Cosmetic/Reconstructive Surgery

Some women, despite all their hopes and wishes, just never develop even average-sized breasts. Other women find pregnancy and nursing rob them of what breasts they had. In both cases, chests just seem to be flatter than they ought to be, blouses don't fill out as they should, and patients may even feel a loss of femininity.

Breast augmentation can help. A pocket is made either within the breast tissue itself or under the pectoralis muscle. The empty implant is then inserted and filled with solution to the desired size. Final cup size can be either B, C, or D. The larger breasts then help proportion the upper body, fill out clothes, and give an increased sense of attractiveness and self-confidence.

This procedure takes about 1 1/2 hours and is done under general anesthesia in the hospital. Patients are discharged either the same day or the next morning, and most women resume normal activities within several weeks.

Silicone breast implants, sometimes referred to as "gummy bear" implants, are still widely available and Dr. Hollingsworth has extensive experience in this area. We will also be more than happy to sit down with you and discuss your options. To get started, call our office at (903)793-8966.

FDA Approved

Filled with Mentor's proprietary silicone gel -- Silicone -- that holds together uniformly while retaining the natural give that resembles breast tissue.

Set fill volume. Dr. Hollingsworth does not recommend adjustable breast implants.

Three projection options: Moderate, Moderate Plus, High Profile.

Two shell surfaces available: smooth and textured.

Slightly larger incision size with various options for incision placement.

The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle. Incisions vary based on the type of implant, degree of enlargement desired, your particular anatomy, and patient-surgeon preference. Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. Over time the incision lines will fade. Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome.

Any woman who has had children knows her body is never the same again. Pregnancy stretches the abdominal skin and muscles, creates "stretch marks," and frequently leaves an unsightly "tummy pooch" after delivery. No amount of exercising or sit-ups seem to help. This wrinkled lower tummy skin and fat create that full, protruding look.

This problem is correctible. By excising the excess skin and fat, tightening the underlying muscles, and trimming excess hip skin, a much flatter tummy can be created.

The operation, called abdominoplasty or "tummy tuck," takes 2-3 hours, and patients are usually back to normal within two weeks. There is very little bruising, and scars can be easily hidden within panty or swimsuit lines. This is an outpatient procedure.

A tummy tuck, or abdominoplasty, is one of the most common cosmetic surgery procedures performed. Often, factors such as multiple pregnancies and genetics can contribute to the development of loose skin, fat deposits, and stretch marks in the abdominal region. Even substantial weight loss can contribute to the development of loose skin in the abdomen. As these areas typically persist despite proper diet and exercise, they can make the abdomen appear disproportionate with the rest of the body.

Women who have only a small abdominal roll just below the belly button are excellent candidates for a mini tummy tuck. This procedure can be done in our office operating suite under local anesthesia, and leaves a much smaller scar than a traditional tummy tuck.

Dr. Hollingsworth injects the area with a local anesthetic. A small incision is made at the hairline level. The abdominal skin is pulled downward, and the excess skin removed.

With aging, skin loses its tone and starts to sag. We are all familiar with our own new wrinkles as we get older. Some people, however, develop a tremendous amount of stretching and sagging of the eyelid skin. When this occurs in the upper eyelids, skin starts to drape over the lid margin, flop into the field of view, and create visual impairment. Patients complain of upper visual loss, which can be accentuated when the head is tilted down. In addition, this excess skin weighs down the lid and gives a very tired and heavy feeling to the eyes.

If this same process occurs in the lower eyelids, thick folds ("festoons") develop and patients again acquire a very tired and saggy look.

The solution to either of these problems is excision of this skin process. For the upper eyelids, a wedge of skin and the underlying fat pad is removed. For the lower eyelids, excess muscle may also be excised. The remaining skin is then resewn into place, giving the eyelids a smoother and younger look.

Bruising is extremely variable, and all sutures are out by one week. Blepharoplasties are usually done under local anesthesia in either the office or the hospital.

Before surgery, the surgeon marks the incision sites, following the natural lines and creases of the upper and lower eyelids. Underlying fat, along with excess skin and muscle, can be removed during the operation. The surgeon closes the incisions with fine sutures, which will leave nearly invisible scars. If there is a pocket of fat beneath the lower eyelids but no skin needs to be removed, the surgeon may perform a "transconjunctival blepharoplasty." In this procedure, a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. The incision is closed with dissolving sutures and leaves no visible scar.

