In-office treatments

Dr. Tapper and the Symmetry team all live and work on Florida’s beautiful Treasure Coast. We totally get the active outdoor Florida lifestyle and also respect the need to minimize your downtime away from work and family obligations. Our goal is restore the appearance and function of your legs with as little disruption to your life as possible.

Remember that Dr. Tapper is board certified in vascular surgery—that means he knows how to diagnose and treat all venous conditions including varicose veins, deep venous thrombosis (DVT), superficial thrombophlebitis, hypercoagulable states, post‐phlebitic syndrome, stasis ulcers, and lymphedema. His 20+ years of experience, state of the art facility and over 10,000 patient evaluations means that there will be no guess work when it come to your legs. All patients are different, but our treatment plans are consistent and directed towards optimizing improved function, improved appearance, and minimal downtime.

The first step is to have an accurate diagnosis. Along with a detailed medical history and physical exam, a properly performed ultrasound can provide a wealth of information about your veins. Depending on the findings, treatment options might include, graded compression hose, injection sclerotherapy, endovenous LASER ablation (ELAS/EVLT), microphlebectomy (ambulatory phlebectomy), ultrasound guided sclerotherapy, or a combination of treatments may be required. Each treatment is briefly explained below.


Graded Compression Hose

Compression Hose

These prescription-strength hose are scientifically engineered to help veins work better. They compress tightest at the foot and ankle and gradually ease up in the calf. This gradient pressure design allows blood and fluid to flow inward and upward. The goal is to get edema fluid out of the skin and into the calf muscle which then pumps it back to the heart. Compression hose will eliminate ankle edema and some symptoms caused by varicose veins. All insurance companies require that you wear compression hose for a 3-month trial period before they authorize other forms of treatment. When the stockings fail to help you, then insurance will allow for more definitive therapy. Although compression hose do help alleviate swelling, they do not eliminate varicose veins. There is no scientific evidence for this 3-month delay and fortunately it is not required by Medicare.

 


Injection Sclerotherapy

During sclerotherapy, Dr. Tapper will inject a solution called sodium tetradecyl directly into your abnormal vein using a very small pediatric needle. The solution does not hurt at all, yet it irritates the inside lining of the vein which causes the vein to collapse or sclerose. Sclerotherapy is performed on spider veins, telangiectasias, and small varicose veins. Sclerotherapy is a simple and ingenious concept, but its proper execution is an art that can take years to master. Sclerotherapy causes the targeted vein to destroying itself without damaging the surrounding tissue. The successfully treated vein sometimes fills with a coagulum of blood that must be evacuated several weeks after the injection. This secondary procedure is done to achieve a maximum cosmetic and functional result.

Before (left) and after (right) treatment


Ambulatory or Micro‐Phlebectomy

In this office‐based procedure, your abnormal varicose veins are gently removed. Phlebectomy is used to remove veins that are too big for sclerotherapy. Before the procedure, you will be given antibiotics, non‐narcotic pain pills, and Valium for relaxation. Your veins will be outlined with a magic marker and photographed. The area over the marked veins will be injected with local anesthesia. The injection of anesthetic hurts for a few seconds but then the area goes numb. Once the area is numb, very small (1/8 to 1/4–inch) incisions are made and the veins are removed. The incisions are closed with Steri-Strip; no sutures are required. The small incisions heal very nicely and are hardly visible after a year.

5 months after microphlebectomy

5 months after microphlebectomy

Before (left) and after (right) treatment


Endovenous LASER Ablation (ELAS / EVLT)

ELAS is the key procedure used to eliminate the source of reflux, the leaky valves that cause varicose veins. Leaky valves in an axial vein such as the saphenous vein can cause blood to flow backwards down the leg or outward towards the skin. Once a value leaks, it puts pressure on the next valve in the chain. As the pressure builds, the next valve leaks and so on. Too much reflux will impair venous return to the heart and result in bulging varicose veins. ELAS has replaced the old time “stripping” procedure that you may have heard about and that was once the only way to remove veins. During the ELAS procedure, Dr. Tapper uses ultrasound imaging to deliver the LASER fiber precisely to the leaky vein. The LASER energy shuts down the vein, the leak is stopped, and normal venous flow is restored.

ELAS is most often combined with micro-phlebectomy so that the refluxing feeder vein and the troublesome varicose veins are removed in one sitting. Following the procedure, you will wear a special thigh‐high compression stocking for 2 weeks. You will be up and walking the day of the procedure, resume normal activities within 2–3 days, and most people can return to work in 3 days. Vigorous exercise is restricted for 2 weeks. After you have ELAS with us we will check you at 3 days, 3 weeks, and 3 months to make sure every thing is alright. 

