Originally contributed by Dr. Qiang Zhang on the Veinsights . Original Link: here
In modern medicine, the treatment of varicose veins has gradually shifted from merely pursuing aesthetic improvement to prioritizing functional recovery and health maintenance. However, misconceptions persist among many patients, who believe that treatment success requires the complete elimination of visible veins. This view is not only incomplete but can also lead to unintended negative consequences. This blog will explain the scientific perspective on varicose vein treatment: function first, with aesthetics as a secondary, balanced goal.
1. Understanding Varicose Veins: More Than Just Visible “Bulging Veins”
Varicose veins are not merely a cosmetic issue. They are primarily caused by abnormal venous hemodynamics and often indicate underlying functional problems in the venous system. Key contributors include:
- Venous valve insufficiency: Dysfunctional valves lead to blood reflux and increased venous pressure.
- Weak vein walls: Prolonged pressure causes veins to dilate and become tortuous.
- Blood stasis: Poor circulation results in symptoms such as leg heaviness, swelling, and even venous ulcers.
Simply removing varicose veins does not address these fundamental issues. Functional recovery must remain the central goal of treatment.
2. The Pitfalls of Pursuing “Perfect” Aesthetics
Some patients prioritize immediate cosmetic perfection without understanding the associated risks and trade-offs. Here are two common pitfalls:
- Aesthetic Perfection ≠ Complete Treatment
Traditional stripping surgery may eliminate visible varicose veins in the short term, but it can lead to long-term complications:- Disrupted hemodynamics: Over-aggressive removal of veins disrupts the venous network and impairs blood circulation.
- High recurrence rates: Failure to address the underlying reflux often results in recurrence rates of 20-40%.
- Increased Risk of Complications
Chasing aesthetic perfection can result in unnecessarily invasive procedures, leading to:- Scarring and pigmentation: Larger treatment areas may cause visible scars or skin discoloration.
- Subcutaneous hardening: Tissue inflammation can create localized lumps or depressions, affecting the cosmetic outcome.
3. The Scientific Approach: Function First, Aesthetics as a Natural Outcome
Modern treatment emphasizes restoring venous function while allowing aesthetics to improve naturally. Techniques such as CHIVA (Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) exemplify this approach:
- Preserving venous function: CHIVA focuses on adjusting hemodynamics by precisely identifying and correcting reflux points, while preserving functional veins to maintain proper circulation.
- Natural aesthetic improvement: As venous pressure decreases and blood flow normalizes, varicose veins naturally shrink and fade over time. While results may not be immediate, they are stable and sustainable.
- Minimally invasive and safe: CHIVA uses small incisions under local anesthesia, reducing trauma and minimizing scarring, which allows for faster recovery.
4. When Function Preservation Conflicts with Aesthetic Perfection
In cases where functional preservation and aesthetic perfection conflict, decision-making should prioritize long-term health and functional recovery. Here’s how physicians and patients can approach this:
- Adhering to Medical Principles
- Addressing root causes: Treating venous reflux and restoring hemodynamics prevents disease progression and reduces recurrence risks.
- Ensuring long-term health: Preserving functional veins maintains proper circulation, reducing the likelihood of chronic venous insufficiency or deep vein thrombosis (DVT).
- Striking a Balance
- Personalized treatment: For asymptomatic patients with mild varicose veins, micro-invasive options like sclerotherapy can address cosmetic concerns while avoiding unnecessary interventions.
- Setting realistic expectations: Open communication with patients about the limitations of aesthetic outcomes helps establish reasonable goals for treatment.
- Leveraging Advanced Techniques
- CHIVA as a balanced solution: By prioritizing venous function while naturally improving aesthetics, CHIVA avoids the pitfalls of overtreatment.
- Avoiding overtreatment: Aggressively removing veins for cosmetic reasons can lead to more harm than good, with higher risks of complications and recurrence.
5. Why Aesthetic “Perfection” Is Unrealistic
Even with advanced techniques, achieving absolute perfection in appearance is neither feasible nor medically sound. Several factors explain this limitation:
- Complex venous anatomy: Veins are interconnected in a network, and eliminating visible veins does not guarantee the complete resolution of abnormal hemodynamics.
- Preserved functional veins: Visible superficial veins may be retained to maintain circulation, even if they remain slightly noticeable.
- Skin and tissue changes: Longstanding venous hypertension can cause skin thinning, pigmentation, or capillary dilation, which cannot always be fully reversed.
The goal of treatment is sustainable functional recovery, with aesthetic improvement occurring as a natural byproduct.
6. CHIVA: A Balanced and Scientific Approach
CHIVA has emerged as a modern, balanced treatment option for varicose veins. Its benefits are supported by both clinical evidence and patient outcomes:
- Developed by French Professor Franceschi in the late 20th century, CHIVA overcame early skepticism and resistance to become widely accepted in Europe.
- Over 20,000 successful cases performed by Dr. Smile Medical Group in China over the past decade highlight its effectiveness in balancing function preservation and aesthetics.
- Global CHIVA initiatives, led by Dr. Smile Medical Group and INTELEOS, are promoting standardized training and clinical practice worldwide.
CHIVA represents a paradigm shift in varicose vein treatment, proving that function and aesthetics are not mutually exclusive.
7. A Patient-Centered Scientific Perspective
Patients considering varicose vein treatment should adopt a rational and scientific approach:
- Prioritize functional recovery: Long-term health and circulation should be the primary goal.
- Avoid overtreatment: Over-aggressive procedures can sacrifice function for superficial results.
- Choose appropriate treatments: Techniques like CHIVA offer a balanced approach, achieving sustainable health benefits and natural aesthetic improvement.
- Set realistic expectations: Minor visible veins do not signify treatment failure, as long as function and health are restored.
Conclusion: Health Over aesthetics
The scientific perspective on varicose vein treatment emphasizes function first, with aesthetics as a secondary, balanced goal. Chasing cosmetic perfection alone can lead to unintended consequences, including complications, recurrence, and disrupted circulation. Modern approaches like CHIVA prioritize long-term health while achieving natural aesthetic improvements, offering patients a scientifically sound and sustainable solution.
Varicose vein treatment is not just about medical techniques—it is a shift in perspective. By choosing a balanced approach, patients can achieve both healthier legs and a better quality of life.