Podcast Episode 36: Bulging Veins on the Forehead

Welcome to this podcast on vertical forehead veins. Prominent vertical forehead veins are a cosmetic problem not a medical problem and for many years people have thought it's impossible to treat them. We don't know how many people do have this problem but we do know that famous celebrities such as Angelina Jolie have had photographs when they're smiling showing these large vertical forehead veins either one central one or two or more running up usually from between the eyebrows up to the hairline. These forehead veins are worse when people bend forward, lie down, in the heat, after exercise and of course after alcohol. All the things that can increase the dilation of veins particularly in the face and forehead. However for these forehead veins because venous drainage is actually from the hairline down towards the eyebrows and then across the cheeks. When patients or people smile this causes a bit of pressure on the veins in the cheeks and that leads to a swelling or back pressure up making the veins in the forehead bulge even more. Hence when people have vertical forehead veins that are a bit prominent and then they smile they become very prominent of course ruining photographs just the time when you don't want to have them showing. So what can we do about them? Well in the past people have tried sclerotherapy but as anyone who knows anything about the work we've been doing at the Whiteley Clinic on sclerotherapy we never recommend sclerotherapy on the face because there is the risk the sclerotherapy agent can actually go through the veins down and into the veins around the orbit on the outside of the eye and even can go inside through the orbit into the skull and cause a cavernous sinus thrombosis. Now although that's incredibly rare it isn't that uncommon to have problems such as pain in the thrombosis of the veins around the eye and there have been sewings of Therefore, we never recommend sclerotherapy for vertical forehead veins or indeed for any veins on the face. Other people have tried laser using external laser the same way that you might use on green veins or thread veins on the face. But this doesn't work because these vertical forehead veins are far far too big and deep for that sort of laser to work. and deep for that sort of laser to work and the cases that I've seen where people have tried that merely show scarring or even quite deep pits on the forehead skin where the skin has been burned. About five years ago or so I started trying to remove these veins using surgery and a little process called phlebectomy where under local anaesthetic the vein was hooked away. And unfortunately this is not very successful and what ends up happening is these veins tend to grow back again and so therefore surgical removal of these veins is not a good idea. A few years ago a colleague of mine Charles Esteves Pereira and myself invented a way of treating this with what's called endovenous laser ablation. And this is where we put a special laser fibre into the vein from just under the hairline, passing it down through the vein in the forehead under ultrasound control, putting lots of local anaesthetic around the vein and using a cooling for the skin. And then using a precise amount of energy, the vein can be ablated or closed permanently. Now, this is similar to the endovenous laser ablation that we have heard of in leg veins, but because it's cosmetic and in very small veins on the face, we have to use special laser fibres with special wavelengths, and we also have to have special equipment to get it into the vein safely. And because there's so much skill involved in this, we actually have a method patent applied for in the United States to actually show how this can be performed. So, how do we know it's safe? Well, we know it's safe firstly, because at the Whiteley Clinic, whenever we invent something new or try something new, we start off by taking it to the laboratory. And we've written up our research paper on using the new wavelength of a 1940 nanometers, which has some advantages in using it in this sort of vein as the laser energy doesn't penetrate so far, keeping the heat just the vein wall reducing the risk of skin damage. In addition we've also done some work on liver showing how far the energy actually penetrates to make sure that we get the right power to only treat the vein and not damage the surrounding structures. Now of course when we do perform the procedure we do it under local anaesthetic so the patient is talking to us the whole time and we can check that there's no burning and I much prefer to undertreat the vein and have to redo it if it's not successful then over treat it and cause a skin burn. However the results have been very successful with at least 95% of our patients being very happy on the first time of doing it. It is possible to get a bit of redness of the skin and we've had one patient who has got some redness of the skin which is going to probably settle down but might need some intense porcelain light to just completely take that redness away but that's a rarity and only one patient has ever had that. We have had also had one patient who had what's called a keloid reaction where the vein has actually become quite bumpy but again we're now watching that and hopefully that will also settle a time. However almost all of our other patients have seen a good reduction of the vein with time. Of course you do sometimes see little bumps in the healing process which fade with time but compared to the big bulging vein in that's there in the first place is a much much better improvement. If you have any questions or any other concerns that you'd like to express about treating the forehead veins please do not hesitate to contact me at the Whitely Clinic and I can answer any questions for you. One of the most common questions is does this affect the hair growth and the answer is no this is taking blood away from the scalp and there are many other veins that can do the same job. So this has turned out to be a very successful way of treating vertical forehead veins and as part of this new speciality in phlebology called aesthetic phlebology. Thank you very much for listening to this podcast and I hope that you found it useful. Please do not hesitate to contact me at the Whiteley Clinic if you want further information.