Varicose Veins

What are varicose veins?

Veins that have become bulging, elongated, thickened and rope-like are called varicose veins. Normally, one-way valves in veins keep blood flowing against the force of gravity. When the valves do not perform their function, blood can flow backwards or reflux within the vein. They usually occur near the surface of the skin and appear as bulging veins with a purplish hue.

Varicose veins can develop through a combination of these faulty vein valves and weakened vein walls. Under a variety of circumstances, normally toned, elastic vein walls can become weak and allow the recirculating blood to flow backward in the vein causing the blood to pool and the vein to bulge.

What are the steps of a varicose vein treatment at Medicus?

1. Complimentary Consultation

During the consultation, your questions will be answered by Dr. Steven Tidwell and will determine if you have varicose or spider veins.

2. Ultrasound Diagnosis

If you have varicose veins, an ultrasound will be performed by Dr. Steven Tidwell. After the ultrasound, he will be able to recommend the best treatment option for your unique case.

3. Vein Treatment

Treatment is scheduled following your ultrasound. Each of the varicose vein procedures are minimally invasive and allows for zero downtime. If you have health insurance, we will handle all of the insurance claims for you.

4. Follow-up Visits

You will see the doctor for a follow-up visit after your treatment for an ultrasound to ensure closure of the treated vein.

What is Interventional Radiology and why is it important for vein care?

Interventional Radiologists are specialized doctors who specialize in minimally invasive, targeted treatments performed using imaging for guidance. They have the ability to access the abnormal veins and navigate through their twists and turns – skills that are developed in Diagnostic and Interventional Radiology training.

Interventional Radiologists are specifically trained on ultrasound technology to not only diagnose, but to also treat venous conditions. The varicose vein treatments we perform at Medicus Vein Care rely on the ultrasound skill to not only diagnose the varicose veins, but are also used during the treatment itself, as well as each follow-up visit to ensure vein closure.

Why does Dr. Tidwell perform every ultrasound at Medicus Veincare?

Board Certified Diagnostic Radiologists such as Dr. Tidwell are specifically trained in ultrasound imaging during their four-year residency training program. His post-graduate fellowship in vascular and interventional procedures allowed him to expand his expertise with the vascular system and its irregularities, and he combines those skills to accurately diagnose and treat varicosities. An ultrasound technologist does not have this training, or diagnostic ability.

Patients should be aware that since an ultrasound is required not only for the initial diagnosis of varicose veins, it is also an integral part of the procedures that eliminate them. It is important to choose a physician who relies on his own training and experience to accurately determine the underlying cause of symptoms, find the abnormal veins, and treat them with familiarity and expertise.

What are the symptoms of varicose veins and venous insufficiency?

Symptoms include aching, throbbing, fatigue, itching, tingling and heaviness – all of which worsen as the day goes on. Mild swelling in the ankles and feet often occur. Many people find that they need to sit down in the afternoon and elevate their legs to relieve symptoms.

People who have venous insufficiency can have symptoms even without visible varicose veins.

How are vein problems diagnosed?

An Interventional Radiologist can assess your clinical situation through an ultrasound evaluation. The ultrasound is important because it determines which veins are not functioning properly and allows the physician to create a "game plan" and to present you with a treatment plan.

How are varicose veins treated?

Using an ultrasound, Dr. Steven Tidwell maps out the veins in your leg to pinpoint the faulty vein that needs to be treated. To treat this faulty vein, he inserts a very small probe using an ultrasound to follow and guide it to the proper position. He will then remove the probe, sealing the vein with either thermal energy or a surgical-grade glue.

What is venous insufficiency?

The reflux of blood in faulty veins result in what is known as venous insufficiency, a very common condition that results in the pooling of blood in the vein and, in turn, creates varicose veins.

Is the loss of a vein a problem?

Not at all. The blood flow of the faulty veins are already being diverted to the many normal veins in the leg.

Is there any downtime?

No, there is no downtime associated with any of the vein procedures. You can go back to your normal activities right away. In fact, we want you to stay active after treatment!

Each of the treatment modalities are minimally-invasive and do not require any sedation, only local anesthetic.

What happens if I leave my varicose veins untreated?

Varicose veins are a result of vein disease and will only continue to get worse if left untreated. Some patients progress to develop skin changes and ulcerations, in addition to swelling and discomfort.

