Sclerotherapy can effectively treat varicose and spider veins. It's often considered the treatment of choice for small varicose veins. Sclerotherapy involves injecting an FDA approved solution directly into the vein with a small needle. The sclerotherapy solution causes the problem vein to seal off, forcing blood to reroute through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades.
Normally, veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Varicose veins may be caused by weakened valves (incompetent valves) within the veins that allow blood to pool in your veins instead of traveling to your heart.
Sclerotherapy is often done for:
- Cosmetic purposes — to improve the appearance of varicose and spider veins
Possible improvement of related symptoms such as:
- Night cramps
If you're pregnant or breast-feeding, our surgeons recommend waiting to have sclerotherapy done.
Frequently Asked Questions
(please read thoroughly)
What is sclerotherapy and what is it used for?
Sclerotherapy is the injection of a sclerosing solution into an abnormal vein. The solution that is injected destroys the vein wall which causes the vein to collapse and shut down. Sclerotherapy is a form of chemical ablation, and is different from laser treatment which is a form of thermal (heat) ablation. A small needle is used to inject the liquid chemical into the vein. Sclerotherapy is typically performed on very curvy varicose veins, bluish reticular veins, and reddish-purple spider veins. We use a special light to see deeper veins that you cannot see on the surface. The number of injections depends on the size and number of veins being injected. Again, each session, there is a limit to the amount of medication we can safely use. It is not common to need more than one session to treat an area satisfactorily.
How does it work?
The solution works by irritating the cells that line the blood vessels. The vessel walls will stick to each other and collapse. The vessels fade slowly over the next 2-4 weeks. We can usually achieve 70-90% fading with an average of 2-4, 30 minute treatments.
Is the procedure painful?
Patients report feeling a small stick with mild to moderate burning during the sclerotherapy procedure. You may also develop a slight histamine effect, similar to a bee sting. Hydrocortisone cream is applied to help. We recommend our patients take oral Benedryl to help as well. This will usually go away shortly after treatment. Generally, the procedure is well tolerated. Please let the provider know if you are having severe pain.
Will the procedure require any anesthesia?
This procedure does not require anesthesia and is performed in our office.
how long does the procedure last?
We usually allow 30 – 60 minutes for sclerotherapy.
Can both of my legs be treated on the same day?
We are limited to a safe amount of medication that can be used in the procedure. If too much is used, you could have a reaction. Some patients require more than one appointment in order to treat both legs effectively. This is dependent upon every individual patient.
If it’s more appropriate to treat one leg at a time, we can schedule each leg to be treated 48 hours apart. For example, we can treat one leg on Monday and the other as soon as Wednesday.
How often will I need to have sclerotherapy?
The same vein may need to be treated more than once. Treatments are usually done every 4 weeks.
Do I need a driver?
You will not need a driver following sclerotherapy.
How quickly can I resume normal activity, i.e. work, exercise?
Patients are walking immediately following the procedure, and typically, resume normal activities immediately. We recommend two 20-minute walks a day to avoid any complications. You may continue light exercise classes and gym routines, as long as it is comfortable to you. Don’t work through any pain (discomfort), but allow it to be your guide. You should avoid strenuous activity for a week. Showers are preferred over baths and Jacuzzis should be avoided. After the first 48 hours, there are no restrictions on bathing.
How long do I have to wear compression stockings?
For 10 days after sclerotherapy treatment, we require wearing gradient compression stockings which offer the greatest amount of pressure. Compression stockings put helpful pressure on your veins. You cannot wear them too much. Amelia will measure you prior to your procedure and you will purchase them directly from Monarch for $50.00 plus tax per pair. Only one pair is necessary per patient.
Do I need to bring my compression stockings and shorts to each visit?
Yes, please bring your compression stockings and shorts to each visit. We ask that you bring old, loose fitting shorts. We use different medical products that may stain or get on clothing. If you forget your shorts, we do have patient gowns that are available for our use.
What are the red, tender lumps forming on my leg(s) after the procedure?
These are what we call "SVT’s" (Superficial Venous Thrombosis). After the vein is treated, it is inflamed. The body’s first response is inflammation – warm, red, itchy spots are common. In approximately 1 – 3 weeks, these spots will likely harden and feel like lumps or knots as they are healing. Eventually, these areas will decrease in size and tenderness. This is a normal response to the vein closing down. You may apply topical ice and take anti-inflammatory medications to help with this and it should quiet down within 3 – 5 days.
