Ask the Doctor is a blog where Dr. Thomas Wright, MD answers your questions with his blog posts and your comments to this blog.
You can use the Category or Section links on the top and use the Search on the side to look for information relating to Veins, Liposuction, Surgery, Before and After.
As we age, our veins and overall cardiovascular system deals with greater and greater pressure as blood circulates from place to place throughout the body. Cardiovascular health is one of the most important aspects of overall health, and your veins are critical to your wellbeing.
The veins in your legs are some of the hardest working veins that you have anywhere in your body. When your leg veins are functioning normally, their job is to return blood to the heart. This is what all veins do throughout your entire body, allowing blood to be recirculated so that it can be enriched with life-giving oxygen again and again.
Under normal circumstances, the veins of your legs have one-way “flaps” that are crucial to their functioning. These flaps serve to ensure that as blood flows back up your legs, it can do so without flowing backwards. However over time, it can become very difficult for your legs to keep fighting gravity while returning blood to the heart.
Occasionally a vein becomes too weak to continue moving blood upwards on a regular basis. When this happens, the one way “valve” is slightly opened and the blood that courses through the vein flows backwards (“venous reflux”). That leads to a situation where the vein gradually becomes full of the blood that is moving incorrectly.
Over time, the vein becomes full of blood and as a result, the vein fills and becomes engorged and enlarged. It is this process of enlargement that creates the discomfort and the unattractive appearance of varicose veins.
Since there are many veins throughout the entire body, you do not need them all. One procedure for more superficial veins seals them using a chemical injection. This procedure is called sclerotherapy. This causes the damaged vein to close and be reabsorbed into the leg, eliminating the problematic vein. If you are interested in learning more about the treatments of varicose veins, contact Dr. Wright’s office at 636-614-1665 to schedule a consultation!
Laser liposuction, also known as laser-assisted liposuction, is performed as traditional liposuction, expect that it incorporates lasers. Traditional liposuction utilizes a cannula (a long, thin, hollow tube) to suction out unwanted fat through small incisions. The difference between traditional liposuction and laser liposuction is that a laser is used on the targeted area before the cannula and suction is performed. This improvement on traditional liposuction has been in use since 2006 with great benefit to patients.
The laser that is used during laser liposuction has the ability to deliver painless light energy to the unwanted fat and render it to a semi-soft state, which makes it incredibly easy to be sucked out by the doctor. The laser can also stimulate the production of collagen in treated areas, helping to tighten up the skin in that area, reducing the appearance of any sagging, loose skin.
What to Expect During a Laser Liposuction Procedure
Our laser liposuction procedures are performed on an outpatient basis, meaning that patients return to their homes the same day as the procedure, and many who have undergone laser lipo in St. Louis are able to return to work after a day. Since the procedure uses local anesthetic, the doctor must be gentle while permanently extracting the fat. This minimizes recovery time.
Before beginning the procedure, local anesthesia with light sedation is administered to help keep the patient comfortable throughout the entire procedure. Local anesthetic eliminates the risk and cost associated with general anesthesia and an anesthesiologist’s work.
After the administration of anesthesia, a special fluid containing a mixture of saline, anesthetic and epinephrine is injected in the areas where the fat is to be removed. Epinephrine constricts the blood vessels so blood loss is minimized. Once this special fluid has been satisfactorily injected, the laser is applied to those areas.
When the targeted fat has been sufficiently softened, the doctor inserts the cannula through tiny, carefully created incisions to suction out the fat. Since the patient is awake during the procedure, the doctor is able to see the patient move and gauge symmetry and ensure precise results. A constant overview ensures that the laser liposuction has effectively removed all targeted fat; if all the offending fat has been removed, gauze is applied to the tiny incisions and the entire treated area is wrapped with a compression garment.
Laser Liposuction Results
Although great results are noticeable immediately after the procedure, results will continue to reveal themselves in the following months. As mentioned above, laser liposuction can stimulate the production of collagen, which results in an overall tightening of the skin on the treated areas. In order to ensure that the most optimal results will manifest, patients should take care to wear their compression garments as directed.
Rivaroxaban’s approval was based mainly on results from three trials with a total of 9,478 patients randomized to Rivaroxaban, placebo, and Enoxaparin (Lovenox) combined with a vitamin K antagonist such as Warfarin (Coumadin).
The major adverse event with Xarelto is increased risk of bleeding, as is the case with other anticoagulant drugs. The studies also indicated that Rivaroxaban has a lower risk of bleeding events. For example, in the EINSTEIN-PE trial, reported earlier this year in the New England Journal of Medicine and at the American College of Cardiology’s annual meeting, 1.1% of patients on Rivaroxaban had major bleeding versus 2.2% with Enoxaparin. However the bleeding events when they occur may be harder to treat because there is no ready antidote to reverse the blood thinning effect of Xarelto if bleeding occurs.
Deep vein thrombosis is the formation of a blood clot in the deep veins. When a thrombosis detaches and subsequently travels to the lungs, it is called a pulmonary embolism. The conditions affect about 1 in 1,000 adults annually.
To contact Dr. Wright, please call (636) 397-4012
Dr. Thomas Wright of the Laser Lipo and Vein Center in St Louis, Missouri, has been chosen for a third time as one of the nation’s top physicians. He has been honored with the 2012 Patients’ Choice Award.
In this, his third consecutive year earning this accolade, Dr. Wright has received near perfect scores from his patients rating such areas as follow-up care, accuracy of diagnosis, the doctor’s bedside manner, the amount of time patients spend with the doctor and overall opinion.
