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Introduction   

Aesthetic nursing is a new and rapidly expanding specialty that involves nurses in providing cosmetic enhancements to patients. These nurses can provide many non-invasive procedures to allow patients to become more confident in their appearance and eradicate unwanted scars and tattoos.  

Providers educate patients regarding these procedures, assess what may work best for the patient’s concern, develop a care plan with the patient, evaluate results, and educate on aftercare. These nurses are different from plastic surgery nurses in that they do not provide invasive procedures other than sclerotherapy. Generally, aesthetic procedures are considered cosmetic and therefore are not covered by insurance. 

At the end of this course, the learner will be able to differentiate cosmetic procedures from sclerotherapy for varicose and spider veins. They will also understand how sclerotherapy is performed, by whom, and where to find classes in this specialty. 

Definition 

There are several types of specialties within the aesthetic nurse role, they are listed below: 

Nurse Injector: This specialty involves nurses who inject cosmetic enhancers such as Botox, which smooths muscles and lines in the face, and dermal fillers which sculpt the face.  Some injections break down fat in the face, such as in the double chin. (2) 

Laser Facial Nurse: This specialty involves nurses who perform facials with a laser technique to remove the outer layers of the skin, which helps to minimize wrinkles, improve discoloration from sun damage, and reduce scars from acne. This type of facial exposes new skin and helps to promote the stimulation of collagen. (2) 

Tattoo Removal Nurse: These nurses use laser technology to remove unwanted tattoos. Nurses must understand which lasers and the settings to use to remove tattoos and as always, the risks and side effects of treatment. (2) 

Laser Hair Removal Nurse: One of the most popular uses of laser technique is hair removal. The patient usually requires more than one visit over several months, The nurse must learn to provide safe and effective treatment as well as at-home care. (2) 

Chemical Peel Nurse: This treatment uses chemicals to cause the outer layers of the skin to peel. It can take days up to weeks to heal. It allows the skin to look more youthful. (2) 

Non-Surgical Body Treatment Nurse: In this situation, nurses can perform cellulite reduction with radiofrequency, “Coolsculpting” which freezes fat, and other treatments that allow for powerful muscle contractions to tone those muscles.  

According to an article in “nurse.org,” the average salary for an aesthetic nurse is $89,970 up to $138.500. (4) Nurses should have a BSN at a minimum and become certified by a medical aesthetic course. 

Varicose and Spider Veins 

There are significant differences between varicose and spider veins.  

Varicosities look like bumps or lumps and nodules. They are twisted or tortuous vessels. Varicose veins may also have a blue-green color depending on where they are located. They are most often found on the lower limbs, including ankles and feet. They may also appear on the male scrotum. (3) 

Spider veins occur within small vessels like capillaries, venules, and arterioles that have somehow been damaged. (3) They can be the same color as varicosities, however, are more superficial and cannot be felt when touching them. Spider veins are usually found on the face and legs. (3) 

Varicose veins are common. About 1/3 of the population will have varicosities. Incompetent valves in the larger vessels allow the venous blood to pool. They can be hereditary, occur as we age, or develop from the pressure of standing on our feet for prolonged periods. This puts many nurses at a higher risk of developing them. Tight or restrictive clothing and obesity are also risk factors. (3) 

Spider veins are more common than varicose veins, but the literature tells us there is less understanding of why they occur because blood vessels can be compromised in many ways. (3) What we do know is how they can develop even in younger people. (3) Some of these factors are:  

• Hormonal changes 

• Pregnancy 

• Family history  

• Injury to the affected area. 

• Smoking  

• Connective tissue disorder 

• Too much sun  

• Sitting or standing for a long time  

(3) 

Sclerotherapy 

Sclerotherapy can be performed by doctors, nurse practitioners, physician assistants, and nurses depending on their state regulations. In other words, each state will determine who is allowed and who is not. In general, advanced nurses who are trained and certified in an aesthetic program can perform these procedures.  

There are many programs offered for providers in the US. Some are through independent companies and some colleges offer the programs. The classes usually begin with online didactic lessons followed by robust in-person clinical instruction. Instructors often work one-on-one with the students and guide them through each procedure using voluntary models. The cost ranges from $1300.00 and up depending on the institution and which classes are being taught. 

Some medical doctors are vein specialists and perform this procedure in a clinic or their office. Sclerotherapy takes an hour or less to complete and the patient is followed up within approximately one month. (4) At this point, aesthetic nursing and sclerotherapy are fast becoming a specialty that can be added to a physician’s practice with little additional cost. (5) 

When researching programs and more information, you will find many nurses and nurse practitioners now setting up practices and even some will go to people’s homes to perform aesthetic procedures. 

Indications/Contraindications 

We previously reviewed those at risk for developing varicosities, however, the following are indications can indicate the need for sclerotherapy: 

• Color changes in the skin 

• Bulging bluish-colored veins 

• Sores on the legs (leg ulcers) 

• Rash 

• Sensations in the legs, such as a heavy feeling, burning, or aching  

(5) 

If left without treatment, the patient can become at risk for phlebitis, blood clots, and pulmonary embolism. (6) It is not unusual for the provider to do a duplex scan on the lower limbs to be certain there are no clots and the blood flow around the damaged vein is within normal limits. 

Very severe varicosities may be treated surgically when the provider removes the vein. This is called vein stripping. 

If the varicosity is not severe enough for sclerotherapy and not causing any disruptions in life, they may be treated with non-invasive treatments. 

There are very few contraindications for sclerotherapy, however, it is not recommended during pregnancy. 

