Prominent veins on the back of the hand: do injections and lasers make them less noticeable? What research shows

Reports indicate that prominent veins on the back of the hand can be made less noticeable with sclerotherapy, a procedure that hardens blood vessels using medication[1]In 41 people treated on the back of the hand, the average number of treatments was 1.5, and side effects such as pigmentation were rare[1]However, research focusing specifically on the back of the hand is still limited, and laser treatment for thicker vessels is at the stage of being inferred from studies on vessels in the legs and forehead[2][3].

Why do veins on the back of the hand become more prominent?

As we age, the fullness and skin elasticity of the back of the hand decrease, making blood vessels, tendons, and bones appear more visible[4]Not only the blood vessels themselves but also the loss of volume in the surrounding area is a contributing factor.

For this reason, hand rejuvenation is also being researched with methods that supplement fullness with fat injection or hyaluronic acid in addition to blood vessel treatment[5]Which method to choose depends on whether what is prominent is the veins or the thinning of the back of the hand.

How much improvement does sclerotherapy achieve?

Sclerotherapy is a treatment that injects medication into blood vessels to harden them, ultimately transforming them into thin, less-noticeable thread-like tissue[6]On the back of the hand, foam-form medication (such as 0.5% polidocanol) has been commonly used[1].

In a report of 41 people treated on the back of the hand, the average number of treatments was 1.5 (range 1–5).[1]Blood clots formed within the treated vessels in 15.2% of treatments, and scarring, swelling, pigmentation, and persistent redness were rare[1].

In this report, no cases of vein inflammation, skin ulceration, or nerve symptoms occurred.[1]In another study treating reticular veins on the back of the hand with foam-form medication, 78.9% reported being "very satisfied"[7].

What are the side effects of sclerotherapy and who cannot receive it?

Common side effects include blood clots, swelling, redness, bruising, and pain; pigmentation is reported to be very rare.[7]Polidocanol has been reported to have few major side effects other than local reaction at the injection site and allergies.[6].

However, with these types of blood vessel treatments, serious complications such as blood clots traveling to lung vessels are possible.[6]In animal experiments, the greater the drug dose, the more lung vessel damage occurred, so the amount used should be kept minimal.[6]With foam-form medication, attention is also needed for thrombosis-related complications.[8].

Sclerotherapy on the hand may not be possible for people with carpal tunnel syndrome, a history of hand surgery, a dialysis shunt, or hand pain, numbness, swelling, or severe joint inflammation.[7].

What is known about laser treatment for thicker blood vessels?

Endovenous laser treatment that closes blood vessels with heat is recommended by guidelines as a safe and effective method for leg varicose veins[9]However, within the scope of this investigation, no research specifically on laser treatment for veins on the back of the hand was found.

In examples from other areas, 90.3% of 93 people treated with laser for prominent forehead veins achieved good cosmetic results with a single treatment[3]At that time, side effects were temporary bruising and swelling.[3].

When superficial blood vessels just under the skin are treated with heat, burns, pigmentation, and firmness can occur.[2]Japan's varicose vein guidelines also report rare cases of burns or nerve damage, and physician experience is required[10].

What should you watch out for specific to the back of the hand?

On the back of the hand, nerves that control finger movement and sensation pass close to blood vessels[11]In examples of treating blood vessel nodules on the back of the hand, surgical removal was chosen out of concern for effects on nearby nerves.[11].

Which blood vessels to treat and to what extent should be decided in consultation with your physician, including consideration of nerve pathways.

What should you confirm before treatment?

In your consultation, ask about the following points:

Method: whether sclerotherapy or laser will be used for your blood vessels and the reason why[1][2]

Number of treatments: approximately how many treatments are anticipated[1]

Medical history: whether you have carpal tunnel syndrome, a history of hand surgery, a dialysis shunt, etc.[7]

Other options: if thinning of the back of the hand is noticeable, how does this compare with treatment to supplement fullness[4][5]

Which treatment is best suited to your hand veins cannot be determined from this article alone. At your appointment, inform your physician about the thickness and depth of your veins and any hand medical conditions or surgical history, and confirm the treatment area and what to do if side effects occur.