Sclerotherapy for Spider Veins

A common form of treatment for spider veins is sclerotherapy. This is an in-office procedure where veins are injected with a solution, using small needles, which causes them to collapse and fade from view. The procedure typically improves not only the cosmetic appearance but associated symptoms as well. A few sessions may be required to obtain maximum benefit. During sclerotherapy, the affected leg is elevated to drain blood, and the sclerosant is injected into the spider vein. The procedure normally takes 5 to 30 minutes, depending on how many spider veins are treated. This form of spider vein treatment may be painful, and the chemical (sclerosant) that is injected can cause a feeling of burning or cramping for a few minutes in the area where the shot was given. You may need repeated sessions and many injections per session depending on the extent of the spider veins and type of sclerosant used.

Laser Treatment for Spider Veins

Lasers may also be used to treat spider veins. During laser treatment, intense light is directed to the veins, eliminating them permanently. Lasers are especially suited to treat small spider veins when a needle cannot be used. Bruising usually occurs in the area treated after laser treatments and lasts for a few weeks. The cost of laser treatment for spider veins is usually higher compared to sclerotherapy.

The Best Candidates For Sclerotherapys

Women of any age may be good candidates for sclerotherapy, but most fall in the 30-to-60 category. 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.

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.

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 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.

Risks Related to Treatment

Serious medical complications from sclerotherapy are extremely rare when the procedure is performed by a qualified practitioner. 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.

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, requiring further injections.

You can reduce the risks associated with treatment by choosing a doctor who has adequate training in sclerotherapy and is well versed in the different types of sclerosing agents available. A qualified doctor can help you select which type of sclerosing medication is most appropriate for your needs.

Are there side effects to sclerotherapy?

There are some possible side effects. They include:

  • Stinging or pain at the sites of injection, swelling of the ankles or feet, or muscle cramps.

This usually occurs when hypertonic saline solution is used. Hive-like reactions usually go away within 10 to 15 minutes after injection.

  • Red, raised areas at the sites of injection.

These are similar to hives and the response should disappear within a day or so.

  • Brown lines or spots on the skin at the sites of treated blood vessels.

Darkened areas may result when blood escapes from treated veins and are probably formed from iron in the blood. These dark areas occur more often in patients who have larger veins treated or those patients that tan easily. In most cases, they disappear within a year, but they may last longer.

  • Development of groups of fine red blood vessels near the sites of injection of larger vessels

About one-third of patients develop groups of vessels especially on the thighs. Most disappear by themselves, some need additional injection treatments or laser therapy, a few may last.

  • Small, painful ulcers at treatment sites either immediately or within a few days of injection

These occur when some of the solution escapes into the surrounding skin or enters a small artery at the treatment site and can be successfully treated, but it is necessary to inform the dermatologist immediately.

  • Temporary bruises.

Bruises usually occur after laser treatments and are probably related to the thinness of blood vessel walls. They usually disappear in a few weeks. Occasionally, bruising is seen with sclerotherapy.

  • Allergic reactions to sclerosing solutions

Although such reactions are uncommon, they can be treated. Inform your dermatologist immediately.

  • Inflammation of treated blood vessels.

This is very unusual but when it occurs, it is treated with medications such as aspirin, compression, antibiotics, or heat.

  • Lumps in injected vessels

This is coagulated blood and is not dangerous. The dermatologist may drain the blood from these areas a few weeks after injection.

  • Burning with discoloration of the skin.

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. A hand-held Doppler ultrasound device is sometimes used to detect any backflow within the venous system. If such problems are identified, your surgeon may refer you to a different specialist for further evaluation. Problems with the larger veins must be treated first, or sclerotherapy of the surface veins will be unsuccessful.

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 usually doesn’t cover cosmetic procedures.)

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Preparing For the Procedure

You will receive specific instructions from your physician on how to prepare for your treatment. Carefully following these instructions will help the procedure go more smoothly.

You’ll be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day of your procedure. You may want to bring shorts to wear during the injections, as well as your physician-prescribed 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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Where Your Treatment Will Be Performed

Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it will be performed in an outpatient setting, most likely your doctor’s office.

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The Procedure

The injection method is a procedure called sclerotherapy. This procedure has been used for spider veins since the 1930’s, and before that for larger veins. One of several kinds of solutions called sclerosing solution is injected directly into the blood vessel with a very fine needle. The solution irritates the lining of the vessel causing it to swell, stick together, and the blood to clot. Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable.

A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. A number of vessels can be injected in any one-treatment session.

The injection solutions available are slightly different, and the choice of which to use depends on several factors including the size of the vessel. Your dermatologist will choose a solution that is best for your particular case.

