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SCLEROTHERAPY
(Laser Vein Treatment Page Also Recommended Reading)

You can simply scroll down in this window to read the entire discussion from start to finish or click on the question that interests you. Topics answered below include:

01. What is Sclerotherapy?
02. Is the procedure painful?
03. What are the possible side effects following treatment?

04. What causes spider veins?
05. What are spider veins?
06. Who are the best candidates for sclerotherapy?

07. What should I expect from Sclerotherapy?
08. What are the treatment risks?
09. How should I plan for my treatment?

10. What should I expect from the procedure?
11. What should I expect following treatment?
12. Can spider veins be prevented?

1. What is Sclerotherapy?

Spider veins or telangiectasias of the legs are a common problem, particularly affecting women. Small purple or red veins, sometimes called sunburst or starburst vessels because of their appearance, can form anywhere on the leg, from the top of the thigh to the ankle. While these spider veins do not pose any major health problems, they may cause discomfort. Many people who have spider veins find them unsightly and often attempt to conceal them with clothing or cosmetic cover-ups or concealers.

Today a simple treatment called sclerotherapy (along with lasers as a primary treatment) is successfully being used to correct unwanted spider veins of the legs. In our practice we often use sclerotherapy for some of the larger vessels that may not respond to a laser. Real large varicose veins require surgical ligation or stripping and one should seek out a general surgeon for these larger varicose veins. What is sclerotherapy?

Sclerotherapy is a procedure in which a physician, using a syringe with a tiny needle, injects a small amount of a solution directly into the spider vein. Several kinds of sclerosants exist for use.

The solution displaces the blood within the vein thus causing it to blanch or turn white. The solution then causes the vessel to become irritated and swell shut prohibiting the blood from reentering the vein. Following the injection, pressure is usually applied to the legs by means of support stockings or support panty hose to aid and promote healing. The support stockings are supplied by the patient, and they are asked to take care of this prior to receiving their first injections (pure laser treatments for vessels do not generally require support stockings). Each spider vein/vessel may require several injections and most will disappear within two weeks to two months after the treatment. It is impossible though with sclerotherapy alone to get rid of very small spider burst vessels and matting of vessels, and this can often be greatly helped by lasers or pulsed light. Even in the best of circumstances though, over time, new vessels will appear in the future that will need further treatments.

Our office feels your money is much better spent on laser vein treatment. Often, one treatment with the laser can accomplish what four or five sclerotherapy sessions could accomplish.

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2. Is the procedure painful?

Patients who have had sclerotherapy have reported little discomfort. Some experience a slight to moderate burning sensation immediately after the injection but this disappears usually within a few seconds.

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3. Following treatment? (Read for potential adverse reactions before any procedure)

Most patients experience minimal adverse effects. Occasionally, a small, dark area of pigmentation resembling a freckle may remain. These spots, however, usually resolve in time or respond to treatment with bleaching agents. Sometimes small hematomas or loculated blood in the vessel may need drainage with a small needle stick drainage. It is best to avoid recent tanning or sun exposure within several weeks before and after sclerotherapy to avoid problems with pigmentation disorders. In rare circumstances, blistering, inflammation, or necrosis (ulcers or erosions) of skin tissue can occur. Even with the best of care, no one can 100% guarantee that an adverse reaction will not occur.

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4. What causes spider veins?

No one has determined for certain why some people are affected with spider veins and others are not, however some families seem predisposed (genetic) to the condition. Trauma to the leg in the form of blows or falls may contribute to the formation of these veins, and long periods of standing or sitting may also be causative factors. More women than men seem to develop this condition perhaps as a result of pregnancy or because of hormones. Other causes that appear related are obesity, estrogens, sun damage, venous insufficiency, and things that aggravate increased vascular pressure to the legs (i.e., pregnancy, abdominal obesity).

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5. What Are Spider Veins?

Millions of women and men are bothered by spider veins - those small yet unsightly clusters of red, blue or purple veins that most commonly appear on the thighs, calves and ankles. In fact, it's estimated that at least half of the adult female population is plagued with this common cosmetic problem.

Today, physicians are treating spider veins with sclerotherapy. In this rather simple procedure, veins are injected with a sclerosing solution, which causes them to collapse and fade from view. The procedure may also remedy the bothersome symptoms associated with spider veins, including aching, burning, swelling and night cramps.

Although this procedure has been used in Europe for more than 50 years, it has only become popular in the United States during the past decade. The introduction of sclerosing agents that are mild enough to be used in small veins has made sclerotherapy predictable and relatively painless.