BOTOX® Cosmetic is a simple, nonsurgical, physician-administered treatment that can temporarily smooth moderate to severe frown lines between the brows in people from 18 to 65 years of age. It is the only treatment of its type approved by the Food and Drug Administration (FDA).

Botox procedures are handled by the professionals at Dr. Hollingsworth's Texarkana location
One 10-minute treatment-a few tiny injections-and within days there's a noticeable improvement in moderate to severe frown lines between the brows, which can last up to 4 months. Results may vary.

BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, which reduces the activity of the muscles that cause those frown lines between the brows to form over time.

In 2005, almost 3.3 million procedures were performed with FDA-approved BOTOX® Cosmetic.

When it comes to selecting a physician-administered aesthetic treatment, chances are you'll want proof, not just claims. The proof for BOTOX® Cosmetic is in the numbers.

In clinical trials, nearly 90% of men and women surveyed rated the improvement in the appearance of frown lines between their brows as moderate to better 1 month after treatment. Results vary.

Results can last for up to 4 months, and may vary.

BOTOX® Cosmetic was approved by the Food and Drug Administration (FDA) in 2002 for the temporary treatment of moderate to severe frown lines between the brows in people ages 18 to 65, and almost 3.3 million procedures were performed in 2005 alone.

The American Society for Aesthetic Plastic Surgery ranked BOTOX® Cosmetic as the most popular physician-administered aesthetic procedure in the United States for the fourth year in a row (surgical and nonsurgical combined).

Here's what you might expect at the doctor's office from the moment you arrive until your procedure is done. (Please note that although this experience is typical, the routine at your doctor's office may be different.)

The day of your appointment. Allow time before your appointment for filling out forms and for consulting with the doctor or a member of his or her staff. If it's your initial visit, you may first meet with your doctor personally or a staff member. Many doctors have on-staff licensed aestheticians or nurses who are trained in skin care and skin care procedures who can answer many of your questions.

You may also be asked about your expectations for treatment and if you have any allergies or any condition that wouldn't make you a good candidate for BOTOX® Cosmetic. (See the full prescribing information for more details.)

Before the procedure. You'll probably be seated in a reclining chair, much like you find in a dentist's office. No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream.

The procedure. Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The entire BOTOX® Cosmetic injection procedure takes approximately 10 minutes.

After the procedure. There's no recovery time needed. You're ready to get on with your day! The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.

Seeing results. Within days, you may notice an improvement in the moderate to severe frown lines between your brows that can last up to 4 months. Results may vary.

Your doctor will administer several tiny injections of BOTOX® Cosmetic directly into the muscles that cause those moderate to severe frown lines between the brows. Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The location, size, and use of the muscles that create a furrowed brow vary markedly among individuals. No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream prior to injecting. Discomfort is usually minimal and brief. You can expect to be in and out of the physician's office without downtime. You may see a marked improvement in the moderate to severe frown lines between your brows within days. Improvement may continue for as long as a month, and could last up to 4 months.

Loss of skin elasticity, gravity, and other factors such as weight loss, pregnancy, and breast-feeding ultimately affect the shape and firmness of the breasts. Patients who are generally satisfied with the size of their breasts can have a breast lift ("mastopexy") to raise and firm them, resulting in a more youthful breast contour. Some patients may be unhappy that they have lost a significant amount of breast volume over time. In these cases, implants inserted in conjunction with a breast lift can increase the breast size while at the same time enhancing the shape and position of the breasts.

A breast lift can be performed at any age, although it is generally recommended to wait until breast development has stopped. In addition, subsequent pregnancy and breast-feeding may have significant and unpredictable effects on the shape and size of the breasts. (Breast-lift surgery usually does not affect the ability to breast feed.)

The surgery generally involves three incisions. One incision is made around the areola (the pigmented skin surrounding the nipple); a second runs vertically from the bottom edge of the areola to the crease underneath the breast; while the third is horizontal and follows the natural curve of the crease beneath the breast. The surgeon removes excess breast skin, then shifts the nipple and areola to a higher position. Skin which was previously located above the areola is brought down and together beneath it to reshape the breast.

