Frequently Asked Questions

Dr. Joan L. Warren, M.D. answers your most commonly asked questions about vein disease and treatment. Click on a question to learn more.

Vein Disease & Treatment

Types of Vein Disease

Spider veins are small, thread-like veins resembling a spider's web that are easily visible through the skin. They appear when tiny, one-way valves inside the veins weaken. When veins are healthy, these valves push blood in one direction, back to the heart. If these valves weaken, some blood flows backward and pools in the vein. Over time, this extra blood can cause the walls of the vein to weaken and bulge, resulting in spider veins and also vericose (large, rope-like) veins. Spider veins can be caused by sunlight, hormone changes, injury, pregnancy, or develop with age. If you sit or stand for extended periods of time, you are at greater risk of developing spider veins. Pregnant people and people over 30 can also develop spider veins.
Varicose veins are large, raised, swollen blood vessels that have a "rope-like" appearance. They can appear anywhere on the body but most commonly appear on the legs or pelvic area. Varicose veins (varicoses or varicosities) happen when your veins become overfilled with blood. Like Spider Veins, these veins have one-way valves which direct the flow of blood to the heart. If these valves become damaged, blood collects in the vein instead of moving to the heart, causing the vein to swell. Varicose veins are often discolored and may cause pain, swelling or a "heavy" feeling over or around the enlarged vein. In severe cases, the veins may bleed significantly, and ulcers may form. Varicose veins can be caused by pregnancy, menopause, normal aging, standing for long periods of time, obesity or if you have a family history of varicose veins.

Treatments for Vein Disease

Duplex Ultrasound is a pain-free, non invasive test for a phlebologist to see the anatomy and check the flow characteristics of the veins beneath your skin. Useful information is then gathered and used to adequately diagnose your specific vein problem and to plan and guide treatment.
Laser is light energy, which can be used to seal shut abnormal main superficial trunk veins (GSV/SSV/AASV veins being most commonly diseased). Heat energy is used inside of these veins. When sealing the GSV (abnormal in 70% of people with varicose veins), usually treatment starts at a location in the vein around the knee. It is then treated from its junction to the deep system at the level of the groin down to the entry site near the knee. Ultrasound guided injections may be used to complete the closure of the GSV below the insertion site if also diseased.
Sclerotherapy is the treatment of varicose veins by injection of the veins with chemicals that cause their destruction. Spider veins generally disappear in three to six weeks, while larger varicose veins may take three to four months to respond. Many patients who have this treatment for cosmetic reasons also notice their legs feeling less tired and heavy especially at the end of the day.
The majority of patients have no complications from sclerotherapy. Some patients can develop changes in skin pigment in veins injected. This is usually a temporary side effect with 90% of this “staining” disappearing after 1 year and 98% after 2 years. Less commonly, patients can develop new, superficial tiny blood vessels in previous areas injected. This “matting” usually dissipates over time if all sources of reflux have been eliminated surrounding the involved area. Serious complications such as skin ulcerations, anaphylaxis (allergy) to sclerosant, deep vein clots, and unintentional arterial injections are extremely rare. This procedure requires a high degree of technical skill and special training to get the best results with fewest amount of complications.
Visual Sclerotherapy vs. Ultrasound Guided Sclerotherapy: What is the difference? Visual Sclerotherapy Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye. Ultrasound Guided Sclerotherapy Ultrasound Guided Sclerotherapy is used to treat veins that are below the surface of the skin. These veins cannot be injected safely without assistance from an ultrasound image of the vein.

What Happens After Treatment?

The backward flow of blood in varicose veins and main superficial trunk veins (greater saphenous vein- GSV, small saphenous vein- SSV, anterior accessory saphenous vein-AASV), actually interferes with the normal venous return of blood. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated leg. It is this improvement in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.
For the treatment of visible veins to last awhile, the source that may not be visible to the naked eye must be controlled as well. Some insurance carriers will not pay for treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.
Yes, for a time. Gradient compression stockings are used to prevent Deep Vein Thrombosis (DVT), during long plane flights and car/bus rides. This is especially important for people with varicose vein disease because they may have an increase risk for getting DVT. They can also temporarily reverse the effects of vein disease by lessening the discomfort, heaviness, swelling, and skin changes. They do this by improving blood flow back to the heart especially during leg muscle contractions. Many insurance companies require a trial of compression stockings before approving other more definitive therapies. Compression stockings are also used to prevent and treat ulcerations caused from chronic venous insufficiency and in some patients with a DVT to hasten its resolution and prevent complications.

Prevention: What You Can Do

Getting plenty of exercise is the best way to ward off spider or varicose veins. Exercise helps keep your weight under control and your leg muscles toned, so your blood flows freely. Avoid sitting and standing still for long periods of time. If your job prevents frequent walking, stretch your leg muscles often to increase circulation.
Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need “maintenance” treatments after their initial treatment is completed.


