Manhattan Beach Dermatology

Sclerotherapy
Sclerotherapy is a quick non-surgical procedure that treats unsightly spider veins of the legs. This method involves injecting the vein with a specialized agent called a sclerosant. Concentrated saline solution is among the most common, safest, and effective sclerosants. The FDA has also approved Asclera, a detergent based sclerosant that is often less painful than hypertonic saline. These sclerosants work by irritating the blood lining, making the vessel walls collapse so no blood can flow through the vessel. Discomfort and downtime after the procedure are minimal and the cosmetic benefits are visible within a few weeks.

What Is Sclerotherapy?
Sclerotherapy is an outpatient, minimally invasive medical procedure in which a special medication is injected with a fine needle to irritate and close off dilated spider or varicose veins.

What causes leg veins?
Leg veins are caused by a combination of heredity, gravity, sitting, standing, hormones and child-bearing, obesity and lack of exercise.

What is injected into the viens?
Many different solutions can be used. The safest is a concentrated salt water solution called hypertonic saline. The FDA has approved Asclera, a detergent solution which is less painful than hypertonic saline but can rarely cause systemic allergic reactions.

Which vessels can be treated?
Vessels of any size can be treated with sclerotherapy. The larger vessels are hardest to treat by this method, and while treatment may be successful, side effects such as dark pigmentation are more common. It is best to limit sclerotherapy to smaller blue vessels and the red spider veins. Patients with larger blue veins and varicose veins will be referred to interventional radiology for ultrasound imaging of their veins and non-sclerotherapy treatments.

How soon do blood vessels disappear after treatment?
The veins disappear over a period of 2 weeks to 2 months. The small blue vessels usually require more treatments and support hose for maximal effect. Recurrences can occur over a period of several years, and treatment does not prevent the development of new veins.

Can anything prevent more leg veins from coming?
Support hose use on a daily basis, weight reduction, and exercise may be successful.

How often can I be treated?
Retreatment to areas with partial success may be done in 4 weeks. New areas can be treated in 1-2 weeks.

How often do I have to be treated for therapy to work?
The number and frequency of treatments depends on the size of the vessels and their location. In general, larger vessels need more treatments. The average number of treatments is 2-3 per vessel performed on a monthly basis for best results.

What type of results should I expect?
You should not expect 100% removal of all of your spider veins, especially if you have a large number of them. Improvement of 50-80% is usual with a full course of treatment. Expect some temporary bruising, swelling, and discoloration between treatments.

What if Sclerotherapy doesn't work?
If no improvement is seen after 3 treatments, other sclerosants can be injected or veins may have to be treated surgically. Laser treatment is successful only for very small veins.

How long has this procedure been available?
Sclerotherapy has been used for many years but popularity has grown rapidly more recently as awareness of the technique and its availability have increased.

What are the potential side effects?

Bruising almost always occurs and lasts for a few weeks. If the vessel wall is very weak, some brown pigment deposition may result. The discoloration may last for a long time (two weeks to two years), but eventually it will fade.
Injection into larger vessels may result in a blood clot at the injection site. This problem doesn't result in internal problems except in the very rare event that a clot would move to another area of the body (embolism).
Welts may occur at the injection site temporarily.
Burning pain or muscle cramping may occur with concentrated salt solution temporarily.
Scabs may form over a sore if small amounts of solution leak out of the vessel into the surrounding tissue and this may leave a small scar when it heals.
Very rarely, the vessels become inflamed and produce a superficial thrombophlebitis. This condition requires treatment with rest, leg elevation, anti-inflammatory agents and sometimes warm compresses.
With Asclera, the most serious potential side effect is a severe allergic reaction. We use small amounts of the medication each treatment session to lessen the very remote possibility that this may occur.
Transient leg swelling may sometimes occur, and is more common in patients with a history of leg swelling or who have prolonged sitting or standing after the procedure.
Very tiny red veins called telangectatic matting may occur in place of the larger spider veins. These can be hard to treat.
You should not be treated if you have any of the following conditions: active thrombophlebitis (blood clots), active infection, poor circulation, confinement to bed, history of pulmonary emboli (blood clots in the lungs), and a history of swelling of the feet and legs.

How do I minimize side effects and get the best results?

Do not shave legs for 48 hours prior to the procedure.
Do not apply lotion for 48 hours prior to the procedure.
Do not take Aspirin, Ibuprofen or the anti-inflammatory drugs for 48 hours prior to the procedure.
Bring shorts to wear during the procedure and wear loose clothes.
Avoid prolonged sitting, standing, or strenuous aerobic exercise for 48 hours after the procedure. Walking for 20 minutes several times per day is beneficial.
Wear fitted support hose continuously for 48 hours after the procedure. After 48 hours, switch to daytime use for the next three weeks. The best brands to buy are Jobst or Sigvaris and they should provide support pressure of 25mm.
Elevate legs while sitting for the first 48 hours.
Avoid sun exposure to the legs for two weeks.

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