Removal of blue periocular lower eyelid veins by ambulatory phlebectomy

Prominent periocular veins, primarily of the lower eyelid, are a relatively frequent cosmetic problem. Reported treatment techniques have included electrosurgical, sclerotherapy, and longer-wavelength lasers.

Ambulatory phlebectomy can be performed on reticular veins of the leg. This technique has been applied over the past few years to periocular reticular veins in order to observe the results and side effects.

Using a hook specifically designed for reticular veins, we treated 10 patients who had larger reticular periocular eyelid veins. One or several punctures with an 18-gauge needle were made in the center of the targeted length of vein. The reticular vein was then gently dissected by undermining with the stem of the Ramelet phlebectomy hook.

All 10 patients tolerated the procedure well. In 8 of 10 patients there was complete elimination with a single procedure. Surprisingly, no significant hematoma was seen in any patient, although two patients had a small hematoma lasting less than 1 week. Two patients had only partial success, as a small segment of vein was difficult to extract. This was eliminated with a second phlebectomy performed 2 months later in both cases. Edema that is usually seen after sclerotherapy was not noted in any of these patients.

Ambulatory phlebectomy appears to be a safe and effective means of permanently eradicating periocular veins.