Venous leg ulcers form when the varicose veins push against the surface of the skin, allowing the skin to become thin over time and break down.

Is there anesthesia involved with the treatment?

No, only local anesthetic is used. Patients find the discomfort from the procedures are minimal and some even fall asleep during the procedure. The procedures allow for zero downtime and you can return to your normal activities immediately after treatment.

Are laser fibers ever re-used?

No, we never re-use laser fibers or any procedure component.

Do I need to wear compression stockings?

Yes, you will need to wear compression stockings for up to two weeks after treatment to ensure complete closure of the vein. We sell many styles and colors of compression stockings to suit your lifestyle.

However, the VenaSeal glue procedure does not require the use of compression stockings.

Does my insurance cover treatment for varicose veins?

Yes, the treatment for varicose veins is considered medically necessary by insurance companies. Our insurance specialists will process all claims and will follow-up with your insurance company as necessary. After your consultation, we will advise you by phone or email of any deductibles, copays or co-insurance amounts that you may owe. If you do not have health insurance, we offer a cash rate.

We accept most major insurance companies including: Aetna, Blue Cross Blue Shield (Florida Blue), Cigna, Coventry, Medicare, Multiplan (BeechStreet, PHCS) and United Healthcare. If your insurance company is not listed, please call us. We may participate with your specific insurance plan.

Health insurance does not yet cover the VenaSeal glue procedure, except Medicare. Please contact us regarding pricing for this treatment.

Spider Veins

Why should I choose Medicus for spider vein treatment?

As a vein specialist, Dr. Steven Tidwell has the skill and latest technology at hand to treat varying cases of spider veins, including reticular, or "feeder" veins.

Reticular veins are the larger blue veins that often "feed" the spider veins and are eliminated using foam sclerotherapy. If previously treated spider veins are stubborn and seem to not go away, injecting the reticular veins will eliminate the spider veins at the source. Sometimes, an ultrasound is needed to see these reticular veins if they are not visible under the surface of the skin. As a board-certified Diagnostic Radiologist, Steven Tidwell, M.D. is specifically trained on ultrasound diagnostics and performs all of his own ultrasounds without the need for a separate ultrasound technologist.

Utilizing a combination of sclerotherapy (including ultrasound-guided sclerotherapy), VeinWave™, and cutaneous laser therapy, if needed, the professionals provide Medicus patients with optimal results normally not attainable with only one type of treatment.

Of course, patients need to keep in mind that with the exception of VeinWave™, all therapies require more than one treatment for optimal results.

What are Spider Veins?

Spider Veins, or Telangiectasias, are small, dilated or broken segments of blood vessel visible through the skin, often seen in a clustered pattern known as “spider veins.”

Hypertonic saline vs. Polidocanol for sclerotherapy?

We use FDA-approved Polidocanol for the sclerotherapy treatments. While the efficacy is the same, hypertonic saline (heavy salt water) is not used because it cannot be made into a foam to inject the reticular (feeder) veins and small varicosities for ultrasound-guided sclerotherapy. Polidocanol is more versatile than hypertonic saline and is more comfortable for the patient; it does not sting when injected.

How long does it take for the spider veins to go away after treatment?

Depending on how large the spider veins are, they typically go away within 2-4 weeks and may require up to 3 to 5 sclerotherapy or cutaneous laser treatments.

When using VeinWave™(used for the small spider veins typically found on the face or ankles), they disappear almost instantaneously after only one or two treatments. However, not all spider veins are candidates for VeinWave.

Are facial veins able to be removed?

Yes, the VeinWave™ treatment is specifically made for the small spider veins commonly found around the face including the nose and cheeks. Using microwave energy, the Veinwave procedure will eliminate these small veins in one to two treatments.

Are veins in the hand able to be treated?

Yes, veins in the hand can be treated by injecting a sclerosant into the vein, also known as sclerotherapy.

We also recommend injecting a dermal filler into the hand to improve the appearance of these veins without actually removing them.

Do insurance companies cover the cost of spider vein treatments?

Insurance companies do not cover the cost of spider vein treatments because they are considered cosmetic procedures.

If ultrasound-guided sclerotherapy is necessary for small varicosities to be injected, these treatments are covered by insurance companies.

Compression Stockings

What are compression stockings?

