It’s a minor surgical procedure used by phlebologists to remove varicose veins. Also known as stab avulsion, it consists of a vein specialist making several tiny incisions through which veins are removed. Dr. Hoyle pioneered this procedure in Southern California after traveling to Switzerland 15 years ago.

All of the procedures Dr. Hoyle does are performed in-office under local anesthetic. If the patient feels that they require some sedation, oral medications are provided that can accomplish this. Patients usually are able to drive home after the procedure. However, if oral sedation was required, a driver may be needed.

Microphlebectomy is often done in a surgical center or hospital setting such as Kaiser or the VA hospital. Dr. Hoyle pioneered performing this procedure in an office setting 15 years ago.

Post-op care is simple since it doesn’t require stitches. The patient must keep the site clean. Generally, the patient will leave the office wearing a compression hose for 1 day and then may resume regular activities.

It’s possible to develop an infection. Bleeding, blood clots, and temporary numbness from nerve irritation can occur. These are extremely rare side effects. Tenderness is common but rarely requires pain medication stronger than Advil or Aleve. Many patients require no medication after the procedure.

Microphlebectomy is most often done after an endovenous procedure such as laser or radiofrequency ablation.

Patients are extremely satisfied with the results of the procedure. Endovenous thermal ablation and microphlebectomy have a success rate well over 95%. New vein problems may develop over time as venous disease is hereditary.

Microphlebectomy is most commonly used to treat large bulging varicosities. The only way to know for sure if a patient is a candidate is to schedule a consultation and have an expert phlebologist evaluate the vein.

Endovenous Laser Ablation

Endovenous thermal ablation is a treatment that is typically used on incompetent saphenous veins, which are usually not visible but are a common cause of varicose veins. EVTA typically utilizes radiofrequency or laser energy to close these abnormal veins in the legs. The associated visible varicose veins may go away or may require treatment in a separate procedure called microphlebectomy.

ETA is not considered a cosmetic procedure although it may improve the appearance of some visible veins. Endovenous thermal ablation tends to be more commonly used to relieve the symptoms that arise as a result of venous insufficiency. For example, undergoing the procedure has the potential to relieve symptoms like swelling, aching, inflammation, and skin irritation.

Endovenous thermal ablation is much safer than many other types of surgical procedures, primarily because it is done under local anesthetic; in many ways, it’s not any different than going to the dentist. The procedure is done through a puncture wound, so no suturing is required which results in minimal to no scars.

The patient should wear comfortable or loose-fit clothing. All articles of clothing including jewelry must be removed before the patient can be examined. The physician will use an ultrasound machine to access the vein with an IV catheter through which the radiofrequency device or laser fiber is inserted. A topical anesthetic is applied to the skin, and a dilute anesthetic solution is injected along the outside of the vein. The energy from the device is applied to the vein to heat it until it closes. The procedure is done in the office, and the majority of patients can drive themselves to and from their visit. Not all doctors can do the procedure this way, so many patients are treated in the hospital or outpatient surgical center setting. Dr. Hoyle has performed thousands of these procedures in his office for more than 15 years. In fact, patients can resume most normal activities the next day, including returning to work.

It’s possible to develop an infection. Bleeding, blood clots and temporary numbness from nerve irritation can occur. These are extremely rare side effects. Tenderness is common but rarely requires pain medication stronger than Advil or Aleve. Many patients require no medication after the procedure.

Ultrasound Guided Sclerotherapy

First, a foam is formed using a small volume of the traditional sclerotherapy solution such as sodium tetradecyl sulfate or polidocanol. The solution is rapidly mixed and aerated. The agitation creates a foam solution that’s injected into the veins. Generally, this form of sclerotherapy works better for larger abnormal veins since it tends to reach a larger area of the vein. The amount of foam can be altered based on the size of the vein.

The solution reaches a larger area since it’s a foam solution. It’s ideal for larger veins. It’s used to treat varicose or spider veins.

The ultrasound machine is first used as a diagnostic tool since it visualizes deeper veins in the legs and can distinguish which veins are normal from veins that are abnormal, incompetent, or refluxing. Ultrasound is also used in treatment as it can guide the placement of needles, catheters, and solutions into the veins.

This is best answered in consultation with the doctor. Dr. Hoyle primarily uses foam sclerotherapy for deeper varicose veins that are not amenable to endovenous thermal ablation or surgical removal. On occasion, he will use foam sclerotherapy on spider veins in certain troublesome areas on the legs.

It may take two or three treatments conducted on different days to successfully treat the problem. An ultrasound machine is used to visualize and gain access to the abnormal veins with a tiny needle through which the foam sclerosant is injected. The ultrasound can also monitor the movement of the foam in the vein. No anesthetic is required.

