FAQs About Sclerotherapy

How successful is sclerotherapy for leg spider vein removal?

After several spider vein removal sclerotherapy sessions, most patients notice a 70-90% improvement in the appearance and symptoms. The full effect and benefit of treatment usually take several weeks. For this reason, many sclerotherapy specialists recommend waiting 3-6 weeks in between sclerotherapy treatments. Compared to surgical removal of veins, sclerotherapy costs less, requires no hospital stay and anesthesia, and allows a quicker return to work and normal activities.

What type of veins can be treated with sclerotherapy?

Other than leg spider veins, sclerotherapy can eliminate prominent hand and arm veins, chest spider and blue veins, and small veins in other parts of the body. Although sometimes used for facial vein removal, laser vein therapy is a safer option.

Is sclerotherapy painful?

In the hands of experienced vein doctors, the discomfort of a vein treatment injection sclerotherapy should be minimal. An occasional spot may be more sensitive than others, but generally, the procedure should be well tolerated for most patients. Even the needle-phobic ones. In fact, most patients are pleasantly surprised at how little discomfort occurs during the procedure. Of course, pain perception is somewhat subjective, but several factors may affect the level of discomfort during injections. These include:

• the skill of your doctor
• the patient’s overall pain sensitivity
• the type and caliber of the needle used
• the nature of the sclerotherapy solution (some solutions are more painful than others)
• the inclusion of numbing medicine in the solution
• the sensitivity of the area injected (ankle, foot, shin area and the back of the knee)
• the use of topical numbing cream, especially for sensitive areas of the leg.

In addition, veins that usually ache before sclerotherapy tend to be generally more sensitive to injections than the ones that do not.

Is sclerotherapy safe?

Sclerotherapy, when performed appropriately by a specialist, is a remarkably safe and effective technique. Common side effects are usually temporary and well tolerated. These include itching, tenderness, skin bruising, and pigmentation, as well as the growth of fine vessels in the treated area. Fortunately, serious complications like allergic reactions, skin ulcers, and blood clots are rare. You should always discuss the risks and treatment alternatives with your physician.

How to prepare oneself for sclerotherapy?

Avoid tanning during the weeks leading to sclerotherapy. Do not take any NSAID medications (such as ibuprofen, Advil, Motrin), vitamin E, or herbal supplements that increase your chances of bruising. Don’t shave within 24 hrs of the treatment as the solution used for cleansing purposes may cause some stinging. We also recommend that you bring a short that you can wear during leg vein sclerotherapy.

When is the best time of the year to have sclerotherapy?

You can have sclerotherapy at any time of the year; however, patients having leg vein sclerotherapy feel more comfortable wearing compression stockings during the colder months of the year. Moreover, complete healing, including the disappearance of the treated spider veins, bruising and pigmentation, may sometimes take several weeks. Consequently, if you want to make sure that your legs are ready for summer, make sure to start the treatment accordingly.

I have seen videos showing spider veins magically disappear when injected. Is this possible?

The precise injection of any clear liquid in a vein will make a vein temporarily disappear from view. Patients should not be misguided however into thinking that that’s all there is to it. Sclerotherapy involves the injection of a solution that is intended to chemically damage and shut down the targeted veins.

Accordingly, one should expect a certain degree of inflammation to follow, including redness, swelling and tenderness. Also right after treatment, a certain amount of blood often leaks out of the injected vein causing bruising and dark blue discoloration. Even under the care of the most skillful and experienced vein doctors, it may take several weeks of healing for real clearance of these spider veins to occur.

What to expect after the first sclerotherapy session?

As the initial bruising subsides, some veins may disappear completely, others may show little islets or isolated beads of clots along the track of the vein. Some veins may survive but become much thinner and weaker and more susceptible to closure with the following session.

Moreover, sometimes one can see the emergence of new and thinner veins around a successfully treated larger vein. These veins can be easily treated during a follow-up treatment session. Generally speaking, most patients should expect an improvement of at least 50-60%, over a few weeks after a single treatment.

How long does it take for the veins to disappear?

It depends on many factors, including the technique of injection, the type, and strength of the solution used in sclerotherapy, the density and thickness of the vessels in a given area, as well as the skin complexion of the patient. In our experience, most spider veins disappear between 2 weeks and two months. Reticular veins may require more than one session to disappear.

Is sclerotherapy safe during pregnancy?

It is advisable that pregnant or breastfeeding women postpone sclerotherapy, as fetal safety is not established. In addition, many women experience spontaneous disappearance of the unsightly veins in the months following delivery, making treatment unnecessary or simpler.

When should one not have sclerotherapy?

Other than pregnant women, almost anyone can have sclerotherapy for hand and chest vein removal. You should avoid leg vein sclerotherapy if you are bedridden, or cannot be physically active for whatever reason. You should also avoid sclerotherapy if you have a history of blood clots in the legs. Finally, do not have sclerotherapy if planning to tan in the weeks following the treatment or if you have a history of an allergic reaction to one of the sclerotherapy solutions.

I’ve heard a lot about lasers. Can they Replace Sclerotherapy?

Not really. Even compared with the best lasers, sclerotherapy is still the “gold standard” for the removal of leg spider veins. In fact, laser treatment ends up being a lot more painful than a comparable sclerotherapy treatment. Moreover,  when it comes to leg spider veins, laser treatments are generally significantly less effective in getting predictable, reliable outcome.

Why do Some Friends Say Sclerotherapy Does Not Work?

