that appear after initial treatment. In the eight years he has been treating patients with Veinwave, he says the clearance rate hovers around 90 percent on face veins with recurrence rates being, "very, very small" on the veins treated.

If rosacea redness accompanies the fine red facial veins, Dr. Newman addresses the underlying infection first before treating with Veinwave. He skips the traditional antibiotics other clinicians might prescribe in favor of a four- to six-week course of 20 percent azelaic acid cream applied prior to Veinwave treatment.

"Antibiotics are a waste of time," he comments but explains that the underlying infection associated with rosacea must be addressed. Redness is the result of excessive sebum production in sweat glands, leading to gland blockage and infection. As blood flow increases to fight off the infection, the result is skin redness and sometimes patchy dry skin because sebum production is inhibited.

While Dr. Newman says traditional antibiotics, "work for a while, the cause is still there; the blockage of the sweat glands." He finds that azelaic acid unblocks the glands, clears up the infection, and clears away dead keratin layers, whiteheads, and blackheads.