If you're considering sclerotherapy to improve the appearance of your legs, this brochure will give you a basic understanding of the procedure - when it can help, how it's performed and what results you can expect. It won't answer all of your questions, since a lot depends on your individual circumstances. Please ask your doctor if there is anything about the procedure you don't understand.

Spider veins - known in the medical world as telangiectasias or sunburst varicosities - are small, thin veins that lie close to the surface of the skin. Although these super-fine veins are connected with the larger venous system, they are not an essential part of it.

A number of factors contribute to the development of spider veins, including heredity, pregnancy and other events that cause hormonal shifts, weight gain, occupations or activities that require prolonged sitting or standing, and the use of certain medications.

Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes; or they may be simple linear and appear as thin separate lines. Linear spider veins are commonly seen on the inner knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.

Varicose veins differ from spider veins in a number of ways. Varicose veins are larger - usually more than a quarter-inch in diameter, darker in color and tend to bulge. Varicose veins are also more likely to cause pain and be related to more serious vein disorders. For some patients, sclerotherapy can be used to treat varicose veins. However, often surgical treatment is necessary for this condition as discussed above.

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6. The best candidates for sclerotherapy:

Women of any age may be good candidates for sclerotherapy. In some women, spider veins may become noticeable very early on - in the teen years. For others, the veins may not become obvious until they reach their 40s.

If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy treatment. In most cases, spider veins that surface during pregnancy will disappear on their own within three months after the baby is born. Also, because it's not known how sclerosing solutions may affect breast milk, nursing mothers are usually advised to wait until after they have stopped breastfeeding. Laser treatments are considered safe during the breast feeding period, and even though no harm has been shown by treating leg veins with lasers during pregnancy, our office does not do treatments during pregnancy. It is your duty to advise us if you are pregnant.

Spider veins in men aren't nearly as common as they are in women. Men who do have spider veins often don't consider them to be a cosmetic problem because the veins are usually concealed by hair growth on the leg. However, sclerotherapy is just as effective for men who seek treatment.

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7. What to expect from sclerotherapy:

Sclerotherapy can enhance your appearance and your self confidence, but it's unrealistic to believe that every affected vein will disappear completely as a result of treatment. After each sclerotherapy session, the veins will appear lighter. Two to four or more sessions are usually required to achieve optimal results.

You should also be aware that the procedure treats only those veins that are currently visable; it does nothing to permanently alter the venous system or prevent new veins from surfacing in the future.

Before you decide to have sclerotherapy, think carefully about your expectations and discuss them with your doctor.

Fees and costs usually run approximately $150 dollars (minimum fee) per 15 minute session of physician time. In general, our office feels your money is much better spent on laser vein treatment. Often, one treatment with the laser can accomplish what four or five sclerotherapy sessions could accomplish. Our office accepts Visa, Mastercard, approved checks and cash. We do not file or accept insurance for this service and it is almost always considered cosmetic and turned down by all insurance companies.

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8. Risks related to treatment:

Serious medical complications from sclerotherapy are extremely rare. However, they may occur. Risks include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing solution and skin injury that could leave a small but permanent scar. (See adverse reactions above).

A common cosmetic complication is pigmentation irregularity - brownish splotches on the affected skin that may take months to fade, sometimes up to a year. Another problem that can occur is "telangiectatic matting," in which fine reddish blood vessels appear around the treated area, maybe requiring further injections. Laser or pulsed light treatments are often very useful for this complication.

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9. Planning your treatment

During your initial consultation, your legs will be examined. Your doctor may draw a simple sketch of your legs, mapping out the areas affected by spider veins or other problems. During the examination, you will be checked for signs of more serious "deep vein" problems, often indicated by swelling, sores, or skin changes at the ankle.

If such problems are identified, your physician may recommend you see a different surgeon for further evaluation. Problems with the larger veins and deeper vascular insufficiency sometimes must be treated first, or sclerotherapy of the surface veins will not be as successful.

Your doctor will ask you about any other problems you may have with your legs, such as pain, aching, itching or tenderness. You will also be asked about your medical history, medications you take, or conditions that would preclude you from having treatment. Individuals with hepatitis, AIDS or other blood-borne diseases may not be candidates for sclerotherapy. Patients with circulatory problems, heart conditions, or diabetes may also be advised against treatment.