The procedure is performed under general anesthesia in either the office or the hospital. Normal activities can often be resumed after 3-4 weeks.

Loss of skin elasticity, gravity, and other factors can affect the shape and firmness of the breasts. Your breast lift surgery can be achieved through a variety of incision patterns and techniques. The appropriate technique for you will be determined based on:

• Breast size and shape
• The size and position of your areolas
• The degree of breast sagging
• Skin quality and elasticity as well as the amount of extra skin

Breast cancer will strike one out of every nine women. Treatments vary depending upon tumor size and type, but complete removal of the breast still seems to be the treatment of choice. This loss of a breast, however, need not be a devastating experience.

In most women, reconstruction can be accomplished by performing two fairly short procedures. The first involves making an incision in the old scar, creating a pocket under the remaining chest skin, and inserting an empty tissue expander. Over the next couple of weeks, this expander is slowly filled with saline solution, thereby stretching the skin. Then, three to four weeks later, the patient is returned to the operating room where the expander is removed, a permanent implant is inserted, and the nipple is reconstructed.

The patient now has a much more symmetrical feel and appearance to her breasts. Underneath clothing, her reconstructed breast can be indistinguishable from the normal side. Most patients miss only 2-3 days of work. Each operation can be done in under two hours, but needs to be done under general anesthesia in a hospital setting. Patients usually go home the same day.

A tissue expander is inserted following the mastectomy to prepare for reconstruction.


The expander is gradually filled with saline through an integrated or separate tube to stretch the skin enough to accept an implant beneath the chest muscle.


After surgery, the breast mound is restored. Scars are permanent, but will fade with time. The nipple and areola are reconstructed at a later date.

Too much of something is not necessarily a good thing. This is especially true for women with large breasts. Carrying 4-8 pounds of extra weight all day can put a real strain on the shoulders and neck.

Patients typically complain of bra strap scarring into the shoulders, upper back and neck pain, postural difficulties, chest wall and breast pain, and summertime skin irritation. With increasing age, neck and back arthritis will worsen. Finding clothes that fit is often a nightmare, and patients can forget about enjoying strenuous physical activities.

Surgical breast reduction is the only relief available to these women. Not only is the excess breast tissue removed, but the droopy breast is uplifted and returned to a more normal position.

This procedure takes 3-4 hours and needs to be done under general anesthesia in the hospital. Patients are usually discharged the next moring. Pain is usually less than expected, and most women can return to work in 7-10 days.

The excessive weight of large breasts can cause physical symptoms such as back, neck, and shoulder pain, as well as skin rashes beneath the breasts.

One common breast reduction technique removes excess breast tissue, fat and skin through the incisions shown. The nipple and areola remain attached to the underlying tissue but are shifted to a higher position. The size of the areola is often reduced at the same time.


Skin that formerly was located above the nipple is brought down and together to reshape the breast.

The visible signs of facial aging occur over time as a result of many factors including sun exposure, heredity and life style. One of the earliest signs of again is a loss of facial fullness and the development of expression lines - wrinkles that appear as a result of the repeated movement of facial muscles. Softening of these facial lines and creases and the restoration of the volume and fullness in the face can often be achieved non-surgically through treatment with injectable fillers.

If you wish to enhance or restore facial contours or reduce the appearance of lines and creases, injection therapy with soft tissue fillers may be right for you. Injectable fillers can plump thin lips and restore fullness to other facial tissue, enhance shallow contours, soften facial creases and wrinkles, and in some cases, improve the appearance of recessed scars. The result is a smoother, fuller and more youthful facial appearance.

The skin consists of two layers: the upper layer is called the "epidermis," the lower layer is the "dermis." The dermis is primarily made up of a protein called "collagen." Collagen forms a network of fibers which acts as the support structure for the skin.

Over time, the skin's support structure weakens and the skin loses its elasticity. As the collagen support gradually wears down, the skin begins to sag, resulting in lines and wrinkles.

In collagen replacement therapy, tiny amounts of collagen are injected just beneath the skin. They replace the body's natural collagen which has been lost over the years, providing additional support for the skin and helping to smooth facial lines and most types of scars.