Usually, it is rather painless besides the pinch of the injections. Some people experience hard lumps where the veins were. The skin where the foam was injected may turn brown. Deep vein thrombosis is possible but extremely rare. Some of the treated veins may remain open and require retreatment. Ulcers, visual disturbances, allergic reactions, or stroke have been reported in worldwide literature but are extremely rare.


ClariVein® is a special device used to close off incompetent truncal veins. The treatment consists of inserting a catheter that has a rotating wire. The wire has a 360-degree dispersion of agents used to treat the area. It’s a minimally invasive procedure that doesn’t require a person to stay overnight at a hospital. In fact, it is performed in the office.

The phlebologist will insert a thin catheter, similar to an IV insertion. Inside the catheter is a wire connected to a motorized handle, which spins the wire very quickly. About an inch of the wire extends past the catheter, causing a spasm of the vein. As the catheter and wire are withdrawn, a sclerosant solution is slowly injected, which closes the vein.

The physician will need to do a thorough ultrasound evaluation of the veins to determine the size and severity. This will allow the physician to determine if the procedure is right for the patient’s specific needs. ClariVein® is not covered by all insurances, which may not make it the best viable option for many patients. A physician will be able to determine if ClariVein® is the best treatment.

In some parts of the leg, there can be a risk of nerve damage with radiofrequency ablation or laser ablation. Since ClariVein® does not use heat, there is no risk of nerve damage, which is an advantage in selecting this treatment. Generally, the patient won’t experience any pain. Bruising, itching, or pain is possible at the site but is minimal and temporary. Infection is possible but isn’t likely because of the small size of the entry point. It’s possible to have a reaction to the medications used. Additionally, skin discoloration is possible with this procedure, like most other varicose vein treatments, but rare. The patient may experience discomfort from the rotating wire, but it goes away once the procedure is completed.


Varithena is an injectable foam treatment for varicose veins. In addition to reducing the appearance of your varicose veins, Varithena also alleviates other varicose vein symptoms such as:
• Heaviness
• Aches and cramps
• Swelling
• Throbbing
• Itching

Varithena is an effective treatment for almost anyone who has varicose veins. Dr. Hoyle uses Varithena to treat several types of varicose veins of all sizes, including twisted (tortuous) veins. He can also use the treatment on varicose veins above and below your knee.
Varithena is also suitable to retreat veins that didn’t respond to other therapies, and it’s a suitable treatment for patients who have issues with the great saphenous vein.

Dr. Hoyle injects the Varithena foam medication into your varicose vein. The microfoam fills the inside of the damaged vein, causing it to collapse and seal itself closed. Your blood is then forced to flow through healthier veins. Over time, your varicose veins atrophy, and your body absorbs the vein tissue.

Varithena™ treatment takes less than an hour. Dr. Hoyle examines your veins and might provide a local anesthetic to ensure your comfort during the procedure. Then, using a specialized needle, he injects Varithena into your varicose veins. Dr. Hoyle can treat more than one vein at a time. When your treatment is complete, we apply compression stockings to your legs, and you can drive yourself home but walking is encouraged. There is essentially no downtime.

After your Varithena treatment, you need to wear the compression stockings for at least 48 hours constantly. They provide compression that helps your treated veins remain closed as the medication takes effect. After 48 hours you can take everything off and shower then, wear compression stockings during the daytime for up to two weeks.

Dr. Hoyle provides customized aftercare instructions, but in general, you should avoid strenuous exercise for a week after your Varithena treatment. However, you should avoid strenuous exercise and heavy lifting. However regular low-intensity exercise and walking is encouraged.

If you have varicose veins and are interested in Varithena treatment, call Advanced Vein Center or schedule an appointment online to meet with Dr. Hoyle today.


VenaSeal is an injectable treatment for varicose veins. Unlike other treatments for varicose veins, VenaSeal doesn’t use heat or a foaming sclerosant medication to close and seal your damaged veins. Instead, it uses an adhesive substance to help your varicose veins close and stay shut.

In addition to sealing off your varicose veins, VenaSeal treatment can also reduce other symptoms of venous reflux disease, including:
• Tired, aching legs
• Throbbing sensations
• Itchiness
• Heavy feeling in your legs

VenaSeal treatment is a minimally invasive outpatient procedure. When the treatment is complete, Dr. Hoyle needs only a small bandage to cover the puncture wound. One of the advantages of VenaSeal is there are no compression stockings.

VenaSeal combines the adhesive substance with pressure to close and seal your veins. Once the adhesive is in place. More than 100,000 patients across the United States have used VenaSeal to treat their uncomfortable varicose veins.

During the VenaSeal procedure, Dr. Hoyle makes a small puncture site in your leg and guides a catheter through your veins and into your varicose vein. Then, as he slowly withdraws the catheter, he simultaneously injects the adhesive substance into your damaged vein.