It's important to be open in discussing your history and treatment goals with your doctor. Don't hesitate to ask any questions or express any concerns you may have. Your doctor should explain the procedure in detail, along with its risks and benefits, the recovery period and the costs. (Medical insurance doesn't cover cosmetic procedures.)

Preparing for the procedure:

The following specific instructions are for preparing for your treatment. Carefully following these instructions will help the procedure go more smoothly. Do not take aspirin for at least 7 days prior to the procedure. Avoiding tanning or sun to the treatment area for 1-2 weeks before and after treatment is very advisable to prevent pigmentation problems.

You are not to apply any type of moisturizer, sunblock or oil to your legs, or makeup on the day of your procedure. You may want to bring shorts to wear during the injections, as well as your advised support hose, and slacks to wear home.

When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored for some weeks afterward. You probably won't be comfortable wearing shorts, a swimsuit or a mini skirt until after your legs have cleared up a bit.

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10. The procedure:

A typical sclerotherapy session is relatively quick, lasting only about 15 to 45 minutes. After changing into shorts, your legs may be photographed for your medical records. You will be asked to lie down on the examination table and the skin over your spider veins will be cleaned with an antiseptic solution or alcohol. Using one hand to stretch the skin taut, your doctor will begin injecting the sclerosing agent into the affected veins. Bright, indirect light and magnification help ensure that the process is completed with maximum precision.

Approximately one injection is administered for every 1-2 inches of spider vein - anywhere from five to 40 injections per treatment session may occur. Compression is used to stop any bleeding. Do not take any aspirin for at least 7 days prior to the procedure.

During the procedure, you may listen to music, read, or just talk to your practitioner. You will be asked to shift positions a few times during the process. As the procedure continues, you will feel small needle sticks and possibly a mild burning sensation. However, the needle used is so thin and the sclerosing solution is so mild that pain is usually minimal.

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11. After your treatment:

In addition to the compression applied during the procedure, tight-fitting support hose may be prescribed to guard against blood clots and to promote healing. Any tape and cotton balls can be removed after 48 hours. However, you may be instructed to wear the support hose for 72 hours or more, up to several weeks is beneficial.

It's not uncommon to experience some cramping in the legs for the first day or two after the injections. This temporary problem usually doesn't require medication.

You should be aware that your treated veins will look worse before they begin to look better. When the compression dressings are removed, you will notice bruising and reddish areas at the injection sites. The bruises will diminish within one month. In many cases, there may be some residual brownish pigmentation which may take up to a year to completely fade. This is one reason why lasers are becoming more and more used for leg vessels because there are few adverse reactions, but often combined treatments may be needed for the overall best result.

One month after the first treatment, spider veins are distinctly lighter, yet still somewhat visible.

Getting back to normal

Although you probably won't want to wear any leg-baring fashions for about two weeks, your activity will not be significantly limited in any other way from the sclerotherapy treatment.

You will be encouraged to walk to prevent clots from forming in the deep veins of the legs. However, during the period of time to complete your treatment program, prolonged sitting and standing should be avoided, as should squatting, heavy weight lifting and "pounding" type exercises, including jogging.

A one-month healing interval must pass before you may have your second series of injections in the same site. After each treatment, you will notice further improvement of your legs' appearance.

Your new look

Most patients are pleased with the difference sclerotherapy makes. The skin of your legs will appear younger, clearer and more healthy-looking. If you've been wearing long skirts and slacks to hide your spider veins, you'll now be able to broaden your fashion horizons. Often, patients are surprised at the dramatic difference in appearance between a treated leg and an untreated one.

Although sclerotherapy will obliterate the noticeable veins for good, it's important to remember that treatment will not prevent new spider veins from emerging in the future. As time passes, you may find that you need "touch-ups" or full treatments for new veins that surface. But even if you choose not to have further sclerotherapy, your legs will look better than if you never had treatment at all.

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12. Can spider veins be prevented?

Scientists have not discovered any clear-cut methods to prevent the onset of these telangiectasias/spider vessels/varicosities, however, some authorities believe that the use of support hose, weight control, and exercise may be beneficial.
Today, thousands of people who have felt self-conscious or embarrassed by unsightly spider veins of the legs are delighted with the results they are getting from laser and/or sclerotherapy treatment. If you are interested in learning more about these treatments, please call our office for a consultation. There is absolutely no need to feel anxious or embarrassed about these unsightly vessels when excellent treatments exist that can cause major improvement.

Call our office at (913) 962-1869 to schedule an appointment. It is time to take care of yourself, go for it!

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