What you described is not that uncommon. There is treatment for this and I would consult someone who is experienced in treating this condition. You may need to see a vascular, general, or a plastic surgeon.
My preferred treatment is to do a microphlebectomy which is the removal of veins through very small incisions with no visible scars. These incisions are around 2mm in size and placed in the skin lines. This should give you an excellent result. I do not like to use sclerotherapy, although it has been tried.
Lasers are of no use in larger veins.
Please keep us posted and good luck.
Submitted by Dr. Bush - 7/31/2012
|Responding to J|
(Old post that we missedÖ..sorry)
This man needs a thorough medical evaluation. Hopefully, this was done. Temporal arteritis can cause pain, however, it is not associated with weight loss or memory loss.
Submitted by Dr. Bush - 7/31/2012
|I have 2 big veins/arteries? That run diagonally from the corners of my forehead to the middle bridge of my nose. They are particularly prominent when I laugh or lay down. They are becoming such a problem that they are leaving me with permanent ridges in the skull which are visible now even when the vessells arenít prominent. I am embarrassed to talk to people because I see them staring at my forehead. What can I do?
Submitted by E - 7/31/2012
|the prominent veins onía 29yr man has been there for 15yrs now aggravating headache and earache radiating vein pain through the neck.pt has loss of memory and wt loss.what is the management to the above complaints doc.
Submitted by J - 2/26/2012
|If theses veins are < 2 mm, I would use liquid sclerotherapy. I would reserve foam for the temporal and lateral peri-orbital veins because of the different draining sites. |
If the veins are prominent, I would do a micro-phlebectomy through 2 small incisions. (1-2 mm)
Submitted by Ron Bush, MD, FACS - 10/9/2011
|Location of vessels are midline.
Submitted by Carla Evans - 10/7/2011
Nothing causes more trepidation among those physicians treating veins than a patient who presents with prominent facial reticular veins. Before I answer your question, I would like to point out a few facts. I must admit, that I am always somewhat cautious injecting veins on the face, even though there is no basis for my caution.
What are the complications that we worry about?
1) Skin necrosis, which would not occur unless you inject into an artery. Extravasation at low doses will not cause necrosis. The biggest complication from injections is bruising, which subsides quickly.
2) Visual impairment Ė no documented cases in the literature that I know of. Why would visual impairment occur? Using sclerotherapy or foam sclerotherapy thrombosis of the ophthalmic vein or the central retinal vein must occur.
Most people that seek consultation for periorbital veins have veins that are actually branches of 3 connecting systems in some form or another. These are branches of the infraorbital, supraorbital, or the superior/medial temporal veins. There is no exact term for the vein that you see. The problem is that this branch connects with both the supraorbital, infraorbital, or transverse facial veins at some point. The real problem is how to keep foam out of the central retinal veins and the ophthalmic veins.
Actually, this is quite easy to do. When injecting the vein under the eye, the needle should point to the temporal vein. You should apply pressure at the medial canthus of the eye to occlude the angular vein. (This leads to the supraorbital vein and the transverse facial veins) At the same time, your assistant should occlude the superficial temporal vein before it bifurcates into the frontal and parietal branches. Your assistant should have their other finger on the lateral canthus of the eye to prevent backflow into the orbital vein from this area.
I will post an image tomorrow of this technique for you to see. Use a small butterfly needle and no more than 1cc of 0.2% Sotradecol foam and milk it laterally. I do not use liquid, since this tends to extravasate the vein. Foam is much easier to inject. This is repeated every 2-weeks until the vein disappears. This is very effective. If the vein is more than 2 mm in size, I do a phlebectomy in two incisions, which is very effective and cosmetically acceptable.
Now to answer your question:
What you described is a frontal vein that is in the midline of the forehead. This connects to the supraorbital vein, which then becomes the angular vein. If you inject the frontal vein, there is always a chance for foam to go into the eye itself. However, if you apply pressure on the supraorbital notch and the medial canthus to occlude the angular vein and place the needle pointing superiorly, you can do foam sclerotherapy safely with 1cc of Sotradecol foam.
However, if the vein is large, I would do a phlebectomy through two small incisions. I am sorry for the very lengthy response. I have done many injections on veins around the eyes with no complications. I have also injected veins on the lower face with no problems. I think much of the concern about injecting around the eye is Urban Legend.
What would really be an interesting study is for you to dilate the patientís pupil. Observe the veins on the retina, inject using this technique, and re-examine the retina 5-minutes later. I donít think you would see any bubbles. Also, remember, there has never been a reported case of blindness after foam injection of peripheral veins of the legs in those patients with PFO.
I hope this helps and thanks for posting the questions.
Submitted by Ron Bush MD, FACS - 7/27/2011
I want to clarify your recommendations for treatment of forehead veins. I have a young patient with a prominent reticular vein in the forehead. The vein runs vertically along the midline of the forehead.
Is this an area that you would recommend sclerotherapy ? My understanding from the literature is that sclerotherapy of periorbital veins is not advised and phlebectomy is preferred.
Submitted by David Fox, MD, FACS - 7/27/2011
|Veins on the forehead may drain into the sagittal sinus, close to the tributaries of the central retinal vein, or into the pterygoid plexus, which is an innocuous draining site. These veins are usually around the temporal region and the infraorbital region. If the veins are not in this location, I would recommend a micro-phlebectomy rather than foam sclerotherapy. |
Submitted by Ron Bush MD, FACS - 6/21/2011
|Havenít seen patient yet donít know location. Why is location pertinent? Close to artery?
Submitted by Carla Evans, FNP-BC - 6/21/2011
|Are they located midline or temporal area?|
Submitted by Peggy Bush, APN - 6/21/2011
I am wondering if Dr. Bush ever does prominent forehead veins? Is this ill advised? Your thought greatly appreciated.