Spider veins and sclerotherapy: What to expect.

BY DR. COHEN

Spider veins, technically called “telangiectasias”, are small spidery, branching red or blue veins and can be located just under the skin surface anywhere on the leg. Spider veins themselves almost never cause any medical problem but they’re not pretty and many people seek cosmetic treatment to improve their appearance (Not typically covered by insurance).

The first step to any decision should be an evaluation by a vein specialist to be sure your spider veins are not signs of a more serious issue. If you also have bulging veins, leg pain, ankle swelling, or skin discoloration, you may have underlying venous insufficiency (Covered by most insurance). A vein specialist can determine this with an examination.

People are sometimes disappointed in sclerotherapy because their doctors didn’t prepare them with realistic expectations. Here’s what to expect:

Sclerotherapy consists of a series of injections directly into the spider veins (or the feeder “reticular” veins) using a very fine needle. The needle is so fine that most people don’t find it painful. There are several medications that can be used but the most common ones are either asclera (generic is polidocanol) or sotradecol (generic is sodium tetradecyl sulfate), both FDA-approved. These medications destroy the inside lining of the veins which causes them to disappear.

Many spider veins are “fed” by slightly larger, bluish veins called “reticular” veins. These veins also need to be treated in order get an optimal result. Doctors will often treat the reticular veins with “foam” which is created by mixing the sclerosant drug with a gas. While many doctors use room air, I prefer to use carbon dioxide which is sterile, pure, and more soluble in blood than air. Ask your doctor what medications they use and why.

Expect the treated veins to look worse (angry, red) for a week or two, and then to fade over the next 30 days. While most doctors won’t re-treat a particular vein more often than every 30 days, you can go more often if you have other veins to treat.

You can usually expect about a 40-50% improvement of the problem vein with each treatment session. What this means is that 3-4 treatments are often needed in order to achieve an 80-90% improvement. As the veins disappear, each session will likely be able to cover larger areas of your leg. You should approach sclerotherapy as a process of treatments over time rather than a quick fix.

Sometimes sclerotherapy can also lead to undesired cosmetic results:

If blood leaks into the skin during the injection, you may see dark streaks called “hyperpigmentation”. This is caused by iron deposits around the vein and almost always resolves on its own. But can take 6-12 months.
Another possible outcome is called “trapped blood”, black-ish spots that appear in the weeks after treatment. This will resolve quickly if you have your doctor drain these areas by puncturing them with a fine needle (aspiration) as part of the follow-up session. If not, this can lead to hyperpigmentation as well.
And sometimes a red blush called “matting” appears as a network of extremely fine veins develops. This usually disappears over time but can sometimes be improved by additional gentle injection treatment.
After sclerotherapy treatments, I recommend compression stockings overnight for the first night, and then during the day for 7 days after each treatment. I also recommend avoiding hot tubs for a week. The issue of sun exposure after treatment is highly controversial. I don’t think it makes much difference but of course I recommend 30-50 SPF sunblock.

Sclerotherapy is proven to be an excellent way to improve the appearance of your legs and give you the confidence and freedom you have when your legs look way they should. But to be sure you have the most satisfying experience and the best cosmetic results, go to a specialist who does a comprehensive exam, explains everything in advance, and earns your trust.

You can arrange for a quick and easy consultation right now by calling 201-265-5300.

About us: There are 20 million Americans with vein problems that can seriously affect the quality of their lives. And as we age, they just get worse. As one of the few New Jersey medical practices committed exclusively to vein care, Advanced Vascular Vein Care is uniquely capable of alleviating those problems, whether they are medical or cosmetic. All treatments are non-surgical, usually covered by insurance, and delivered in an office setting. And we do it as it should be done – with compassion, excellence, affordability, convenience, and the personal touch. Call 201-265-5300 or visit AdvancedVascular.com for a quick and easy consultation.