If you are considering vein surgery, please be careful about your choice of surgeon. The Florida Attorney General has issued a Consumer Protection Alert because of the rampant fraud and abuse by unethical and poorly trained physicians who are cashing in on unsuspecting patients. If you are considering vein treatments, ask questions, get a second opinion, don't be the victim of an unnecessary laser procedure. See our Blog post on 5 questions you want to ask of your vein surgeon.

We take pre-op pictures of all patients and show them to you at the 3 month post-op visit. You will be amazed by the difference!

3 months after ELAS and microphlebectomy

3 months after ELAS and microphlebectomy

Before (left) and after (right) treatment


Ultrasound Guided Sclerotherapy  

Dr. Tapper may choose to use ultrasound guided sclerotherapy (UGS) to precisely localize and inject a specific vein. Special perforating veins carry blood from the skin into deeper veins in the muscle. The muscle then pumps the blood back to the heart. Leaky perforating veins are often found near the ankle and can lead to edema, stasis dermatitis, and ulceration. These veins are ideally suited to UGS. During UGS, Dr. Tapper will use ultrasound to see the abnormal vein and simultaneously inject it with tetradecyl solution. UGS is especially valuable in helping you heal a venous stasis ulcer. It is done in the office, does not require anesthesia or pain medicine, causes little discomfort, and is very effective. After UGS, you will wear a calf‐high compression stocking for 1 week. Dr. Tapper will recheck the area in 1-3 weeks to make sure that the vein is closing and your ulcer is healing.

Ulcer present for 2 years healed with several UGS and good wound care

Ulcer present for 2 years healed with several UGS and good wound care

Before (left) and after (right) treatment


Insurance Coverage for Varicose Vein Treatment

A common question we hear from patients before they come to us for treatment is “How much will this cost?” Patients are pleasantly surprised to find out that depending on your plan, insurance will usually cover the cost of your varicose vein treatments.  At Symmetry Vascular Center we are experts at dealing with the bureaucratic maze of insurance companies.

During your first visit to Symmetry Vascular Center, you will meet with Dr. Tapper for a complete vascular consultation. This appointment is billed to your insurance and the cost to you is typically the copayment/deductible/coinsurance you pay when visiting any doctor’s office. At this appointment, Dr. Tapper will examine you, discuss your diagnosis and treatment options, and the staff will review your insurance benefits with you.

Varicose vein treatment, when performed for medical reasons, is covered by most insurance companies. Most plans provide coverage for ELAS/microphlebectomy as a primary treatment and sclerotherapy as a secondary treatment. In order get coverage, patients must have symptoms such as pain, swelling, heaviness, itching, or throbbing. You must have an ultrasound that confirms enlarged veins with leaky valves. If you have had an ultrasound that only looked for clot in the veins and did not look at valve function, then it will need to be repeated with proper technique.

Symmetry Vascular Center is contracted with and “in network” with most major insurance plans and Medicare. Our staff is very experienced in working directly with insurance companies to ensure that all the necessary authorizations are in place for you to get the treatment you deserve. We understand how complicated and expensive insurance is, we are on your side!

Accepted insurances (subject to change):

  • Medicare
  • Medicare Replacement Plans (Humana HMO, United Healthcare, Coventry/Summit, Wellcare, Freedom)
  • Florida Blue
  • Out of State Blue Cross
  • Aetna
  • Cigna
  • Humana
  • Meritain
  • United Healthcare

Spider Vein Treatment

Robyn Fore R.N., B.S.N. is an expert at using sclerotherapy to treat spider veins. Spider veins are not as prominent as varicose veins, but they can be unsightly and symptomatic. Spider veins range in appearance from a thin, red lines to purple clusters involving a large area of the leg. Injection sclerotherapy is relatively painless and takes between 15–45 minutes depending on the extent of your veins. Using a very small needle, Robyn injects your spider veins with dilute sodium tetradecyl solution. This irritates the lining of the spider vein and causes it to collapse. Improvement is usually visible within 6–8 weeks. There is no “down time” following treatment, however a few activities (aerobic exercise, hot showers, sunbathing) should be avoided for 4–5 days. The number of treatments depends on the extent of veins and your response to the injections.

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Before (left) and after (right) treatment


Laser Hair Removal

Symmetry offers laser hair removal by Robyn Fore RN, BSN who is experienced and fully licensed. Laser therapy is an effective way of removing or reducing unwanted body hair. Highly focused, intense beams of light target dark pigments in the hair follicles, destroying them with heat and preventing future hair growth. Multiple treatments are required 6–8 weeks apart for maximum results. The procedure is needle‐free and requires no anesthesia, although a topical anesthetic is available if desired. Most patients feel nothing more than a slight sting like the snap of a rubber band. Following treatment there is no discomfort, only a little redness and/or swelling for a brief period. Our pricing is competitive and available at initial consultation.


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