“Treating our patients is truly an enjoyable experience,” says Dr. Wright. “We are pleased that our attempts to give them great health care and personal attention mean something to our patients. We are honored to have them come to us with their health needs.”
Dr. Wright is the Medical Director of the Laser Lipo and Vein Center in St Louis, Missouri. His practice specializes in vein treatment and cosmetic medicine, including liposuction, cosmetic surgery, body sculpting and treatment and diagnosis of vein disease.
Dr. Wright was one of the first two-hundred-plus surgeons in the United States to become board certified in Phlebology by the American Board of Phlebology. Dr. Wright received his undergraduate degree from Duke University in Durham, NC and completed his medical training at the University of Missouri at Columbia. He completed his residency at the University of Alabama Birmingham. He is also a registered medical sonographer, credentialed by the American Registry for Diagnostic Medical Sonography, and a Fellow of the American Society of Laser Medicine and Surgery, and a former Howard Hughes Research Fellow. Dr. Wright is a board-certified surgeon who has been performing cosmetic procedures for over ten years. He was trained in liposuction by the inventor of tumescent liposuction, Dr. Jeffrey Klein.
In addition to the 2010, 2011 and 2012 Patients’ Choice Awards, Dr. Wright has been accorded many other honors during his medical career. Some of these awards include election to the Alpha Omega Alpha Medical Honor Society, the American Medical Association Physician Recognition Award, and appointment as a Howard Hughes Research Fellow. In 2009, Dr. Wright was selected as one of St Louis Magazine’s TOP DOCS. TOP DOCS are chosen by physicians that have been previously honored. The selection represents the endorsement of the St. Louis medical community.
Of over 700,000 active physicians in the United States, only 5 percent received the prestigious Patients’ Choice Award in 2012. The voting takes place exclusively among patients.
To contact Dr. Thomas Wright of the Laser Lipo and Vein Center in St. Louis, Missouri, call 636-397-4012 or request a consultation online.
A: Polidocanol injection is used to treat small varicose veins of the lower legs and spider veins. It is a type of medicine called a sclerosing agent.This medicine is available only with your doctor’s prescription.
A: Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter) medicines.
A: Do not take Asclera if you have a thromboembolic disease. Also avoid it if you are allergic to any of the ingredients or have had an allergic reaction to polidocanol, Asclera’s active ingredient, in the past. Asclera has only been tested on veins measuring less than three millimeters.
A: Asclera, approved for use in early 2010, is a drug used to treat small varicose veins and spider veins or “thread veins” . It is a solution that is injected directly into the vein and is only used on veins less than 3mm wide. Asclera is a prescription drug administered by a doctor. The active ingredient is polidocanol.
I am a healthy 45yr old with no circulation problems. I’ll be taking long flights (Washington, DC to Bhutan) and wonder if I should wear compression socks as a precaution. Would drugstore grade be adequate or should I order medical quality?
A: There have been several studies that compression stocking help prevent blood clots from forming when you are immobilized as occurs on a long flight. The compression socks sold at drug stores, if they fit right and are at least
20mmHg pressure, will likely work.
I’m not sure what I need, what would you recommend for veins that are showing up in my cheeks?
A: There are several options available . The old standby is the Lyra or KTP
laser. It works, but it can take several treatments and it hurts.
The Veinwave which use Radio Waves works as well or better and is more
comfortable. IPL, Intense Pulsed Light, can help for veins but only on the
smallest veins . IPL also can help with skin pigment.
Can I wear compression stockings during my menstrual period?
A: Yes, wearing compression stockings during your menstrual period is OK and
should be encouraged.
I had EVLT preformed 3 weeks ago. When I went for the 2 week follow-up ultrasound it showed that the vein was still open and doctor said he needed to redo the procedure. Please advise – I thought this was a one-time procedure.
A: An EVLT is usually, 98% to 99% of the time, a one time treatment . That is 98-99% the vein is closed and stays closed for at least several years, that is as long
as we have data for, maybe for ever. Redo procedures do occur but they should be uncommon.
Are there higher risks for a patient with Factor V Leiden during the endovenous laser ablation procedure?
A: Endovenous Laser Ablation, ELA, has a very small but real risk of
complications such as DVT and or phlebitis. The risk is somewhere between 1
in 1000 and 1 in 10,0000 ELA will have that complication. Factor V Leiden
is an inherited disorder that increase the risk of phlebitis or DVT by 8
fold for patients heterozygous the disorder, have one copy of the gene, and
80 fold for patient homozygous have two copies of the gene. So yes there is
higher risk.
Should we increase the watts to compensate for a big vein?
A: There is some evidence that the size of the vein effects long term
closure . The best way to scientifically make this adjustment is to not
just keep track of the amount energy give per centimeter LEED , but also
the amount energy delivered per centimeter of length and per surface
are of vein wall { which is determined by its diameter} .This
is calculation is called the endovenous fluence and should be used to give
the optimal energy to have successful treatment of the vein. At this year’s
annual congress of the American College of Phlebology I presented a paper
that looked at what average endevenous energy densities which were
not successful and which were successful at 2 year closure of saphenous
veins. It is clear that the amount of energy delivered to a vein should be
increased for a larger veins.
![[del.icio.us]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/delicious.png)
![[Digg]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/digg.png)
![[Facebook]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/facebook.png)
![[Reddit]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/reddit.png)
![[StumbleUpon]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/stumbleupon.png)
![[Technorati]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/technorati.png)
![[Twitter]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/twitter.png)
![[Yahoo!]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/yahoo.png)
![[Email]](http://www.laserlipoandveins.com/askthedoctor/wp-content/plugins/bookmarkify/email.png)