As we age, our skin changes. Over time, the natural volume of youthful skin begins to diminish as wrinkles and folds form. But, with Juvéderm™ injectable gel, you don't have to just sit back and let it happen! Recently approved by the FDA, Juvéderm™ injectable gel is a "next-generation" dermal filler. The smooth consistency gel helps to instantly restore your skin's volume and smooth away facial wrinkles and folds, like your "smile lines" or "parentheses" (nasolabial folds-the creases that run from the bottom of your nose to the corners of your mouth).

Juvéderm™ is a smooth consistency gel made of hyaluronic acid-a naturally occurring substance in your skin that helps to add volume and hydration. Your healthcare professional eases Juvéderm™ injectable gel under the skin to provide a smooth, natural look and feel-so everyone will notice (but no one will know)! In fact, studies show superior results of Juvéderm™ compared to a collagen-based dermal filler.* And, almost 90% of all study volunteers who were treated with both Juvéderm™ injectable gel and another dermal filler* preferred Juvéderm™! In addition, Juvéderm™ injectable gel is the first FDA-approved hyaluronic acid dermal filler that is proven to be safe and effective for persons of color.

With Juvéderm™ the injection process takes only about 15 minutes and results are immediate. Plus, there's minimal recovery or downtime. So you can step into your doctor's office for treatment and step right back into your life.

*The other dermal filler used in this study was ZYPLAST® dermal filler (bovine-based collagen).

Dermabrasion and dermaplaning help to "refinish" the skin's top layers through a method of controlled surgical scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance. Dermabrasion is most often used to improve the look of facial skin left scarred by accidents or previous surgery; or to smooth out fine facial wrinkles, such as those around the mouth. Dermaplaning is commonly used to treat deep acne scars. Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone, or in conjunction with other procedures, such as facelift, scar removal or revision, or chemical peel.

Both procedures can enhance appearance and self-confidence, but neither will remove all scars and flaws or prevent aging. In addition, individual factors such as your skin type, coloring, and medical history must be taken into account. People with dark skin complexions may become permanently discolored or blotchy after a skin-refinishing treatment. Those who develop allergic rashes or other skin reactions, cold sores, or fever blisters may experience a flare-up. Also, most surgeons won't perform treatment during the active stages of acne because of a greater risk of infection.

In dermabrasion, the surgeon scrapes away the outermost layer of skin with a rough wire brush, or a burr containing diamond particles, which is attached to a motorized handle. In dermaplaning, the surgeon uses a hand-held instrument called a "dermatome," which resembles an electric razor. The dermatome has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the defects.

Dermabrasion and dermaplaning are commonly performed under local anesthesia, although general anesthesia may be used instead. The procedures usually take up to about 1 1/2 hours, depending on how large an area of skin is involved. In cases of deep scarring, or when a large area of skin needs to be treated, the procedure may be performed more than once.

In dermabrasion, the surgeon scrapes away the top layers of skin using an electrically operated instrument with a rough wire brush or diamond-impregnated burr.

This cross-section shows how dermabrasion smooths irregularities in the outermost layer of skin.

Dermaplaning uses an instrument called a "dermatome" to skim off surface layers of skin that surround facial defects. The dermatome is a hand-held instrument which resembles an electric razor. It has an oscillating blade that moves back and forth.

With aging, the effects of gravity, sun exposure, and daily stress can give a tired look to your face. The normally tight elastin and collagen fibers in the skin begin to stretch and break, the dermal layer thins, and little fatty pockets begin to form. These effects, in turn, lead to deep creases around the nose, a jawline that begins to sag, and a neck that can become very loose. Patients begin feeling as tired as they look.

The best way to correct this problem is simply to cut out the stretched and excess skin -- artistically, of course. A facelift cannot stop the aging process, but it can remove excess fat, tighten the underlying muscles and redrape the face and neck skin.

Incisions begin in the mid-scalp, go down in front of and behind the ear, and end in the posterior scalp. The procedure can be lengthy -- 4-5 hours -- and can be done under local or general anesthesia. Scars are easily hidden by normal skin creases and hairstyles. The results are a more-refreshed look to the face and enhanced self-confidence. Bruising is usually less than most people expect. This operation can be done in either the office or the hospital.

Incisions usually begin above the hairline at the temples, then follow the natural line in front of the ear, curve around behind the earlobe into the crease behind the ear, and move into or along the lower scalp.

