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Frequently Asked Questions and Answers About Varicose Veins and Venous Dilation

Question) If veins are visible in the legs, does that mean they are all varicose veins?

Answer) Not all of them are.

In people who are naturally thin-skinned or have large blood vessels, veins may be visible even when the venous system is normal.

However, even if there is no abnormality in the venous system, if capillaries or larger veins are visible under the skin and are unsightly from a cosmetic standpoint, you may want to consider treatment to make the veins less visible.

Question) Can varicose veins be treated with a laser?

Answer) No, they cannot.

In the case of very fine capillary dilations, a pigment laser may be effective, but larger vessels beyond that size are not responsive to laser treatment.

At present, there is a method for treating thick veins by inserting a laser catheter and burning the inner wall of the vein with a laser, but in terms of effectiveness, it does not produce as clean a result as surgery. In addition, because treatment is difficult for veins that are too large or too small, its indications are more limited than surgical treatment.

In advanced countries, surgical treatment for varicose veins is widely used, while lasers are rarely used because of various side effects and limitations in use.

Question) If sclerotherapy is used, will unsightly veins disappear?

Answer) The sclerosing agents currently in use are drugs whose safety has been proven. Their effect can be seen immediately after the sclerosing agent is injected into the vein, and usually good results can be achieved with about one or two treatment sessions.

If the area is small, just one treatment session may be enough to achieve the desired effect.

Question) I heard that sclerotherapy recurs easily. Is that true?

Answer) If you simply see a visible vein and undergo sclerotherapy without proper evaluation, that is not appropriate.

Before that, the exact cause of the varicose veins must be identified through Doppler ultrasound in order to achieve a cure.

In other words, recurrence can be prevented only when the exact area of venous reflux is diagnosed and both the underlying cause and the localized dilated veins are treated at the same time.

If only sclerotherapy is performed without treating the source of the reflux, it will continue to recur.

Question) Is treatment only possible for the legs, and not for the hands, arms, or face?

Answer) Veins may be visible on the hands, arms, or face. This can be said to occur more because of a person's constitution than because of varicose veins.

In overweight people, the veins are buried deeper and are not easily visible, while in thin people the veins show more easily, which explains the difference.

These cases can also be treated with sclerotherapy.

Question) Does surgical treatment leave many scars?

Answer) In the past, conventional surgical methods were performed under general anesthesia and left many scars. The treatment methods currently used involve making about a 2 mm incision at each site under local anesthesia, so scars are barely left behind.

Question) The hospital recommended surgery, but I do not want surgery. Is there another option?

Answer) Surgery is indicated when venous reflux is severe.

However, depending on the diameter of the vessels, treatment can be done without surgery using ultrasound-guided sclerotherapy.

If reflux is severe, surgery is unavoidable, but an accurate ultrasound diagnosis is needed to determine which procedure should be performed.

Question) If sclerotherapy is performed on the legs, do I absolutely have to wear compression stockings?

Answer) In the case of leg varicose veins, wearing medical compression stockings after sclerotherapy can produce better results.

After the sclerosing agent is injected, the vein must be compressed so that fibrosis can occur in the inner wall of the vessel for treatment to be complete.

During this period, appropriate compression of the vein is needed to achieve the maximum effect.

They are usually worn for 3 to 6 weeks.

However, for very small areas or small capillary dilations, they do not need to be worn.

Question) Won't compression stockings feel too tight and uncomfortable?

Answer) Not at all.

Medical compression stockings are ergonomically designed to help venous return, so they provide a comfortable fit.

Their purpose is different from that of ordinary medical compression stockings.

After wearing them, they help improve circulation in the legs.

At our clinic, we import and use German Sigvaris products, which are certified by the European Textile Association (EMPA).

Question) Do I need to lie down after surgery or sclerotherapy?

Answer) No.

Doing appropriate exercise for 1 to 2 hours a day actually speeds recovery and helps venous circulation.

You can return to normal daily life immediately after surgery or sclerotherapy.

