Cheap varicose veins treatments by beauticians and other non-healthcare professionals increase the risk of burns, ulcers and stained skin, a doctor warned.
Varicose veins are swollen veins that may appear black or purple, usually on the legs and feet, as a result of blood flowing backwards and collecting in the veins, according to the NHS. They can cause pain, itchiness, and a burning or throbbing sensation, along with lower self-esteem.
One TikTok video with nearly 16m views shows dark purple veins vanishing instantly as a chemical solution flows from a needle - a procedure known as microsclerotherapy. A treatment offered by some beauticians and cosmetic clinics for thread or spider veins for as little as £90, it is available on the NHS to treat varicose veins, but the health service's website says "it's unlikely you'll receive treatment on the NHS for cosmetic reasons".
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People eligible for varicose veins treatments like sclerotherapy, endothermal ablation or ligation and stripping on the NHS may wait a year for it. Dr Jag Naik, a consultant vascular surgeon in Liverpool for the last decade, works after hours at the private Spire Liverpool Hospital on top of his role at Aintree Hospital, part of Liverpool University Hospitals NHS Foundation Trust.
He has a steady stream of customers willing to pay to avoid the lengthy NHS waiting list for the 12-surgeon team at Liverpool Vascular and Endovascular Service. Temporarily based at Aintree Hospital, and running clinics at hospitals in Liverpool, Sefton and St Helens, it has a big patch to cover with limited resources.
On average, patients wait 14 weeks for their first outpatient appointment and 23 weeks for treatment at this specialist service, according to My Planned Care, an NHS website publishing average waiting times for hospital services based on data provided by each hospital trust.
Next to the lengthy NHS waiting lists, quick and cheap treatments for problem veins can be appealing. It's possible to treat thread or spider veins - thin red lines on the surface of the skin - with a procedure known as microsclerotherapy, which is also a treatment for the smallest vessels of varicose veins that can't be removed with other methods.
This involves injecting a chemical solution into small veins, some of which are less than a millimetre in size, to strip their lining, make them sticky and block them off. This should remove them from view on the surface of the skin, and it's generally a safe procedure if there are no underlying issues, as there often is in the case of varicose veins.
Microsclerotherapy is available as a treatment for varicose veins on the NHS, but the eligibility criteria is restrictive. The National Institute for Health and Care Excellence (NICE), which publishes treatment guidelines for the NHS in England and Wales, only recommends referring people to a vascular service if they have:
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symptomatic primary or symptomatic recurrent varicose veins.
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skin changes in the lower limb, including pigmentation or eczema
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superficial vein thrombosis, characterised by the appearance of hard, painful veins, and suspected venous incompetence.
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a venous leg ulcer
With the vascular service at Aintree Hospital also treating life-threatening conditions like strokes, blocked arteries and aortic ruptures, while tackling an NHS-wide backlog of cases, it doesn't prioritise patients with varicose veins. Before the pandemic, varicose veins patients could wait six months from referral to treatment at the NHS service, according to Dr Naik.
Now, the waiting list is a year long, in which time patients may be given compression stockings designed to maintain blood flow and reduce discomfort and swelling by applying pressure to the lower legs. Treatments like lasering the trunks of varicose veins to seal the vessels, cutting and pulling out the "twisty bits" of the affected vessels, and microsclerotherapy, might require Dr Naik, the consultant, along with at least one scrub nurse and a healthcare assistant, as well as an available theatre.
They run extra lists - essentially overtime - to see more patients, but with staff shortages across the NHS - including a shortfall of nearly 47,000 nurses - capacity isn't as high as Dr Naik might like. Long waits push some people towards private healthcare providers, like Spire, where they could pay roughly £3,000 for treatment by Dr Naik.
Dr Naik told the ECHO: "That's not a small amount of money. If you're insured, the insurance company would cover that, and that's a very rough, ballpark figure that varies if it's one leg or two legs. A lot of people coming here are not coming because they're in agony, because if that's the case, if they're complicated, they'd be treated at [Liverpool Vascular and Endovascular Service].
"In fact, if they're complicated, I tell them, 'Look, you don't have to come here at all because you're eligible for treatment on the NHS. Why are you coming here, you're wasting money'. However, there is certainly a swing towards the more cosmetic side of things, where people say, 'You know what, I don't like the look of this, it's uncomfortable, and I want it sorted out soon'."
The combination of limited eligibility for treatment on the NHS with the high cost of private medical care "pushes people down certain routes", Dr Naik warned. Although nurses and junior doctors can perform microscleroptherapy, this can only take place under the supervision of a consultant.
Healthcare workers are accountable to their respective professional bodies - doctors to the General Medical Council (GMC), and nurses to the Nursing and Midwifery Council (NMC). Cosmetic clinics, where such professionals perform non-surgical treatments including microsclerotherapy, are regulated by the Care Quality Commission (CQC).
But beauticians and other-non healthcare professionals, who aren't accountable to such bodies and may have taken only a day-long course in microsclerotherapy, offer 30-minute treatments for as little as £90 to £200. Some advertise it as being suitable for varicose veins as well as thread veins, without offering the scans and other treatments available from medics.
Dr Naik said: "It takes a bit of skill and knowledge to do it properly and use the right concentration. Even then, I can't guarantee it's risk free, so I counsel my patients and say the risks are that if the chemical comes out, it can burn the skin, it can cause a tiny ulcer. Rare, but 1 to 2% can get that.
"What was a fine line can become a blotch because if the blood leaks out, blood has iron, and that can cause a brown stain. It can last a year. Very occasionally it's permanent, but usually it goes away. The bigger the vein you inject, the bigger the risk because once you go from the smallest to the medium sized veins, that chemical form will flow into the system a little bit. We use such small amounts that it dilutes it, but if you use too much too soon, it can go into the lungs."
Dr Naik has had patients whose previous treatments haven't worked because those who administered it hadn't treated the trunk and branches of varicose veins with laser or ligation. Occasionally, people collapse and have "terrifying" allergic reactions to the chemical used in microsclerotherapy.
Surgery always comes with risks - as Dr Naik tells his patients, "surgery is controlled violence" - but at hospitals like Aintree and Spire, Dr Naik has the resources to help when things go wrong. He said: "There are always anecdotal stories of very scary complications like temporary visual loss because it's gone through the system, but admittedly they're rare.
"But again, if you start seeing this, you need to know what to do, so the main thing is that you do it in a facility where you can deal with the complications both immediate and later. In a hospital, you have anaesthetists around, I know what I'm doing, and I have top class colleagues who are next door and can help."
He added: "Anybody can be caught out with it, but if you're having something like that done, wouldn't you rather be in a medicalised, CQC institution, or do you want to be on the high street with a hairdresser next to you?"
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