Success in sclerotherapy is very technique and skill dependent. First of all, choose your doctor well. Needless to say, an experienced vein doctor (phlebologist) would probably give you the best results. In good hands, most patients should get a remarkable clearance in the order of 80-90%. Success in spider vein removal by means of sclerotherapy is dependent on many factors, like:

• the injection skill and technique of your doctor
• the type and strength of the solution used
• the use of a trans-illuminating device to identify and treat the underlying feeder veins that supply spider vein clusters
• completing the required number of treatment sessions for a particular area (most leg veins have to be treated more than once for optimal results)
• identifying and treating any underlying venous reflux disease. Venous reflux refers to the backward and outward flow from the deep to the superficial veins in a reverse flow pattern. Suffice it to say that unidentified and untreated venous reflux is the most common reason for a poor outcome.

Why to wear compression stockings after leg vein sclerotherapy?

For most vessels other than the tiniest leg spider veins, compression is believed to increase the effectiveness and safety of the procedure. Compression enhances the effectiveness of the procedure by keeping the treated and injured vessels compressed and preventing the trapping of blood in them. Note that the trapped blood may lead to the pigmentation of the treated area and cause pain, inflammation.

In addition, compression pushes the venous blood out of the leg faster and accelerates the blood circulation in the legs. In addition, wearing compression minimizes the chances of a clot formation in any of the non-targeted vessels. This, of course, increases the safety and comfort of the procedure. To learn more, click compression therapy and compression stockings.

For how long and how to wear compression stockings?

Except for the tiniest spider veins, most patients would probably benefit from a week of compression therapy. You should put them on first thing in the morning and take them out the last thing at night, before sleep.  You can also remove them for a quick lukewarm shower, but avoid hot baths or sauna, as these dilate your veins.

What are the side effects of sclerotherapy?

Serious medical complications from reticular and spider vein treatment with sclerotherapy are extremely rare when performed by a qualified physician. Common side effects of spider vein treatment with sclerotherapy are usually temporary and well tolerated. The most common side effects of sclerotherapy include:

• Swelling, redness, tenderness, and itching (these tend to gradually disappear within hours to days).
• Some bruising, which gradually fades over the course of a few weeks in most cases
• Retained dark blood clots.
• Brown pigmentation and matting (the appearance of blush like a microscopic network of fine red vessels).
• Small skin ulceration that would heal leaving a permanent scar. This should be a rare event in experienced hands and is minimized by a meticulous technique and use of the mildest solution that can achieve the desired result.
• Allergic reactions to the commonly used sclerotherapy solutions (tends to be very rare).

Why does pigmentation occur after sclerotherapy?

The chance for developing brown staining (pigmentation) after sclerotherapy is anywhere from less than 1% to about 30%. It is dependent on several factors, like the skill and technique of the doctor, the nature and strength of the solution, the density, size, and depth of the vessels treated, as well as your skin complexion.

Could the pigmentation resulting from sclerotherapy be treated?

Most pigmentation resolves spontaneously over time, although it may sometimes take several months or longer to disappear. Light-based treatments like IPL sometimes help expedite the process.

What can one do to get rid of the matting that sometimes follows sclerotherapy?

Matting, not a common side effect, may disappear even if untreated. In resistant cases, it may be treated with a combination of sclerotherapy and or light based treatments like lasers and IPL (Intense Pulsed Light).

What is cryo-sclerotherapy?

Cryo-sclerotherapy is a new modified sclerotherapy technique using cold air before and during the injections of sclerosing liquid into unsightly veins. The use of cold air for cooling is not new in cosmetic surgery; for example, cold air is used for many laser procedures such as in laser resurfacing.

Main advantages of cryo-sclerotherapy instead of traditional sclerotherapy rely on the physical effect of cold at treated veins, whereby the skin is cooled and numbed at the injection site.  This alleviates the discomfort during the procedure, reducing it to a sensation of multiple pinpricks or mosquito bites. The effect is similar to that achieved by applying a topical numbing cream on the skin of the targeted area. Cryo-sclerotherapy may be used for the treatment of small varicose veins, reticular veins, and spider veins of the leg and hands.

What are the sclerosant solutions?

Hypertonic saline (18%-30% salt solution) was the primary sclerosing agent for many years. Hypertonic saline is FDA (U.S. Food and Drug Administration) approved, but not as a sclerosant for spider vein removal. Until recently, Sotradecol (Sodium Tetradecyl Sulfate or STS, an anionic surfactant) was the only FDA approved sclerosant intended for spider vein removal. On March 30, 2010, the FDA approved Asclera (polidocanol, a non-ionic detergent agent) for the treatment of spider veins (tiny purple or red veins less than 1 millimeter in diameter) and reticular veins (blue veins that are 1 to 3 millimeters in diameter).

Chromated glycerin (Sclermo), regularly used for spider vein removal by many vein specialists in the United States, is not an FDA-approved solution, despite being a very popular sclerosant throughout the world with a long track record of safety and effectiveness.

Other sclerosant solutions that are rarely used for spider vein treatment of the legs include ethanolamine oleate, hypertonic saline/dextrose, sodium morrhuate, and polyiodide iodine. Among these, Dr. Dishakjian uses Polidocanol, Sotradecol, both FDA approved, or chromated glycerin, especially when brown pigmentation has been a problem with previous sclerotherapy treatments with either Polidocanol or Sotradecol.

Can you have leg vein sclerotherapy before a vacation trip?

Vacation trips often involve long periods of immobility in a car or an airplane and therefore are best avoided for at least two weeks after a leg sclerotherapy treatment session. Furthermore, avoidance of sun exposure and tanning following sclerotherapy may not be possible with a “fun in the sun” vacation experience.

How soon can you tan after sclerotherapy?

Since sun exposure of an inflamed area increases the risk of pigmentation, one should avoid tanning until all bruising has disappeared.

Is the use of spray tanners allowed after sclerotherapy?

Spray tanning does not present problems and can be used safely after and in between sclerotherapy sessions.