Frequently Asked Questions and Answers About Calf Reduction Surgery

Question) Is calf muscle retraction surgery a procedure that anyone can undergo?

Answer) Calf procedures are absolutely not something just anyone can undergo.

As with all surgeries, the results vary depending on the surgeon's experience and expertise.

Simply having the equipment does not mean everyone can perform the procedure well.

The same applies to calf retraction surgery: success or failure depends on how the procedure is performed.

If the nerve block is not done properly, there will be no effect or the nerves may regenerate and the problem may recur.

The key to nerve blocking is to find many nerve branches quickly and perform definite electrocoagulation to reduce the recurrence rate.

Blocking just one or two nerves will not cause calf retraction.

Many people think calf procedures are simple, but that is absolutely not the case.

Question) Is ultrasound-guided selective nerve block performed only at this hospital?

Answer) Conventional nerve block procedures have a high recurrence rate, so ultrasound-guided selective nerve block was developed as an improvement.

Even if another hospital introduces a nerve block device and ultrasound at the same time and can perform the procedure, simply having the equipment does not mean the procedure can be done.

The experience and skill of the practitioner are important.

Except for our clinic, there are no hospitals that perform ultrasound-guided selective nerve block.

We are the only hospital that performs non-incisional ultrasound-guided selective nerve block.

Question) During calf muscle retraction surgery, other hospitals do it under local anesthesia, but do I really need sedation?

Answer) Nerve block for muscle retraction requires sedation.

When the nerve is electrically coagulated with a nerve locator, heat of around 100°C is generated and the nerve is blocked, and this heat causes pain.

Therefore, if sedation is not used, the procedure cannot be performed because of pain.

In addition, local anesthesia is also used during calf procedures, but this only numbs the skin layer where the needle enters; it does not numb the muscle itself, so it is essentially ineffective anesthesia.

If the muscle is anesthetized, the muscle will not respond to the nerve locator, so the procedure cannot be performed.

There are cases at other hospitals where the procedure is performed without sedation, yet the pain is minimal and the procedure is tolerable.

The reason is that the heat used during electrocoagulation is kept weak and the procedure is performed at a low temperature, so there is little pain.

In such cases, the nerve is not properly electrocoagulated, so the procedure either has no effect right after treatment or appears to work only temporarily before the calf bulge returns within a few months.

A poorly done procedure using weak low-temperature heat will recur 100% of the time, so caution is needed.

Question) How much volume does calf muscle retraction surgery reduce?

Answer) As the muscle volume decreases, the calf becomes slimmer, but the degree varies from person to person.

The more muscle volume a person has, the greater the reduction. If the volume is smaller, the reduction is also smaller.

A simple example is the difference between the extent of change when a balloon is inflated a lot and then deflated, versus when it is inflated only a little and then deflated.

Question) Are calf reduction surgery and muscle retraction surgery different?

Answer) The meaning of calf reduction surgery is broad.

Since it means reducing the calf, it includes muscle retraction surgery and liposuction.

In a broader sense, it includes calf plastic surgery.

This includes all types of plastic surgery such as muscle retraction surgery, liposuction, lower extremity varicose vein surgery, and scar revision.

In other words, calf reduction surgery falls within the scope of overall calf plastic surgery, and within reduction surgery are muscle retraction surgery and liposuction.

Question) Are calf muscle retraction surgery and nerve block surgery different?

Answer) They can be considered to have the same meaning.

Muscle retraction surgery is a comprehensive term.

Since muscle retraction surgery means reducing the calf muscles, the method used for this is nerve block surgery.

In other words, because muscle retraction is achieved by using the method of nerve block surgery, they can be considered the same.

Question) What is the most effective calf muscle retraction surgery method?

Answer) Although various methods have been developed and performed so far, the most effective procedure is ultrasound-guided selective nerve block.

It is an advanced version of selective nerve block, and the biggest problems with the conventional method were that it was difficult to locate the nerves and that it was difficult to recheck and treat the same area once the nerves were found.

As a result, the effectiveness of the procedure was reduced and the recurrence rate was very high.