Facial/neck tissue and muscle may be separated, fat may be trimmed or suctioned, and underlying muscle may be tightened.

Forehead lift is most often used to improve such facial characteristics as drooping eyebrows, "hooding" or drooping tissue at the outer part of the eyes, furrowed forehead, and frown lines at the top of the nose. The desired result is a more alert and less tired appearance, smoother forehead skin, and softer lines between the eyes. Although generally used to combat the effects of aging, forehead lifts can also benefit younger people who have (for example) congenitally low eyebrows which may interfere with the upper field of vision.

Due to recent advances in plastic surgery, the results of a forehead lift may last anywhere from 5 to 10 years, or even longer.

An incision is made across the top of the head a few inches behind the hairline (which minimizes the chances of the scar's being visible). If the patient has a high or receding hairline, however, the incision will be made at the hairline -- in which case, a thin scar line may be visible unless covered by the hair. Several strips of forehead muscle are then removed. If there are deep vertical furrows at the top of the nose, a portion of the muscles between the eyebrows is removed as well. The forehead skin is then pulled upward, and any excess skin at the point of the incision is removed.

Bruising and swelling are natural; they will begin to decrease in 7-10 days. Most patients can resume their normal routines, including work, within this same time period. The surgery itself takes 1-2 hours.

Brow lift surgery can be performed through multiple limited incisions hidden within the hairline or through a single incision in the natural crease of each upper eyelid.

Results of a brow lift may be enhanced through laser resurfacing or a chemical peel that can further improve skin tone and surface appearance.

When there is significant excess skin in the forehead, an alternate technique using a wide incision across the top of the scalp may be recommended.

An incision is usually made across the top of the head a few inches behind the hairline. In preparation for this incision, the hair is tied with rubber bands in front of and behind the incision area. The forehead skin is gently pulled upward, and any excess skin is removed.

Labiaplasty, sometimes spelled as labioplasty, is an outpatient surgical procedure performed to reshape or reduce the appearance of the labia minora - the skin that covers the female clitoris and vaginal opening. Women with large labia sometimes experience pain during intercourse, embarrassment with a sexual partner, discomfort during cycling, walking or sitting, and/or problems with personal hygiene.

The length of surgery is usually under an hour and is performed either under local, twilight or general anesthesia, depending upon the patient's preference. After surgery, women may experience some mild discomfort and swelling which typically disappears after 1-2 weeks. Labial incisions are rarely noticeable after healing.

Some people are just predisposed to localized fat deposits in various areas of their bodies. These areas are usually the lateral thighs, hips, abdomen, or waist. No matter how much exercise is done, the deposits just seem to persist. Sad to say, these patients, mostly women, are just genetically programmed to have this problem.

Rather than cut out these areas with a knife and leave unsightly scars, a vacuum-type procedure has been developed: liposuction. Several 1/2-inch incisions are made near the fatty areas, a perforated tube (called a "cannula") is inserted into the deposits, and excess fat is broken up and suctioned out. A few sutures then close the cuts, a girdle is slid over the area, and the patient can return to normal activities.

After the surgery jeans, shorts, and skirts drape better over a more normally proportioned body.

Depending upon the area and amount of suctioning required, liposuction can be performed either under local anesthesia in the office or under general anesthesia in the hospital. Note that this procedure is not a substitute for dieting, and no more than 3-4 pounds can be safely removed at any one time.

The best candidates for liposuction are of normal weight with localized areas of excess fat -- for example, in the buttocks, hips, and thighs.

The surgeon makes small incisions in the skin, then inserts a perforated tube ("cannula") through the incisions. At the other end of the tube is a vacuum-pressure unit that suctions off the fat. A snug compression garment worn after surgery helps reduce swelling.

Lop-ear deformity is a condition whereby the ears protrude abnormally from the side of the head. Instead of slanting backward, they stick almost straight out and look excessively large. For young children this obvious difference can be a source of embarrassment and teasing. Ears usually reach their adult size by the age of 5 or 6. Correction of this problem can be done anytime thereafter.

The ear is reformed by removing skin and cartilage from the ear's back side, re-creating natural folds, and then sewing everything into a more flattened position. A headband will need to be worn for 2-3 weeks after the surgery. Rarely are there any noticable scars. Children require general anesthesia for this procedure, but teenagers and adults can be done under local anesthesia. Surgery is often performed in the hospital, but it requires no overnight stay.