Next, Dr. Hoyle applies pressure to your varicose vein to help it close and seal itself. Finally, he withdraws the catheter and applies a bandage to cover the small puncture site.
Dr. Hoyle provides a local anesthetic, but you don’t need a regional nerve block or other types of anesthesia. You also don’t need to do anything special to prepare for the procedure.

When your treatment is complete, you’re free to drive home. Regular exercise is encouraged.

Unlike with other varicose vein treatments, you don’t need to wear compression stockings after your VenaSeal procedure. You can return to your regular exercise routine after 48 hours. If you don’t have an active lifestyle, aim to walk for at least 10-15 minutes every day to promote healthy circulation.

Call Advanced Vein Center or make an appointment online today to learn more about VenaSeal and whether it’s the right varicose vein treatment for you.


Microneedling involves using fine needles to create hundreds of tiny, invisible puncture wounds in the top layer of skin. This minimally invasive treatment can be very effective. The micro-injuries stimulate the body’s natural wound healing processes, resulting in cell turnover and increased collagen and elastin production, therefore reversing as well as preventing signs of aging. In fact, according to a 2009 study, almost 100% of micro-needling participants reported a noticeable difference and vast improvement in the appearance of their acne scars after a treatment.


A vampire facial is a combination of microneedling and Platelet-Rich-Plasma. Platelet-Rich-Plasma is a concentrate of platelet-rich plasma protein derived from the whole blood after it has been processed by spinning in a centrifuge to remove the red cells. The Platelet-Rich-Plasma has a rich concentration of growth factors and other nutrients which help tissue heal and repair. The Platelet-Rich-Plasma injections can help stimulate collagen and combined with microneedling, the treatment can result in scar reduction, correction of sun damage, and minimizing fine lines and pores.

Bioidentical Hormone Replacement Therapy

Bioidentical hormones have the exact chemical and molecular structure as the human body’s hormones. Bioidentical hormone replacement therapy is a way to replace the hormones men and women lose over the course of their lives in a way that is safe and effective. This treatment can be used to address symptoms of hormonal imbalance, resulting in potential benefits including reduced fatigue, reduced hot flashes, less dry skin, increased sex drive, improved sleep, Improved bone density, improvement in strength, reduced bloating, better thinking and memory.


Fillers Cosmetic is the first and only treatment FDA-approved to temporarily make moderate to severe frown lines, crow’s feet and forehead lines look better in adults. It is a quick 10-minute treatment with minimal downtime and you may begin to notice results within 24 to 48 hours for moderate to severe frown lines. Fillers deliver predictable, subtle results, so you look like you, only with less noticeable facial lines.


Over-the-counter products condition eyelashes. In 2008, LATISSE® became the first prescription product FDA approved to grow eyelashes—fuller, longer, and darker—in patients with with inadequate or not enough lashes.


LUMA is ideal for clients seeking dramatic improvement without the risk or recovery time of more aggressive treatments. If you would like to experience a remarkable difference in the quality of your skin – diminished sun spots, improved tightness and a healthier glow – LUMA may be right for you.

Second Opinions

Patients who have been diagnosed with restless leg, diabetic neuropathy, or other conditions and are not showing improvement with treatment may want to seek a second opinion. With these and other venous conditions, the symptoms are often very similar and a misdiagnosis can extend the time that a patient suffers from a painful condition. If patients from Orange County or the greater Los Angeles area are concerned that their treatment is not as effective as it could be, they should make an appointment with Dr. Hoyle at the Advanced Vein Center. Dr. Hoyle is truly an expert in his field and one of the leading physicians treating venous conditions in the United States. He was the first doctor in Orange County to perform endovenous ablation. His training and expertise are extensive which has led Dr. Hoyle to become a highly credible source to both patients and doctors alike.

Many patients who have venous disease also have arthritis and back problems with sciatica. They may have varicose veins, however, their pain may be a result of the other conditions not associated with varicose veins. Dr. Hoyle was also boarded in sports medicine and is able to perform an orthopaedic assessment. Regularly, Dr. Hoyle sees patients that often associate their pain or discomfort with a venous disease. However, since Dr. Hoyle has a background in sports medicine he is able to distinguish an orthopaedic problem from a venous disease. Dr. Hoyle is one of the very few doctors within Southern California that is able to distinguish between the two and offers the correct treatment as necessary through diagnosis.

If your vein doctor is suggesting multiple ablations or to receive treatment immediately, get a second opinion. Patients should NEVER feel bad about asking questions, inquiring about additional treatments, or feel pressed into making a quick decision. If a patient isn’t sure about his or her options it may cause him or her to forego alternative treatment. Second opinions give the patients the ability to make the best choice for their specific condition.

• Your vein doctor is seeking to perform treatment immediately.
• Your vein doctor is recommending more than 2 endovenous ablations.
• Your vein doctor is not willing to provide a copy of your ultrasound image (not just the report)
• Your vein doctor’s ultrasound tech is incentivized to find abnormal vein problems.