Spider veins can be a significant source of embarrassment and discomfort for many of us. In several instances they are the reason some woman avoid wearing dresses in the summer. They can also be a source for fatigue and vague leg pain, specially if they are larger, or called reticular veins. Sclerotherapy is the gold standard for the treatment of spider veins and reticular veins. Different agents can be used for treatments these are called sclerosing agents. This page will discuss how we use sclerotherapy for spider veins at NOVA Plastic Surgery in Ashburn, Northern Virginia. But before talking about the treatment, it’s important to talk about spider veins and reticular veins.
What are Spider Veins?
Spider veins are red or blue little veins that run up and down the legs.
They resemble a road map. They may be grouped into little star burst patterns. Spider veins can also fan out along the outside of the thigh or lower leg. They are particularly common around the ankle in the knee. Spider veins can also be present on the face, however, we do not recommend using sclerotherapy on the face but instead using either IPL/BBL or laser for this the face. Spider veins are also sometimes called Telangiectasias.
What Causes Spider Veins?
several factors can contribute to the formation of spider veins in the legs including:
- Gender: spider veins are rarely seen in men and are much more common in women.
- Genetics: spider veins are more common in certain families.
- Pregnancy: the hormonal changes during pregnancy can trigger the formation of spider veins.
- Occupations that require prolonged sitting
- Sitting with the legs crossed for a long period of time.
What are Reticular Veins?
Those are deeper darker veins that form bluish networks that crisscross over the thighs and legs.
They pump blood from the skin to deeper veins that perforate the muscles. These veins do not have valves so if pressure rises in the deeper veins blood can stagnate in the reticular veins making them dilated and more pronounced.
Sclerotherapy for the Treatment of Spider Veins:
The agent causes irritation to the cells lining the walls of the vein. Eventually the vein collapses and turns into scar tissue. at NOVA Plastic Surgery we use Polidocanol injection as a sclerosing agent. We use a technique called foaming to improve the efficacy of the agent. This sclerosing agent has been shown to have excellent results and will lower the rate of side effects.
This spider vein treatment usually takes around half an hour, but the veins only disappear completely between a period of two to twelve weeks. Often, a patient would have to return for more sessions, because varicose and spider veins usually cover big areas in the lower extremities. There is a possibility that new veins would thicken again, so maintenance injections are needed after a few years have passed since the initial Polidocanol injection.
As with any procedure, the Asclera polidocanol injection also carries certain risks. Potential side effects include swelling, irritation and bruising in the target area. There is a possibility that particular tissues would be damaged and contract infections as well. Patients can also experience pain and discomfort during and after the spider vein treatment, although the Asclera polidocanol injection is said to be less painful than other agents. The images below show a nice improvement after Asclera therapy and are taken from the EASI study
The treatment is associated with minimal pain during injections. But not enough to need giving numbing injections.
Sclerotherapy Pre Treatment Instructions
Are required to be worn immediately after each injection treatment or if you have had aspiration of trapped blood from an injected vein. Hose can be purchased from our office or you may request a prescription to purchase at a pharmacy or medical supply store. We use hose style with 30 to 40mm Hg compression. You cannot be injected without your compression hose. The hose must be worn continuously 24 hours a day and for 7 days. They may be removed to be laundered, preferably at night while you are inactive. Your doctor may adjust the length of time to wear your hose. The compression hose is critical to the success of the treatment.
Do not apply oil, lotion or powder to your legs the night before or the day of your injections. Use of these toiletries will not allow the cotton balls and tape (if needed), to adhere to your skin.
Bring a pair of loose, comfortable shorts to wear during your treatment. Dress in loose clothes and comfortable shoes to accommodate the cotton balls, tape and hose after your treatment.
Discontinue Aspirin and Ibuprofen (Motrin, Advil, Aleve etc.) for 10 days before and after injections to reduce bruising. Acetaminophen (Tylenol) is allowed.
A sclerotherapy treatment should last approximately 30-60 minutes. You should arrive 10-15 minutes early for your first sclerotherapy treatment to allow time for photographs and to sign your consents. You should then allow an additional 10 minutes to apply your support hose, get dressed and to check out of the office. If you need to cancel or reschedule your sclerotherapy treatment, please give our office at least 72 hours notice.
Photographs will be taken before your first treatment to document progress and/or for the purpose of medical education, research, scientific publication or educational presentations. You will not be identified in your photographs and informed consent will be obtained before you are photographed.
Before standing, you will put on your compression hose. Proper compression is very important because it minimizes the blood re-entering the injected vein, decreases the incidence of post sclerotherapy hyper pigmentation and telangiectatic matting and improves venous blood flow. The cotton balls and tape can be very uncomfortable and may even irritate and blister sensitive skin. The hose should be worn for 24 hours a day continuous for 7 days. They may be removed to launder, preferably at night when you are inactive. If larger varicose veins are injected, you may be advised by your doctor to wear them for two to three weeks.
A shower is allowed after the first 24 hours. Hot baths, hot tubs and saunas should be avoided for two weeks after sclerotherapy to avoid venous dilatation.
If you develop hyper pigmentation after sclerotherapy you should apply sun block to those areas when sun exposure is anticipated to avoid increasing the hyper pigmentation. Continue to use sun block until the hyper pigmentation has resolved.
You may drive immediately after your treatment. If your trip home is longer than an hour we recommend you stop hourly to stretch your legs.
In most cases, you may return to work and resume normal activity after treatment. Please take a 15-minute walk immediately following your treatment. This will help circulate the solution that was injected. Walking is encouraged; it promotes efficient venous circulation. Avoid sitting and standing for extended periods and elevate your leg(s) above the level of your heart when possible for the next two to three days. If large varicose veins were injected, your clinician may recommend you stay off your feet with your leg(s) elevated for the rest of the day. Avoid high impact aerobics, jogging, running, leg weight lifting and sit-ups for one week after each injection treatment.
Do not use Aspirin or Ibuprofen products for ten days after each treatment to reduce bruising. Acetaminophen (Tylenol) can be used if you experience any discomfort from sclerotherapy. FOLLOW-UP-subsequent treatments are usually every four to six weeks. Your clinical provider will advise you when you should return. If you notice dark knots or cords at your injection sites please call our office; you may need to return sooner to have these areas aspirated.
Remember it is important to call our office if you have any questions or concerns before or after your sclerotherapy treatment. Please keep your follow up appointment after treatment. It is important for the physician to assess the results you achieved from each treatment.
What are the most common side effects?
Depending on the type of solution used, you may experience mild itching along the vein route. This itching may last 1 to 2 days.
Approximately 30% of patients who undergo Sclerotherapy notice a discoloration of light brown streaks after treatment. In almost every patient, the veins become darker immediately after the procedure but slowly clears over a few weeks. In rare instances, this darkening of the vein may persist for 4 to 12 months.
Sloughing occurs in less than 3% of patients who receive Sclerotherapy.Sloughing consists of a small ulceration of the injection site that heals slowly. A blister may form,
open, and become ulcerated. The scar that follows should return to a normal color and blend-in with surrounding skin color and texture.
A few patients may experience moderate to severe pain and some bruising, usually at the injection site. The veins may be tender to the touch after treatment, and the uncomfortable sensation may run along the vein route. This pain is usually temporary, in most cases lasting less than 5 minutes. In rare cases pain and tenderness can last up to a week.