Ultrasound-guided selective nerve block was developed to address these issues.

Because the nerves are directly identified on the ultrasound screen during the procedure, they can be found more accurately and quickly, and the same area can be checked and treated again, which has the advantage of bringing the success rate close to 100% and significantly lowering the recurrence rate.

In addition, because it causes almost no damage to other tissues, swelling and pain are minimized and recovery is faster, among many other advantages.

Question) What are the problems with the conventional selective nerve block procedure?

Answer) The foundation of selective nerve block is to retract the muscle without causing scars or damaging the muscle.

The biggest problem with the conventional selective nerve block procedure was that, in order to find invisible nerves, the practitioner had to probe here and there with a search needle to locate the hidden nerves.

As a result, finding the nerves was very difficult, it took a lot of time, and if the nerves were not properly found, the effectiveness of the procedure decreased and recurrence occurred easily.

Although selective nerve block is theoretically an ideal method for retracting muscle with minimal scarring and minimal tissue damage, the actual results do not meet expectations.

Therefore, ultrasound-guided selective nerve block can be considered the best alternative.

Question) What is the difference between medium-frequency radiofrequency muscle retraction surgery and selective nerve block?

Answer) Both procedures have the same purpose: retracting the muscle.

The difference lies in the method. Medium-frequency radiofrequency treatment reduces muscle volume by directly burning and necrotizing the muscle, while nerve block treatment differs in that it causes the muscle to atrophy naturally by blocking only the nerves going to the muscle without causing much damage to the muscle itself.

In other words, the difference is between directly burning the muscle to reduce it and blocking only the nerves going to the muscle to reduce it.

Question) What are the problems with medium-frequency radiofrequency muscle retraction surgery?

Answer) Medium-frequency radiofrequency treatment is a method that directly burns and necrotizes the muscle.

Tissue damage is severe, and side effects and aftereffects occur frequently.

Severe swelling and pain, inflammation due to tissue necrosis, leg curvature, and depressions caused by concurrent necrosis of fat tissue may occur.

In addition, the effect of reducing volume is not great, so it is not a recommended method for calf muscle retraction surgery.

Question) What are the side effects of selective nerve block?

Answer) These are problems that occur when the practitioner lacks experience and skill.

Side effects include blocking the wrong nerve and reducing leg strength, damaging sensory nerves and causing sensory impairment, severe pain caused by damaging tissues other than nerves, curvature or asymmetry caused by incomplete nerve block, and tiptoe side effects caused by incorrect instructions after the procedure.

However, if the procedure is done properly according to the correct principles, there is no need to worry about these side effects.

Question) Does selective nerve block leave scars?

Answer) Since it is not surgery with a scalpel incision, but a procedure using a 1 mm blunt-tipped search needle, scars are almost never left behind.

There may be a 1 mm mark at the treatment site, but it is too small to be noticeable, so it cannot be considered a scar.

Therefore, there is no need to worry about scars.

Question) I heard that a side effect called tiptoe, where the heel does not touch the ground, can occur after the procedure. Why does that happen?

Answer) The tiptoe side effect, where the heel does not touch the ground, is caused by wearing high heels continuously right after the procedure.

It is not a side effect caused by a poorly performed procedure.

If the tiptoe side effect occurs, you should walk around barefoot as much as possible so that the tightened muscle stretches and lengthens again.

Walking barefoot indoors or wearing shoes with almost no heel outdoors will naturally stretch and straighten the muscle.

After the tiptoe side effect appears, if you take off your shoes, walking may become uncomfortable, making it unavoidable to keep wearing high heels.

But that will only make the symptoms worse.

In the early stage of the tiptoe problem, the best approach is to quickly stop wearing high heels, switch to shoes without heels, and keep practicing walking until the muscle lengthens and straightens again.

Usually, if you practice walking in shoes without heels for up to 6 months after the procedure, the tiptoe problem will resolve on its own in most cases.

In conclusion, if you do not wear high heels for about a month after the procedure, this side effect will not occur.