Occasionally, larger varicose veins are connected to them. In such cases, these vessels should be treated along with spider veins. This can be done by sclerotherapy, or the latest techniques using endovenous laser, stripping, ligation, or radiofrequency. Great advances have been made in the use of ultrasound to guide the injection of sclerosing solutions. Ultrasound may be used to treat large vessels, as well.

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. Using one hand to stretch the skin taut, your doctor or nurse 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 inch of spider vein – anywhere from five to 40 injections per treatment session. A cotton ball and compression tape is applied to each area of the leg as it is finished.

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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After Your Treatment

In addition to the compression tape applied during the procedure, tight-fitting support hose may be prescribed to guard against blood clots and to promote healing. The 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.

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.

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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 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.

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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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FAQs

What is sclerotherapy?

Sclerotherapy is a microinjection procedure to treat spider veins. The procedure involves injection of a sterile solution (called a sclerosing solution) into the small veins using a very fine, thin needle. This solution irritates the vein lining causing it to undergo fibrosis and eventually disappear. Multiple veins can be injected at each session. The sclerosing solution used may be either hypertonic saline or sodium tetradecylsulfate.

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What are spider veins?

Spider veins are most common in women in the age groups 30-50. This has been related to the hormone estrogen and pregnancy. Spider veins look like a network pattern in a circular fashion. These light purple veins usually appear in a lattice pattern and are completely harmless.

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How are spider veins treated?

Spider veins are most common in women in the age groups 30-50. This has been related to the hormone estrogen and pregnancy. Spider veins look like a network pattern in a circular fashion. These light purple veins usually appear in a lattice pattern and are completely harmless.

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How are spider veins treated?

The most important thing to know is that these veins are entirely of a cosmetic concern. There are several options in treating spider veins. The most common is sclerotherapy, laser and camouflage. Surgery is never used to treat spider veins.

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What happens if spider veins are not treated?

Absolutely nothing. Spider veins are small veins which are entirely of a cosmetic nuisance. They do not form blood clots, they do not ache, and they do not cause swollen feet or pain. One may elect to observe them.

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Is there any harm in removing spider veins?

Spider veins have no function and removing does no harm. The only reason they are removed is because of their unsightly appearance.

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When is the best time to have the spider veins treated?

Spider veins have no symptoms and the major problem is cosmetic. Therefore, the surgery is strictly elective and can be done any time. Spider veins do tend to become more prominent during pregnancy and so it is best to wait until the pregnancy is over.

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Where is the procedure done?

It is usually done in the doctor’s clinic. It generally does not require any type of anesthesia. The patient is asked to come to the clinic in loose fitting clothing and the spider veins are identified. With a very fine needle, these spider veins are injected with a chemical that will destroy the vein. There is minimal pain. For those who are unable to tolerate the pain, a topical local anesthetic can be pasted on the skin about 30 minutes before the procedure.Spider veins have no symptoms and the major problem is cosmetic. Therefore, the surgery is strictly elective and can be done anytime. Spider veins do tend to become more prominent during pregnancy and so it is best to wait until the pregnancy is over.

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What chemicals are used for sclerotherapy?

No, absolutely not. Sclerotherapy should never be done on the face and hands. The hand veins may not look pretty at times, but they should never be treated. Even though veins on the face are being done with sclerotherapy, the injections can be painful and the results are variable. If the facial veins are very conspicuous, laser is a better option than sclerotherapy.

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Can anyone undergo sclerotherapy?

The spider veins are destroyed by injecting a small amount of a chemical in the vein. The sclerosants is either hypertonic saline or sodium tetradecyl sulphate. The chemical irritates the small vein and causes it to undergo fibrosis and eventually disappear.

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Can sclerotherapy be used to treat large varicose veins?

Unfortunately, sclerotherapy is generally used for the very small superficial veins next to the skin. Sclerotherapy is not effective for large veins and requires large amounts of the sclerosants with the potential to be absorbed. When large veins are treated with sclerotherapy, a stronger solution and a higher volume is required. Following the treatment for larger veins, compression hose stockings are usually recommended to be worn for at least 2 weeks. It is best to get spider veins treated in the winter months as one can easily wear stockings.The spider veins are destroyed by injecting a small amount of a chemical in the vein. The sclerosants are either hypertonic saline or sodium tetradecyl sulfate. The chemical irritates the small vein and causes it to undergo fibrosis and eventually disappear.

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How many sclerotherapy treatments are required?

It varies from individual to individual but typically 2-4 treatments are required for the best results. In patients with milder cases, 1-2 will suffice. The treatments are more when there are more veins or slightly larger veins.