Ears that appear to stick out or are overly large can be helped by ear surgery.

An incision is made in the back of the ear (1) so cartilage can be sculpted or folded (2). Stitches are used to close the incision and help maintain the new shape (3).

Creating a fold in the cartilage makes the ear lie flatter against the head and appear more normal.

Not every nose looks normal on every face. Noses can sometimes be too large, too wide, or too crooked. They may also be obstructed, function poorly as an airway, or have a prominent hump. As the major feature of the mid-face, the nose has great potential to enhance or detract from an already pretty face. Likewise, a nose that does not breathe well can be a real nuisance.

For breathing difficulties, the inside cartilage of the nose may need to be straightened ("septoplasty") or chronically swollen tissue may need to be amputated ("turbinectomies"). Cosmetic problems often require shaving off bone, breaking and then resetting the nose. Patients may need to wear a splint for 5-7 days. Bruising can be extremely variable. There are no external incisions or sutures with any of these surgeries, and patients can sometimes return to work in 4-5 days. All of these procedures need to be done in the hospital under general anesthesia, but none require an overnight stay.

Incisions are made either inside the nostrils or at the base of the nose, providing access to the cartilage and bone, which can then be sculpted into shape.

To remove a hump, the surgeon uses a chisel or rasp, then brings the nasal bones together to form a narrower bridge. Cartilage is trimmed to reshape the tip of the nose.

Trimming the septum improves the angle between the nose and the upper lip.

If the nostrils are too wide, the surgeon can remove small wedges of skin from the nostrils' base, bringing the nostrils closer together.

Whenever the skin is cut, either by accident or surgery, it heals by forming scar tissue. Scarring is determined not only by skin texture, wound size, and wound depth, but also by the patient's genetic make-up. Some people are just programmed to be good scar formers, while others are not.

Scars initially are red, raised, and hard, but over time they become flat, soft, and normal colored. Sometimes, however, scars can remain wide and unsightly. In these cases, it may be worthwhile to perform a scar revision.

The surgery involves excising the old scar, freshening the wound edges, and resewing the wound with different sutures or technique. This second time, the blood supply is often better and there is no trauma, glass, dirt, or grass in the area. These operations vary in length, but can usually be done under local anesthesia. There is no overnight hospital stay.

Years of sun exposure leaves not only wrinkles and tan, but increased risk of skin cancer. Lengthy exposure to ultraviolet rays damages cellular DNA, causing cells to multiply aimlessly and aggressively. The result is skin cancer.

Squamous and basal cell carcinomas are the most frequent, but melanomas are the most dangerous. Lesions are often present as dark or crusted spots which progressively increase in size. They then become painful, ulcerate, and bleed.

As expected, the majority of skin cancers are found on the most sun-exposed areas of the body: hands, arms, and face. Early cancers can often be treated with burning or the use of Efudex® ointment, but more advanced lesions require surgical excision and sometimes skin grafting. Melanomas in particular require agressive surgical therapy.

Small lesions can be excised under local anesthesia in the office, but larger or more involved cancers may require general anesthesia in the hospital. Most patients return to normal activities in a couple of days. These surgeries can usually be performed in the office or as a day-surgery procedure at the hospital.

Spider veins are small, thin veins which lie close to the surface of the skin. Although these fine veins are connected with the larger venous system, they are not an important part of it. Factors contributing to spider veins include heredity, pregnancy, weight gain, or activities which require prolonged standing or sitting.

Spider veins manifest themselves as reddish or purplish lines upon the thighs, and they can sometimes be so numerous as to be cosmetically disfiguring. These veins are usually treated by sclerotherappy. For this procedure, a number of injectible substances can be used. The solutions irritate the sides of the veins badly enough that the veins collapse and slowly wither away.

Not all veins, however, respond to injections equally well. Some may require several injections to achieve the desired result. The procedure can be done in the office and can take from 15-45 minutes. Tight-fitting support hose will help with vein collapse. Most patients can return to work immediately afterward.

The skin is held taut while the injection of sclerosing solution is administered under bright light and magnification.

A cotton ball and compression tape are applied to each treated area. Elastic bandages or stockings may be used to help further the action of the injected medication.