Sclerotherapy is a non-surgical injection treatment for small, irregular, painless, bulging blue veins and small red spider veins anywhere on the body. Spider veins can be caused by obesity, genetics, hormonal changes, blood clots, prescription drugs, and certain medical conditions. Spider veins are typically small, irregular purple, blue, or red veins that are easily visible under the skin. Evaluation and elective treatment are sought for cosmetic reasons.
When they branch out on the face and body, they usually have a thicker “supply” vein that also needs treatment to improve the outcome. Dr. Z performs injection sclerotherapy with FDA-approved Asclera (Polidocanol, an anesthetic agent), laser and light treatments, and ambulatory phlebectomy (surgical removal) to minimize or remove visible spider, reticular, and small varicose veins on the face and body.
During sclerotherapy, a special solution or foam is injected into the vein to damage its lining, shrink it, and allow it to be gradually absorbed by the body.
Alternatively, external laser and IPL vein treatments are noninvasive. Light energy is delivered through the skin to the vein, causing it to coagulate and be absorbed by the body. Sclerotherapy is usually better for medium to large spider veins and smaller bulging varicose veins of the legs, while laser and light treatments are better for smaller vessels above the waist.
Large varicose veins that cause pain, swelling, and fatigue may be better treated by a vascular surgeon using a laser or an RF catheter, both guided into the vein with ultrasound. Energy is delivered to destroy the vein as the catheter is slowly withdrawn. Some larger veins are closed under ultrasound guidance with a product like super glue.
IDEAL CANDIDATES FOR SCLEROTHERAPY
Sclerotherapy is a good option for men and women who are bothered by small or medium-sized blood vessels visible beneath the skin. Spider veins are most noticeable on the legs when standing. Self-conscious individuals may avoid swimsuits, shorts, or other clothing that does not cover their spider veins. The vessels on the backs of the hands can be treated with the same techniques. Patients undergoing sclerotherapy must be in good overall health and not be taking any blood thinners. Patients shouldn’t have a history of blood clots or be pregnant.
THE SCLEROTHERAPY PROCEDURE
Sclerotherapy treatments are performed in a private treatment room with an assistant. No anesthesia is required for the small injections. A painless study (DPPG or vascular ultrasound) will confirm that the deep veins are functioning and that it’s safe to treat the redundant superficial veins. These studies can sometimes be done elsewhere under your insurance or performed in the office for a modest fee. At your consultation, you will receive a prescription for a compression hose to bring to your treatment appointment. These are sometimes covered by insurance for patients who stand a lot at work and experience muscle fatigue or swelling.
Ultrasound may be used to demonstrate valve dysfunction or arterial connections that would be addressed by a vascular surgeon or interventional radiologist prior to elective cosmetic vein treatment.
Blood vessels targeted for treatment can be visualized under polarized light and then marked. The skin is cleaned. You will be positioned lying down or sitting, as needed. A fine needle is inserted into the vessel to inject a small amount of sclerosing solution. Once the needle is removed, a compression dressing is temporarily applied to reduce bruising and help retain the sclerosant within the vein. The sclerosant is pushed/milked into the adjacent veins. The process is repeated for nearby spider veins. The maximum amount of sclerosant used per session depends on your weight.
Once your sclerotherapy treatment is complete, you can leave our office wearing your compression hose and resume your daily routine after your first 20-minute walk. You may have mild swelling, redness, or bruising in the treated areas, but this will usually fade on its own. Wear compression garments continuously for the first several days to a week, then while you are up, to support blood circulation after your procedure for better, faster results. It can take a while for results to appear, but the treated spider veins should get smaller and eventually fade or disappear. You will be asked to walk at least 20 minutes a day for at least 2 weeks after each treatment to minimize “trapped blood” and potential skin staining. You may need at least four sessions, spaced at least a month apart, to achieve your best results, though many people are happy with the improvements after the first session. You will likely develop more spider veins in the coming years, which can be treated similarly if desired.
How long should I wear compression stockings after sclerotherapy?
Dr. Z or a member of his staff will talk to you about how long you should wear compression garments after leg sclerotherapy. The compression garment is designed to help your blood circulate, compress the treated veins as they are absorbed by your body, and minimize bruising. Ideally, you should continue to wear some level of compression garment after your recovery whenever you are seated for a long time, such as during long car rides or on airplanes, or when standing (dealers, surgeons, etc.) to help prevent new spider veins from forming.
CONSULTATION
Elective vein treatments are a deeply personal decision. During your consultation, Dr. Z will review your medical history, goals, target areas, and lifestyle to determine whether sclerotherapy can be used safely to treat the veins you are concerned about. If he determines that sclerotherapy is not the best or safest option, he will discuss alternatives we offer, such as laser and light treatments, vein ligation, or surgical removal, and will create a personalized vein treatment and maintenance plan to accomplish your goals.