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Does sclerotherapy hurt?

There is a little sting associated with each injection. The burning sensation lasts few seconds. Most individuals tolerate the procedure and do not require any type of anesthesia. The majority of patients claim that the procedure is much less than painful than what they anticipated.

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Can sclerotherapy be done on the arms or face?

No, absolutely not. Sclerotherapy should never be done on the face and hands. The hand veins may not look pretty at times, but they should never be treated. Even though veins on the face are being done with sclerotherapy, the injections can be painful and the results are variable. If the facial veins are very conspicuous, laser is a better option than sclerotherapy.

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Can anyone undergo sclerotherapy?

Almost anyone with unwanted spider veins can be treated, except women who are pregnant or nursing. Other relative contraindications include those with skin infections, uncontrolled diabetes, fever, history of deep vein thrombosis, anticoagulant therapy those patients taking corticosteroids.

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Is there any preparation required before sclerotherapy?

No preparation is required before the procedure. It is recommended that one stop smoking and stop taking aspirin a few day before the procedure. Any patient on a blood thinker is not a candidate for sclerotherapy.

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What happens after sclerotherapy treatment?

There is some mild pain which can easily be overcome with Tylenol. The injected site will appear bruised and swollen for a few days. Continual wearing of the ace bandaged will relieved the swelling and pain. The bruising usually disappears in 2-3 weeks. One will have no problem with walking. After the first 2 days, most patients can resume their normal activities.

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How long is each sclerotherapy session?

Generally, most individuals have multiple spider veins and only up to 15-20 injections can be done at seating. Each treatment session lasts up to 30 minutes. After the treatment, sterile dressings are placed over the injection site and the entire leg is covered with an ace bandage. The ace bandage is left on for 2-3 weeks until the patient returns to see the doctor.

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How successful is sclerotherapy?

After several treatments, most patients can expect an 80 – 90 percent improvement. Fading will gradually occur over months. Disappearance of treated spider veins is usually achieved, but similar veins may appear in the same general area.

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Will treated veins recur?

Large veins may recur even after surgical procedures. Spider veins may also recur. Although spider veins can develop during subsequent pregnancies, previously treated veins should not reoccur. Spider veins can be removed but new ones can always occur. Most people who have spider veins have a predisposition and despite treatment, new veins will appear in the coming years. It may seem that a previously injected vessel has recurred when, in fact, a new spider vein has appeared in the same area. There is no cure for spider veins.

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Is a history of blood clots in the lungs or legs a reason to avoid therapy?

Not necessarily, but the procedure must be done with caution to lessen the risk of blood clots.

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When can the treatment be done?

Sclerotherapy is an elective procedure and can be done whenever the individual wants to have it done. The procedure does not take more than 30-60 mins and can even be done during an office lunch break.

Treatment is done on an outpatient basis during convenient office hours. You can resume most activities shortly after each session.

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What are side effects of sclerotherapy?

Besides some stinging pain, sclerotherapy can rarely cause a few side effects. Allergic reactions are rare. A few individual may develop intense itching at the site of injection. If the chemical is injected outside the vein, profound discoloration and pain can occur.

The majority of the treated spider veins will disappear within two to three treatments. The treatments can be spaced four to six weeks apart. If new veins appear, additional treatments are required for optimum results. The treatments may be spaced every three to four week intervals.

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What do I do after treatments?

Dermatologists may differ in their treatment instructions to patients. Most advise their patients to “clear” the sclerosing solution out of the circulation. Patients are instructed to walk following the procedure.

Some physicians bandage the injected areas and instruct patients to “compress” the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin, and reduce the development of dark spots. It also may reduce the number of treatments necessary, and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or in special locations.

Between treatments, many dermatologists recommend the use of compression or support hose. This may be recommended for people who spend a lot of time on their feet, or work in a standing occupation.

The treatment of spider and varicose veins can be successful. Treatment methods vary depending on the size and location of the abnormal veins. The injection method is presently the method most commonly used, but great advances have been made recently in other techniques such as lasers.

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Which is the best treatment for spider veins: LASER TREATMENT OR SCLEROTHERAPY?

Sclerotherapy has been round for 20 years and is a safe procedure. The procedure involves the use of multiple injections to destroy the vein. Lasers on the other hand do not require needles and are currently in vogue. Laser therapy is also slightly more expensive than sclerotherapy. Laser therapy is fast becoming the procedure of choice.

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Does insurance cover sclerotherapy?

Unfortunately, spider veins and sclerotherapy are considered cosmetic in nature and the cost of treatment is not covered by any insurance companies.

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