Tallying up the hours logged over a long career, Claudia Leoni figures she has spent 15 solid years on her feet, working among some of the most appearance-conscious and observant people around. The sort of people who don't hesitate to take action when they see something in the mirror that's aesthetically not right.
"Working all this time in a hair salon, I see people who've had all sorts of cosmetic procedures done -- big things," said Leoni, 55, of San Marino. "I've also seen how happy those changes can make them."
Leoni wanted to do something smaller. Since high school, she'd noticed faint violet webs peeking through the thin, delicate skin on her legs. Later, as a young mother with three children and a job, she didn't have time to worry about the veins. Yet the purple traces only got darker and longer with time, some beginning to bulge at the surface. One day her 7-year-old daughter suggested that she "grow hair on your legs like Daddy" to cover the tracks.
"She wasn't trying to be funny," Leoni said. "She was serious."
Contrary to common perception, varicose veins are not reserved for waitresses, hairdressers, bellhops and others who work on their feet. The bulging vessels tend to run in families, developing over time as valves that help blood move through the body's vascular system begin to weaken. This allows some blood on its way up the vessels to the heart to back up, putting pressure on vein walls. By middle age, 50% of women and 20% of men have some varicose veins, usually in the legs. If left untreated, the veins can lead to aching, swelling, discoloration and poor circulation.
Leoni did everything she could to manage the condition. Because aerobic exercise can soothe and sometimes hide varicose veins, she maintained good muscle tone by playing tennis. She regularly wore support hose, which helps keep the veins in their place. She elevated her feet when possible, and tried to watch the number of hours she spent on them. Yet in the end these measures were modest checks against the flow of time. When surface veins become prominent, and sore, the only remedy is to close them off or remove them. "If you don't get rid of them, they just keep coming back and getting worse, especially if you're spending all day standing," said Dr. Han Lee, director of dermatologic surgery at the USC School of Medicine.
Doctors usually begin by examining the blood flow in veins, using ultrasound imaging technology. If there is a significant amount of blood backup and poor circulation, especially involving deeper veins, they often recommend a procedure called stripping. The term is descriptive: Surgeons cut into the leg, tie off neighboring veins and peel away the bulging varicose one. The surgery can take several hours and cost $2,000 to $4,000 per leg, which insurance may cover if circulation is the issue. The blood re-routes itself around the missing links in its network.
When a varicose vein is large but not causing circulation problems, doctors may opt to simply pull it out, using small hooks inserted through tiny cuts in the skin. This $1,000 to $1,500 operation, called a phlebectomy, usually takes less than an hour and heals within days, said Dr. Ronald Moy, a dermatologist at UCLA. "The stab insertions in the leg are so tiny we don't even suture them," Moy said. "There's some bruising and swelling, but usually not enough that you need painkillers."
In some cases, doctors may use newer technologies, such as lasers or radio wave probes, to eliminate the vessels.
Yet by far the most common answer for the flares of "spider veins" and longer, threadlike superficial vessels Leoni had is destruction by injection. Along each vein, dermatologists inject a solution that causes vessel walls to collapse. The veins wither, and blood is rerouted. The procedure is called sclerotherapy. "There's a little pain from the injections," said Lee, "but it's like little pinches, it's not bad at all." Anesthesia typically is not needed, Lee said.
Leoni's treatment took half an hour. After the injections, doctors covered the treated areas in cotton and taped them tightly. They then fitted her with a pair of thick, tight stockings and instructed her to wear them for several weeks, to make sure the vessels didn't reopen. The tights also provided cosmetic cover; bruising is common in sclerotherapy, and often the veins darken at first and take weeks to disappear. Total cost: $400, out of pocket. Insurers usually do not cover cosmetic vein removal, doctors say.
As it happened, Leoni was ready to show off her legs after a few days. "The tights were very uncomfortable, and my legs healed quickly," she said.
Weeks later she saw that some of the veins still showed, however, and she was back in the dermatologist's office for another series of injections and another $400 bill. Repeat visits are the rule when it comes to sclerotherapy. To clear the legs of varicosities large and small, dermatologists may have to perform four or more series of injections, according to Moy. The treatment generally holds up for a year or two, but over time withered veins tend to reopen.
"You have to think of it like Botox injections or collagen -- a cosmetic procedure you need to touch up occasionally," Lee said.
Certainly that was the case for a busy hairstylist. More than a year after her last treatment, some of the veins reappeared and Leoni made an appointment to see Lee. Summer's on the way, she said, "and it's too hot not to be able to wear shorts and skirts."