Why do I have bruising and how long will it last?
Bruising near the site of injection can occur and usually resolves with 7 – 10 days. Follow up visits are scheduled 4 weeks following your procedure for optimal evaluation.
When will I see results?
Large veins may take approximately 6 – 9 months or even more to fade, while small veins may take approximately 2 – 3 months or even more to fade.
What happens if I need to travel within the time that is recommended not to travel?
You will need to wear your compression stockings while traveling. If traveling by car, stop and walk every 90 minutes or so. Avoid airplane travel for two weeks.
Can I reschedule?
Normal cancellation policy in place.
Who am I seeing?
Sclerotherapy patients will consult with and be treated by a certified nurse injector, Amelia Combs RN, BSN. Monarch Plastic Surgery always has a surgeon in our office during procedures should any questions arise. Amelia is an expert and frequently performs sclerotherapy treatments. She is highly trained and competent to perform this procedure. She has been practicing sclerotherapy over 12 years and has over 21 years of nursing experience. We also recommend an additional complimentary consultation with one of our licensed aestheticians, who may need to treat smaller, non-injectable veins with laser therapy.
How do I prepare for treatment?
For 24 hours before the procedure, avoid shaving or applying any lotion to your legs. Wear loose, comfortable clothing to your appointment. You may change into a pair of shorts so that your legs are exposed. For the procedure, you'll lie down with your legs slightly elevated. After cleansing the area to be treated with alcohol, your provider will use a fine needle to slowly insert a solution into the appropriate vein. Once the needle is withdrawn, your injector applies compression and massages the area to keep blood out of the injected vessel and disperse the solution. The number of injections depends on the number and size of veins being treated.
After the procedure, you'll be able to get up and walk around. Walking and moving your legs is important to prevent the formation of blood clots.
How do I plan for Sclerotherapy?
For one week prior to the procedure we recommend you do not take any aspirin, ibuprofen, Motrin, Aleve, or other NSAIDS unless medically necessary (always check with your physician prior to stopping any medication). In addition, supplements like Vitamin E, Ginseng, and Fish Oil, may also potentiate bleeding and bruising during and after the procedure. We recommend that you consider the time of year you undergo this procedure, as there is a healing period where the veins will look worse before they look better. In addition, you may require more than one treatment and being treated in the fall and winter will have your legs ready for summertime shorts and skirts.
Allow yourself one to four weeks healing time. Sun avoidance is important so the treated sites do not develop any hyperpigmentation or tan discoloration. Compression support hose are available through our office. Using these pressure/support measures may improve your response after your visit.
Important Information for my provider?
Tell your provider of any pre-existing medical problems such as genetic bleeding disorders, low platelet count, or if you are on any blood thinning medications which may be contraindications to this procedure.
Tell your provider if you have a strong aversion to needles that makes you light headed (vasovagal) or if you have fainted in the past while giving blood.
Tell your provider if you have had hip or knee replacement or if you have Mitral Valve Prolapse requiring you to take an antibiotic prior to a dental or other procedure.
Tell your provider if you have ever had sclerotherapy, laser, vascular surgery, or radiofrequency therapy in the past to your leg veins.
Will I have enough veins after this treatment?
It is important to understand that the veins we treat are abnormal and are not necessary for your circulation. Removing these superficial veins may actually improve circulation while also improving the appearance of your legs.
How will my legs look after my Sclerotherapy Treatment?
Not pretty. Generally, during the first 2-3 weeks, you will see a darkening purplish discoloration at the treated sites. Bruising is quite common or a period of days or weeks. This time frame is shortened with the compression stockings/hose. In addition, it is not uncommon to feel a firm area, lump, or bump beneath the skin. It may be non-tender or tender, usually forming a week to 2 weeks after an injection session, or it may never happen. This may be remedied with an aspiration and anti-inflammatory medicines. As with any procedure, should you have a question or concern, you should call the office and be evaluated so that the proper treatment can be given.
Gradually, after 3-4 weeks you will see a regression and disappearance of the injected vein. Should you see any tan or brown discoloration overlying the treated vein, a topical medication and bleaching agent can help to fade this hyperpigmentation which is a possible side effect of this procedure. We will schedule a follow-up appointment four weeks after your initial session for evaluation. Additional treatments may be necessary. Ultimately, after you sclerotherapy session(s) are completed, you may be a candidate for touch up treatments using a laser with our Skin Care Center. Once adequately treated, your treated spider veins will disappear leaving you ready to skip into summer!