Varicose and telangiectatic leg veins impact more than 30% of people by age 30, increasing to nearly 80% by age 80. Although these veins often signal underlying venous hypertension and potential complications like thrombophlebitis and ulcers, patients frequently seek treatment primarily for cosmetic concerns. Today, sclerotherapy is a well-known, minimally invasive treatment. But when I started my journey, this was far from the case.
Discovering Sclerotherapy: My Early Days at UCLA
My introduction to sclerotherapy began in 1984 during my dermatology residency at UCLA. One afternoon, my attending physician, Dr. David Duffy, excitedly demonstrated injecting polidocanol—procured during his travels in Europe—into a nurse’s visible leg veins. Intrigued but skeptical, I questioned the concentration and mechanism of action. Dr. Duffy confidently replied, “This stuff works every time,” urging me to simply watch and learn.
Determined to understand this mysterious procedure fully, I scoured medical libraries—without modern computer databases—to uncover research mostly available in European languages. With help from a fellow resident, Patty Cavender, and UCLA’s translation services, we translated crucial studies, laying the groundwork for my initial experiments.
Rabbit Ear Veins and Near-Expulsion from Residency
By 1985, eager to scientifically validate sclerotherapy, I proposed a study using rabbit ear veins to test various solutions. Though supported by my mentor Dr. Richard Bennett, the unexpected costs for research animals and translation services sparked controversy among faculty. I nearly faced expulsion from residency, accused of performing “irrelevant” research.
Fortunately, thanks to advocacy from Dr. Bennett and colleagues, I was allowed to continue. This early setback transformed into a defining moment, fueling my resolve to demonstrate the procedure’s medical and cosmetic importance.
Groundbreaking Publications and Professional Recognition
My rabbit studies led to multiple landmark publications addressing key complications such as hyperpigmentation and skin ulceration, significantly improving patient outcomes. This work culminated in the 1991 publication of my frist textbook, Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins, now in its sixth edition and used globally.
Encouraged by influential dermatologists like Dr. Samuel Stegman, my research gained widespread recognition, eventually positioning me as a leader in the emerging field of phlebology.
Unexpected Innovations Stemming from Sclerotherapy
- Intense Pulsed Light (IPL): Initially explored to treat resistant leg veins, IPL became a revolutionary technology widely used for various cosmetic treatments due to its gentle, versatile application.
- Endovenous Laser Ablation (EVLA): Collaborating with leading colleagues, we co-developed EVLA to replace invasive vein-stripping surgeries. EVLA is now a gold-standard treatment, dramatically reducing pain, complications, and recovery times.
- SkinMedica® Skincare Line: Inspired by findings from sclerotherapy and laser wound healing, I co-founded SkinMedica®, significantly enhancing dermatologic post-procedure skincare.
Educating a New Generation
My sclerotherapy research sparked unexpected and groundbreaking dermatologic innovations, including:
Reflecting on my career, I’m reminded of how crucial mentorship and education are in driving innovation forward. Throughout my journey, I have continuously emphasized the importance of rigorous scientific inquiry and evidence-based practice. Teaching and mentoring dermatology residents and fellows has allowed me to pass on not only clinical skills but also a mindset of curiosity and persistence, essential for future breakthroughs.
A Legacy of Transformation and Patient Care
Today, at Cosmetic Laser Dermatology, my passion for sclerotherapy continues through advanced, patient-focused care. We remain committed to innovation, ensuring patients achieve healthier, aesthetically pleasing outcomes safely and efficiently.
Reflecting on this journey, I encourage young dermatologists never to underestimate the power of curiosity, persistence, and collaboration. My early struggles and triumphs illustrate that today’s “controversial” idea may become tomorrow’s life-changing treatment.
Schedule your consultation today and discover firsthand the transformative results of expert sclerotherapy care.
About the Author
Dr. Mitchel P. Goldman is a world-renowned dermatologist with over 35 years of experience in dermatologic surgery, laser treatments, and vein therapies. He is the Medical Director of Cosmetic Laser Dermatology in San Diego, California, and has authored numerous groundbreaking research papers and textbooks, significantly shaping modern dermatological practices. Dr. Goldman continues to lead advancements in cosmetic and medical dermatology, committed to providing the highest standard of patient care.