VeinGogh™ uses a small stylus that contains a hair-like fiber which is inserted into the vein to be treated. Once inside, a microburst of controlled heat is applied directly inside the vein. The heat damages the walls of the vein, causing it to seal shut and eventually collapse. As your body heals the collapsed vein is absorbed and the blood flow is rerouted through nearby healthy veins.
Some of our patients experience mild redness around the treatment area; this is common and generally disappears a few days after treatment. Aloe can be applied topically after your treatment to reduce redness and aid in healing.
VeinGogh™ is an alternative for veins which are too small to be treated using sclerotherapy or laser ablation, and offers greater flexibility in treating skin imperfections other than spider veins.
Patients tell us that discomfort during the procedure is tolerable. Some feel the treatment is more intense in sensitive areas, such as the nostrils or near the eyes, and report a feeling similar to having a hair plucked from the chin or eyebrow when the needle is inserted. A topical anesthetic can be applied to the treatment area to minimize discomfort if needed.
Most patients see results after a single treatment; however, other patients require a series of treatments to achieve full results. During your consultation, Dr. Warren will discuss available options and treatment plans to help you decide on the one that's best for you.
VeinGogh™ is an outpatient procedure; there is little to no downtime. Most patients see results after the first treatment and those results continue to improve over time. Your results will depend on how long it takes the treated vein to close and collapse.
The VeinGogh™ Ohmic Thermolysis system can be used on any type skin and has fewer complications and side effects.
Skin Rejuvenation Treatments

Perfectio LED Facial Treatment

The end of the Perfectio wand features 25 red and infrared LED lights which function at wavelengths ranging from 640 to 840nm. In this range, the gently pulsing lights penetrate deep through the dermis, the epidermis and the hypodermis layers of your skin without emitting harmful UVA or UVB rays or heat. The lights stimulate arteries in the direct area to release nitric oxide gas, which signals vessels to dilate. The increase in blood flow brings more vital nutrients to cells and connective tissue in the area. This abundance of nutrition causes collagen, elastin and new skin cells to be repaired or replaced.
There do not appear to be any side effects associated with this treatment.
The Perfectio LED Facial Rejuvenation treatment is suitable for the face, forehead and around the eyes.
Unlike other anti-aging treatments, Perfectio LED light therapy is gentle, painless, safe, non-invasive and non-abrasive.
This treatment is non-invasive and there is generally no downtime, so most patients resume normal activity directly following treatment. Dr. Warren will advise you, based on your skin's unique needs, if any special precautions need to be followed after treatment.
The majority of patients see results after the first treatment. You may need additional treatments depending on your skin type. This treatment improves sunspots, age spots, dull complexions, uneven pigmentation, large pores, sun damaged skin and early signs of aging on all skin types.
This treatment is safe for all skin types and skin tones.
No. Perfectio LED Facial Rejuvenation treatments are safe for everyone.

EndyMedPro™ 3Deep® iFine

EndyMedPro™ 3Deep® iFine treatment gradually heats the deep layers of the skin to encourage new collagen formation, reducing wrinkles while tightening and firming the skin over time.
An EndyMedPro™ 3Deep® iFine treatment can improve sagging, wrinkled skin; improve skin tone and texture; reduce wrinkles and fine lines; and supports long-term collagen remodeling.
The iFine handpiece is specifically designed to treat the delicate tissue around your eyes and mouth. This includes above the eyebrow; under the eyebrow; below the eye; corners of the eyes; and fine lines around the mouth.
There is some discomfort but it is very minimal and most tolerate treatment very well.
Most patients experience no side effects and little to no downtime after treatment.
Yes! We recommend mineral make-up.
The high safety profile of the EndyMedPro™ 3Deep® iFine treatment makes it suitable for all skin types.

Laser Hair Removal

The eLaser can treat large zones very fast, and there are fewer clients excluded based on skin type or hair color. It has two energy sources which selectively target the hair follicle while minimizing unwanted side effects, such as superficial burns to the skin. Other lasers indirectly heat the hair shaft by superheating the melanin, hoping for collateral damage.
Laser hair removal is most commonly used to remove unwanted hair on the upper lip, chin, neck, breasts, stomach, arms, shoulders, bikini area, legs and back.
The total number of visits varies from person to person and upon the area being treated. Most people achieve satisfactory clearance after 5 or 6 treatments but individual results depend on medical and genetic factors. Lighter and finer hair may require more visits than darker and coarser hair. There are more hair follicles in facial hair, often requiring 7-8 treatments.
The laser target is hair in the active phase of growth only, so visits should be made every 4-6 weeks for most areas.
Patients tell us the sensation is like a “snapping” feeling. You may also feel warmth or a tingling sensation for a short time afterward. An external cooling device is used to minimize discomfort.
Patients should avoid tanning the area 2 weeks before treatment and a few days following the treatment. Deeply tanned skin should be treated 4-6 weeks after sun exposure.
Currently there is no hair removal method that can provide permanent hair removal. After several laser hair removal treatments, you should experience a substantial reduction in the amount of hair and when the hair does grow back it will often be finer and lighter.

