MEET OUSAIMA AL-MISKY, MD: NEW YORK CITY VEIN TREATMENT SPECIALIST
Bathing suit season is once again upon us, but for the 80 million Americans who have spider and varicose veins on their legs, this is not such a cause celebre. These often unsightly, twisty or bulging veins may make hitting the beach and showing some skin less than appealing this summer.
New York City vein specialist Ousaima Al-Misky, M.D. understands exactly how this feels. She was once one of the afflicted. Treatment to remove her veins was so successful that she decided to devote her practice to helping others achieve the same results.
Al-Misky sat down with Beauty in the Bag to talk about the difference between spider and varicose veins, their treatments as well as her personal experience and how it shaped her career path.
Here’s what we learned:
 1. What is the difference between spider and varicose veins?
Spider and varicose veins are both the result of loss of elasticity within the vein wall, causing pooling of blood and not allowing the venous blood to return normally to the heart. These abnormal veins are classified as spider or varicose based on their size. Spider veins are smaller veins that appear red, purple, or almost black in color. Varicose veins are larger, usually green in color, and can be bulging.
2. Are varicose veins dangerous?
Varicose veins are usually not dangerous. They are generally a benign disorder. However, the blood pooling from varicose veins can cause significant discomfort and swelling. Unhealthy skin around the ankles can eventually break open into ulcers. If left untreated, this pooling of blood can possibly lead to a superficial thrombophlebitis (blood clot in the superficial veins). The good news is that varicose veins are easily treatable. It is important to treat them to keep your skin looking healthy and symptom free. The bad news is that varicose veins is often chronic.
3. Besides the legs where do varicose veins appear?
Varicose veins are predominantly found on the legs. Â Spider veins can be found in other areas of the body, including the face, hands, and chest.
 4. How do you treat varicose veins?
Treatment depends upon a clear understanding of the exact anatomy of the abnormal veins and their highest point of reflux (location of the leaking vein valve). It is important for the doctor doing the treatment to be certified in performing venous ultrasounds.  There is a lesser chance of making a misdiagnosis if the doctor does the ultrasounds herself instead of having a tech or other colleague do it. The best treatment for larger varicose veins is often laser ablation, done in the doctor’s office under local anesthesia. In laser ablation, we pass an optical fiber through a catheter to the leaking valve. We then apply the laser energy to the vein to seal it closed, drawing the fiber back steadily as the energy is applied.
The gold standard treatment of spider veins is sclerotherapy. We inject a solution into the abnormal veins to close them.  The solutions used are US Food and Drug Administration (FDA)- approved for the closure of spider and varicose veins. These injections are done while a stream of cold air numbs the skin. Patients tolerate them very well and get great results.
5. How has treatment changed over time?
In the 1990s, most varicose veins were treated by “stripping”, a surgery performed under general anesthesia that often involved groin to ankle incisions and long recovery times. Around 2000, the minimally invasive laser ablation method proved safer and less painful. In the last 15 years, the lasers have improved. The wavelength of the laser we use, 1470 nm, targets the water in the vein tissue so less energy can be used, resulting in less bruising, swelling, redness, and recovery time.
Techniques to help reduce the discomfort of treatment have advanced as well. We use a recently developed machine that blows cold air on the skin as we inject small branch varicose veins, temporarily numbing the skin.
One of the most significant advances for the field has been the recognition of a vein specialty by the American Medical Association. The American Board of Venous and Lymphatic Medicine developed a process to become a Diplomate which helps patients to find well-trained and certified vein specialists.
 6. Why do you love what you do?
I suffered from spider and varicose veins and know first hand the symptoms and embarrassment they can cause. I developed spider veins in my early 20s. During my second pregnancy I developed profound varicose veins.  I avoided wearing shorts or bathing suits. I got my legs treated by a vein-specialist colleague, and the results were remarkable. My legs were healthy and pain free during my third pregnancy and continue to be so with regular maintenance sclerotherapy treatments. I enjoy treating my patients since I fully understand how they feel about their condition and can share their concerns about what the treatment will entail. Best of all, I enjoy sharing with their elation when they see their varicose and spider veins eradicated. I am a perfectionist by nature and love to try and get great cosmetic results for my patients.
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