Spider Vein Treatment (Sclerotherapy):

It is estimated that almost three-quarters of all adult women have spider veins – red, blue or purple thread-like lines just under the skin. The condition is associated with increased pressure to the veins.

Since the most common causes are the normal monthly hormonal fluctuations of the female cycle and pregnancy, spider veins occur most often in women, and they often first appear during pregnancy. Other contributing factors include injuries, medications that affect hormones, and a family history of spider veins. Although it is less common, men can develop spider veins as well. The condition usually appears after age 30, although it can sometimes develop as early as the teen years.

Spider veins, or “starbursts,” are so named because the series of veins often radiates out from a central point, reminiscent of the shape of a spider. They may also appear as fine, separate lines, a web-like maze, or as “branches” from a single “tree trunk.” They can develop on any part of the body, including the face, but most often appear on the thighs, calves, or ankles.

Spider veins are caused by abnormal blood flow and weakening of the blood vessel wall in the affected veins. Any condition or activity that puts pressure on the veins -- such as gaining weight, and sitting or standing for long periods of time -- can contribute to their development.

While unsightliness is the most common reason for removal, spider veins may also be removed to alleviate problems with restless legs, aching, burning, and/or cramps. Spider veins are most often treated with sclerotherapy, in which a saline or chemical solution that is injected into the vein, irritating the lining and causing the vein to collapse and disappear.

In some cases, laser treatment may be used either alone or in combination with sclerotherapy. If you are considering sclerotherapy, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a plastic surgeon who is board certified or has completed a residency program that includes instruction in this procedure.

What are some of the most common benefits of this procedure?

Although treatment does not prevent the development of new spider veins, the removal of existing veins can dramatically improve the appearance of the affected area, providing a more youthful, healthy look and an even color pattern to the skin. Veins lighten after each treatment. Two or more sessions are usually required for the best results.

 What will happen at the initial consultation?

During the consultation, your doctor will talk to you about the changes that you would like to make in your appearance. He/she will explain the different options available to you, the procedure itself, its risks and limitations, and the costs.

Your doctor will begin with a physical exam and a complete medical history. He/she will need to know the medications you’re currently taking, any history of blood-borne diseases, and whether or not you are pregnant or nursing. In some cases, elaborate tests such as ultrasound or Doppler may be performed, but this is usually not necessary. Often patients will have both spider veins and varicose veins, and your doctor may need to use these tests to clearly differentiate between the two. (More elaborate tests are sometimes performed in scientific studies.)

Be sure to tell your doctor about any discomfort you may be having, such as pain, itching or swelling. These symptoms may indicate more serious circulatory problem. If your doctor does suspect a more serious condition, you may be referred to a specialist for further evaluation. Any underlying condition should be treated before sclerotherapy treatment is begun.

Be sure to ask all the questions you have about the procedure, and ask to see photos of the doctor’s recent patients, before and after treatment. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

How is sclerotherapy performed?

Your doctor may recommend that you avoid aspirin and alcohol, as well as herbal medications and anti-inflammatory medications, for two weeks prior to your treatment to minimize bleeding during the procedure. On the day of your treatment you will be asked not to use moisturizers, sunblock or oil on the affected area. You should wear shorts or other comfortable clothing that exposes the spider veins.

Your doctor will apply antiseptic to the area, then inject a solution into the affected veins with a very fine needle. Each injection covers about one inch of the vein. During the procedure, you may feel a slight pinch as the needle is inserted and a burning sensation as the solution is injected. Next, cotton dressing and compression tape will be applied to the area. After one area is injected and taped, the doctor will proceed to the next area.

Generally a second treatment will be required in order to complete the collapse of the vein. If you have many veins requiring treatment, multiple sessions may be required.

How long does the procedure take?

Sclerotherapy normally takes fifteen minutes to one hour, depending on the number and length of the spider veins. A series of treatments at bi-weekly or monthly intervals may be required.

Will I need to stay in a hospital?

No. Because anesthesia is not necessary, the procedure is usually performed in the doctor’s office or at an outpatient facility.

How much pain is there?

Most patients report minimal pain. However, the type of sclerosing solution used is a factor in the amount of pain involved. Be sure to discuss with your doctor the benefits and drawbacks of the sclerosing solution that he/she recommends.

What can I expect after the procedure?

You may experience temporary itching or cramping at the injection site. You will be asked to wear a compression wrap for several days. During this time you must keep the area dry. Your doctor may prescribe support hose to be worn for several weeks. This helps to keep the treated vein collapsed. It also reduces the likelihood of blood clots.

 What is the recovery period like?

Although you should avoid activities that put pressure on the treated area (such as heavy lifting or jogging) for a few days, your doctor will probably suggest a regular walking program to increase circulation and promote healing.

When the compression wrap is removed, you will notice bruising and discoloration. This will gradually fade over a period of several weeks.

What is the long-term outcome like for most people?

Most patients report a high degree of satisfaction with the procedure and relief at no longer having to hide unsightly veins. The treated areas are noticeably clearer and in most cases the skin continues to improve with each successive treatment.

Ideal candidate:

In general, the best candidates for sclerotherapy:

• Enjoy good physical health
• Are psychologically stable
• Do not smoke
• Want to improve their appearance
• Are well informed about the procedure
• Hold realistic expectations about the outcome
• Do not have a blood-borne disease or condition affecting the vascular system
• Are not currently pregnant or nursing

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you.

Other important information:

Sometimes laser treatment is preferable to sclerotherapy. This method is often used to remove spider veins on the face, which tend to be close to the surface of the skin. Laser treatments have some advantages over sclerotherapy, including being able to target the veins with less damage to the surrounding skin. However, laser treatments have some disadvantages, too. They cannot penetrate deeply enough to successfully treat most cases of spider veins on legs. Sometimes a combination of laser treatment and sclerotherapy is recommended.

Spider veins should be distinguished from varicose veins, which are large, bulging or knotted veins that usually cause pain. Although varicose veins can respond to sclerotherapy, they must often be surgically removed. Varicose veins may be related to an underlying circulatory problem, so your doctor may refer you to a specialist before recommending a specific treatment.

 Risks and limitations:

Occasionally “telangiectatic matting,” a new network of veins, appears around the treated area. If this occurs, these veins can also be treated with sclerotherapy. Discoloration and blotchiness is a more common side effect, but this usually fades over a period of time. Avoiding direct sunlight can minimize this. More rarely, sclerotherapy can lead to blood clots or inflammation in the veins. Allergic reactions to sclerosing agents have also been reported. Bruising is not uncommon and often will fade within a few days or, rarely, within a few weeks. In order to minimize these risks, it is important that you follow all of your surgeon’s instructions, both before and after surgery.

If you have recently been pregnant, ask your surgeon about delaying the procedure, since spider veins caused primarily by pregnancy often resolve on their own.