EndyMedPro™ 3DEEP™

EndyMedPro™ 3DEEP™ targeted skin therapy implements the interaction of multiple energy sources for controlled delivery of energy to the dermis and hypodermis. The unique energy delivery mode minimizes the risk to the skin surface or surrounding tissue for an optimal aesthetic result. Selective phase-controlled heat delivery to the collagen fibers results in an immediate skin tightening followed by a second stage of collagen remodeling for anti-wrinkle effect.
Your skin may be pink for a short period after treatment but this will quickly fade.
A 3DEEP™ treatment can produce effective results on your tummy, hips, thighs and flanks (area between the last rib and the hip).
Due to the advanced technology of the 3DEEP™ handpiece, there is a gradual, gentle heating of the skin that most of our patients say is very relaxing.
You can expect little to no recovery time. You may experience redness of the skin around the treatment site, but this is a temporary side effect that will lessen in a few days. You may resume normal activities immediately following your treatment.
You can return to your normal activities as no special after-treatment care is necessary. The rapid contraction of collagen fibers will make your skin look firmer, but the benefits of treatment are progressive. You will generally notice the greatest benefit within 2-to-3 months after a series of treatments.
All skin tones from fair to dark tones or tanned skin can be treated with 3DEEP™.
You should NOT receive 3DEEP™ treatments if:

► You have epilepsy
► You have been fitted with a pacemaker
► You have metal implants in your body, including dental implants
► You are pregnant or breast-feeding
► You have a history of keloid or hypertrophic scarring

EndyMedPro™ Intensif

The EndyMedPro™ Intensif device uses sophisticated technology to direct precisely controlled radio frequency (RF) waves into the deepest layers of your skin, stimulating new collagen production and resulting in improved appearance of skin texture.
You might experience a slight redness (like a mild sunburn) in the treatment area but this generally fades in a few days.
The EndyMedPro™ Intensif treatment is most often used to tighten skin on the face, neck and upper arms but it can also be used to treat cellulite on the thighs, hips and back.
Our patients tell us the treatment is like having a warm massage and that it is very relaxing! The EndyMedPro™ Intensif handpiece features tissue sensors and an on-screen readout, which Dr. Warren carefully monitors during your treatment. The advanced technology of the handpiece allows for customization for your individual body area and skin characteristics, ensuring your treatment will be safe, effective and pain-free.
Some patients experience slight redness in the treatment area for a few days, although the majority of our patients heal completely in 24-48 hours.
We recommend not wearing makeup for 2-to-3 days following the procedure, although this can vary depending on the type of treatment you receive.
EndyMedPro™ Intensif treatments are safe and suitable for any skin type or color.

Laser-Assisted Liposuction

Laser-Assisted Liposuction is for people who are in good health, have an active lifestyle and have pocket(s) of fat that they just haven’t been able to get rid of with normal diet and exercise.
If you have any of the following conditions, you are not a good candidate for Laser-Assisted Liposuction:

►  Liver Problems
►  Blood Disorders
►  Kidney Problems
►  Heart Problems
►  Skin Disorders
►  Upper Abdomen
►  Lower Abdomen
►  Waist
►  Chin (Double or Hanging Chin)
►  Inner and Outer Thighs
►  Upper Arms
►  Male Breast Tissue (Gynecomastia)
The procedure is excellent for removal of localized fat, and as much as 3,500 mls of fat can be removed at a single session.
The fat removal is semi-permanent. If you gain weight, some fat cells will enlarge in areas treated and not treated with the laser. Despite what the manufacturers and the doctors claim, there is no treatment, which can permanently remove all the fat cells. The best way to have permanent fat removal is to continue exercise and watch your diet.
The procedure is done in the office. Prior to the procedure, the fatty areas are marked and a local anesthetic is used to numb the area. The laser is a pen-held device, which is fired close to the skin. As soon as the laser is fired, the fat cells break up. The fluid released is removed with a suction cannula in areas numbed by a local anesthetic. The laser also causes small blood vessels to coagulate (gel) immediately on contact, resulting in less bleeding and swelling. The laser also affects the collagen in the skin. The procedure causes the skin to tighten and shrink giving a pleasing appearance. Each session takes 1 – 3 hours.
You may experience minimal bruising, but the procedure itself is basically pain-free. A pressure dressing or a compression garment is applied depending on the location of the treated area. The compression dressing or garment helps to decrease the swelling and set the treated area in place. Dr. Warren will determine how long you should wear the garment or dressing and most people resume normal activities in a day. The bruising disappears in 7-10 days. The mild ache can be relieved with over-the-counter pain medications.
Soon after the laser liposuction procedure, the treated area will appear tighter, compact and smaller. Within the next 6-8 weeks, the skin and surrounding area will remodel and adjust to the body contour. The remodeling is a gradual process and the best results are seen after two months.
In most cases you should be able to return to work within 24 hours.
►  Laser-Assisted Liposuction offers minimal discomfort during the procedure.
►  There is minimal pain after procedure, improved by over the counter medications.
►  Majority of individuals can return to work in 24 hours.
►  There is minimal bleeding or bruising.
►  There is little to no loosening or hanging skin after the procedure.
►  There are no side effects of general anesthesia.
►  This is a minimally invasive procedure with no suturing involved.
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