Procedure  

Sclerotherapy is a procedure used to scar the varicosities and/or spider veins in patients to reduce or eliminate them. The procedure is performed by a needle inserted into the vein with sclerosing (also called detergent) which causes the veins to collapse.  

In the case of varicosities, the sclerosing solution may be stronger than in a spider vein. (4) The scarring of these vessels allows blood to flow through healthier veins. Veins should begin to fade in two weeks. Some veins may need to be done more than once. (4) Sclerotherapy can lessen pain, limb swelling, burning sensations, and nighttime cramping. (4)  

The patient will be lying on their back, legs elevated slightly. When the needle is removed, pressure and massage are utilized to stop leakage of blood into the vessel and to ensure the solution spreads out and into the vessel. (4) Usually, no anesthesia is needed, and the patient will be encouraged to get up to walk and move around in the prevention of blood clots.

Aftercare 

Generally, sclerotherapy has few serious complications. (4) Bruising, hives, skin sores that are usually small, skin darkening around the area injected, and the appearance of some tiny blood vessels may occur. Most of these side effects will resolve within days or weeks. (4) 

Side effects that may need treatment include: 

1. Inflammation which could cause some swelling. Using a pain non-steroidal anti-inflammatory (NSAID) can help to relieve this. 
2. Blood Clots may appear at the treated site and may need to be drained. Deep vein thrombosis (DVT) is very unusual as the veins treated are superficial. 
3. Air bubbles can make it to the blood causing headache, nausea, syncope, and light flashing in the eyes. 
4. Allergic reactions to the solution are uncommon but slightly possible. (4) 
5. Excessive bruising or bleeding (8) 

Once home, the patient will generally wear compression stockings or bandages for about 14 days to keep pressure on the area. (4) They should not use lotion or shave until it is determined the site has healed. 

The patient should stay away from the sun for two weeks and can perform light exercises like walking. (6) Heavy lifting and strenuous activities should be avoided. Drinking increased amounts of fluids helps promote healing by keeping blood volume homeostatic. 

Alcohol and caffeine should be used in moderation, as they can cause dehydration which will affect healing. It is recommended to reduce salt and processed food intake, as salt can cause water retention and increased venous pressure. (6) 

A patient may shower 24 hours after the procedure and pat the injected area dry but should not rub. Hot showers and baths or immersing the area, as with swimming, should be avoided for at least two weeks to keep veins from dilating veins. (6) Legs should be elevated on a pillow during sleep or resting. (6) 

The patient should be diligent about follow-up visits to monitor progress and to be able to verbalize concerns and questions.  

(6) 

Complications 

There are relatively few complications with sclerotherapy, however, if the patient has any of the following symptoms it is important to report them to their provider. 

• Sudden swelling in the affected area 

• Skin discoloration 

• Fever or chills 

• Difficulty breathing  

Although these symptoms are concerning, most patients experience no symptoms after sclerotherapy. (6) 

As nurses, we understand that depending on the procedure the risks and side effects will vary. Some of the risks associated with any aesthetic procedure can be reduced by the patient understanding what those risks are. (8)  

A patient seeking cosmetic surgery should know that all risks are not eliminated. This depends on the length of the procedure, whether it is invasive or non-invasive and in particular the patient’s health. Issues that can be done to mitigate aftereffects or complications are to stop smoking, be well hydrated, eat a healthy diet, and maintain physical activity, as well as avoid or stop anticoagulants and aspirin before the procedure. (8) It is also important to advise the patient results may not be permanent and what procedures or appointments may be necessary as needed. (8) 

Newer Treatments for Sclerotherapy 

According to the Vein Treatment Center in the United Kingdom, (7) treatments for varicose vein sclerotherapy have emerged that are non-invasive and can be done on the same day as a consultation.  

Examples of types of sclerotherapies used include Endothermal Ablation, Radiofrequency ablation (RFA), and Vein light Transilluminated Microsclerotherapy (VTM). (7) 

Endothermal Ablation 

This procedure applies heat to the inner portion of the vein, collapsing and closing it off. This method uses either radiofrequency or laser ablations to heat the vessel allowing it to collapse. Endothermal Ablation is recommended as a first-line therapy for varicosities and is performed in the physician’s office as a walk-in, walk-out appointment. (7) 

Radiofrequency Ablation 

RFA is performed after the patient has an ultrasound to determine which veins are appropriate for the procedure. Under local anesthesia, with ultrasound guidance a small catheter is introduced into the vein, and a wire with a heated tip is then inserted into the catheter. This wire heats the vessel collapsing it. This method is sometimes used when Endothermal Ablation is not suitable for particular patients. (7) 

Veinlite Transilluminated Microscleropathy 

VTM is the most useful for spider veins and other small varicosities.  It is performed using a light to visualize a vein transparently. A liquid sclerosant is then put into the vein causing the body to easily absorb it. (7) 

Research 

There is very little current research on aesthetic procedures. Although the research is limited all articles agree that sclerotherapy is important and well-indicated for those patients who want relief and cosmetic enhancement of their veins. AI technologies, such as ChatGPT, have also been researched specifically for use within cosmetic consultations, with varying results. 

Conclusion

Cosmetic surgery is very common today and is fast becoming a specialty in nursing practice. We have looked specifically at vein therapy including spider and varicose veins. Nurses can engage in this practice by taking certification courses that are offered around the country.  

We have discussed the various iterations of sclerotherapy, and how it is performed, the risks associated with electing this procedure, and common side effects. We have learned of newer procedures and what types of solutions are used in vein injections to collapse these varicosities. Permanency is not guaranteed, and nurses should be involved in educating the patient before and after the procedure. 

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