Question) Other hospitals say that even if you wear high heels immediately after the procedure, tiptoe side effects will not occur. Is that true?

Answer) After the procedure, as the muscle atrophies, the muscle shortens, which causes the tiptoe side effect, and high heels are the main trigger for that.

When you wear high heels, the muscle contracts and its length becomes shorter, which causes the tiptoe side effect.

However, among people who underwent procedures at other hospitals, most do not develop tiptoe side effects even if they keep wearing high heels right after the procedure.

The reason is that the procedure was not done properly, so the muscle did not atrophy, and therefore the tiptoe side effect did not occur either.

In other words, it is the same as someone who did not undergo the procedure continuing to wear high heels without developing a tiptoe side effect.

If you keep wearing high heels right after a calf procedure and do not develop a tiptoe side effect, that proves the procedure had almost no effect, and if you check your calves, the original bulge will likely still be there.

Question) When can normal daily life be resumed after selective nerve block treatment?

Answer) After selective nerve block treatment, normal daily life is possible from the next day.

On the day of the procedure, the leg may feel slightly weak and sore.

However, you can fully return to daily life from the next day, and you only need to wear the compression band provided by the hospital for about a week.

Question) What happens if recurrence occurs after the procedure?

Answer) Recurrence after general selective nerve block is very common.

Some hospitals have recurrence rates higher than 80%.

In other words, if 10 people undergo the procedure, 8 to 9 will recur, and if the recurrence rate is that high, the procedure has no real value at all.

The non-incisional ultrasound-guided selective nerve block at Duhan Plastic Surgery's Calf Plastic Surgery Clinic was designed to reduce recurrence as much as possible.

Currently, the recurrence rate at Duhan Plastic Surgery's Calf Plastic Surgery Clinic is below 3%, and we continue to research and work tirelessly with the goal of reducing the recurrence rate to 0%.

If recurrence does happen, we provide a repeat procedure to correct it.

Question) If I had a recurrence after selective nerve block at another hospital, can I have the procedure done again here?

Answer) After nerve block treatment at another hospital, the recurrence rate is high, and when recurrence happens or there is no effect, many people resign themselves to thinking it may be due to their constitution.

In cases of recurrence, constitutional factors are only a minority.

Most cases are caused by the practitioner's lack of experience and skill, or by insufficient equipment.

Once a procedure has been done, the tissue becomes firm and dull, so the nerve often does not respond to the nerve locator.

If the nerve does not respond, its location cannot be identified, so the procedure cannot be performed.

Therefore, for a repeat procedure after recurrence, good results can only be achieved by directly locating the nerve with an ultrasound imaging device and performing the treatment that way.

After recurrence, repeat treatment can only be properly performed with ultrasound-guided selective nerve block.

Question) I had medium-frequency radiofrequency treatment at another hospital but did not see any effect. Can I receive nerve block treatment here?

Answer) Medium-frequency radiofrequency treatment is a method that directly burns the muscle with a cauterizing device to cause necrosis, but in most cases the effect is weak or recurrence occurs.

In some cases, a difference in height between the treated and untreated areas can also cause curvature.

Even in such cases, non-incisional ultrasound-guided selective nerve block can be performed.

Because nerve block treatment causes almost no damage to the muscle and blocks only the nerves, it can induce natural muscle atrophy and create a natural shape even in cases with recurrence or curvature.

Question) I have had all kinds of procedures at other hospitals, including nerve block and radiofrequency treatment, but why is there still no effect?

Answer) As with all surgeries, the results vary depending on the surgeon's experience and expertise.

Without ultrasound equipment, repeat nerve block treatment is almost impossible.

Medium-frequency radiofrequency treatment itself is not a procedure that can produce major effects for calf muscle retraction surgery.

The lack of effect is due to choosing the wrong procedure and the practitioner's lack of equipment, experience, and skill.

Proper treatment can produce permanent results with just one procedure.

Even if you have failed after many procedures at other hospitals, at our clinic you can usually see satisfactory results with just one procedure.​

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