Compression stockings are elastic garments worn around the leg to help the blood flow up the leg, as well as promoting improved circulation and to aid in the management of venous disorders.

Why should I use compression stockings?

Everyone can benefit from compression therapy. Those with venous insufficiency find the stockings help in easing their symptoms, while individuals with leg swelling and lymphedema find the gradient compression useful to encourage the movement of fluids, whether it is blood fluid circulation or lymph fluid circulation. Compression stockings are also during post-treatment for the varicose vein procedures to ensure closure of the treated vein.

Compression stockings have the added benefits of creating a "lightweight" and "active" feeling in the legs, making them ideal for everyday use around the house or even when exercising. They are also fit for travel to help improve circulation when seated for long periods of time.

Which compression strength should I use?

There are four types of compression: 8-15 mmHg (Mild), 15-20 mmHg (Moderate), 20-30 mmHg (Firm), and 30-40 mmHg (Extra Firm).
If you aren't sure which strength you need, visit us for a free fitting and we will speak with you to determine your amount of compression strength. If you need a prescription for a stronger compression strength, we will supply that for you.

How can I purchase compression stockings?

We encourage you to either call us to book a personalized free fitting, or mention during your vein care appointment, to discuss your symptoms and lifestyle needs for us to determine your compression strength, measure your leg for the proper fit, and show you the stocking choices available to you. We offer many colors and styles of compression stockings to suit your lifestyle.


Am I a good candidate?

Good candidates have noticeable bulges in certain areas they’d like to get rid of. The CoolSculpting fat reduction procedure is specifically designed for those who have unwanted fat that resists diet and exercise. Unlike gastric bypass surgery, the CoolSculpting procedure is not a weight loss solution for people who are obese. It is, however a non-surgical alternative to liposuction. Request a one-on-one consultation with us to determine if the CoolSculpting procedure is right for you.

How much does the CoolSculpting procedure cost?

The price for CoolSculpting procedures varies depending on your areas of concern, the number of sessions needed, and your ultimate goals. We will help create a customized treatment plan, in person, that’s tailored to your body, your goals, and your budget.

How long is each session? How many sessions will I need?

We will help you create an individualized treatment plan tailored to your specific goals. The length of your CoolSculpting session will vary depending on the number of areas being treated during one visit. We may schedule additional sessions in order to meet your goals.

Where does the fat go? Are the results permanent?

Once the treated fat cells are crystallized (frozen), your body processes the fat and eliminates these dead cells. Once the treated fat cells are gone, they’re gone for good.

What does it feel like?

As the cooling begins during the first few minutes, you will feel pressure and intense cold. This soon dissipates. Many people read, watch videos, work on their laptop, or even take a nap during their treatment.

Is the CoolSculpting procedure safe?

The CoolSculpting procedure is FDA-cleared for the flank (love handles), abdomen, and thigh. With over one million CoolSculpting treatments performed worldwide, it is proven to be a safe and effective treatment for non-surgical fat reduction.

Are there any side effects?

During the procedure you may experience deep pulling, tugging, pinching, numbness or discomfort. Following the procedure, typical side effects include temporary numbness, redness, swelling, bruising, firmness, tingling, stinging and pain. Rare side effects may also occur. The CoolSculpting procedure is not for everyone. You should not have the CoolSculpting procedure if you suffer from cryoglobulinemia or paroxysmal cold hemoglobinuria. The CoolSculpting procedure is not a treatment for obesity. As with any medical procedure, ask us if the CoolSculpting procedure is right for you.

Can I return to normal activities after my treatment?

Yes, you can. The CoolSculpting procedure is completely non-surgical, so typically you can return to normal activities immediately. Often times, patients return to work after their CoolSculpting session is over.

When will I see results?

You may start to see changes as quickly as three weeks after your treatment, and will experience the most dramatic results after two months. But your body will still flush out fat cells and continues doing so for up to four to six months after treatment.

Do I need to take special supplements or follow a strict diet and exercise program?

No supplements or pills are required and you do not have to adopt new diet and exercise habits. Many patients feel more motivated to take care of themselves after their CoolSculpting treatment. It is as if they get a second lease on their body and want to start anew again by taking even better care of themselves.

What happens if I gain weight down the road?

Many people, after seeing the results from their CoolSculpting procedure, take even better care of themselves. However, if you do gain weight, you may gain it evenly all over your body, not just in the treated areas.