Cosmetic Sclerotherapy

What is cosmetic sclerotherapy?
Cosmetic sclerotherapy is a nonsurgical treatment for unwanted spider veins. Using a very fine needle, a medication called a sclerosant is directly injected in to the spider veins, causing the lining of injected veins to become irritated. Over time, the veins close down and the body absorbs these nonfunctioning vessels. Sclerotherapy has been performed for decades and is very safe.

At our office, we use a sclerosant called Sotradecol (Sodium Tetradecyl Sulfate or STS), an agent which is recognized and used around the world, and is FDA-approved in the U.S. Although Sotradecol is more expensive, we use it exclusively as saline sclerotherapy results are not as successful and long lasting as Sotradecol; moreover, saline injections are painful, whereas Sotradecol injections are nearly painless.

How effective is cosmetic sclerotherapy?
Successfully treated spider veins generally respond to treatment in 3-6 weeks by starting to disappear or lighten. However, many patients may need between 2-5 sessions to treat spider veins successfully.

The key to understanding why some spider veins tend to recur depends on whether there is underlying disease, call feeder vessels. Only when the underlying problem is solved by stopping the feeder vessels can the spider veins be properly treated.

At Advanced Therapies, we use state-of-the-art technology which is able to show how and where the feeder vessels lead to the spider veins. These feeder vessels are then injected, stopping the source of the problem. Then, and only then, can the spider veins be properly sclerosed.

How do I know if I am a candidate for cosmetic sclerotherapy?
Cosmetic SclerotherapyAt your initial consultation, you will meet with one of our Interventional Radiologists, who are board-certified physicians and vascular specialists trained in minimally invasive procedures, especially in vein treatments. They will determine by history and ultrasound if you simply need injection treatment or if there is a underlying problem. Only after ensuring that no underlying problem is present will we proceed to start the cosmetic sclerotherapy for your spider veins.

You are not eligible for sclerotherapy if you are pregnant, breastfeeding, or are bed ridden. If you recently gave birth, you must wait at least three months after delivery before you can be considered for the procedure. If you have had a blood clot in the past, your eligibility will be determined on an individual basis, and will depend on the leg and the cause of the clot.

Will my insurance cover sclerotherapy?
Cosmetic sclerotherapy is considered to be a cosmetic procedure and is therefore usually not covered by insurance. In some cases, some insurance companies may cover sclerotherapy for extenuating circumstances and extensive disease, but this is not common practice.

What are the possible side effects of cosmetic sclerotherapy?
Common side effects include itching, bruising with some pain, transient hyperpigmentation (brownish discoloration along the course of the vessel), sloughing (less than 1% of patients report small ulcerations at the injection site), blood accumulation in the treated vessel, telangieactic matting (development of new blood vessels in the treated area), and in rare instances, patients may experience an allergic reaction to the sclerosing agent that is used.

How do I prepare for my sclerotherapy?
Do no take aspirin, ibuprofen, or other anti-inflammatory medications for 48 hours before and after sclerotherapy. These medications may interfere with the action of the sclerosing agent or increase bleeding. Tylenol is permitted.

Steroids such as Prednisone also decrease the effectiveness of the sclerosing agent, and if possible should be discontinued 48 hours prior to the sclerotherapy, only if deemed safe by your physician. Also, Tetracycline and Minocin (both antibiotics), may cause a staining or hyperpigmentation of the skin if taken 7 to 10 days before or after sclerotherapy. Ask your doctor about alternative antibiotics if required during that time frame. Finally, do not apply lotion to your leg the day of the procedure and bring your compression stocking with you.

How many treatments will be needed?
The number of treatments needed to clear or improve the condition varies and depends on the number of varicose and spider veins present. While sclerotherapy is safe and highly effective, most patients need between two and five treatments to clear or improve unsightly veins. A small minority of patients do not improve even after multiple treatments, while others improve after only one.

What can I expect after the treatment?
A sclerotherapy session generally lasts 20-30 minutes. Following the injection, you will wear a 20-30 mm Hg (Grade 1) compression stocking over the treated area. You may resume your regular activities, including work, and are encouraged to walk immediately after the procedure. You must wear the compression stocking for 48 consecutive hours following the treatment. After that, wash the injection sites with mild soap and lukewarm water as needed.

Following the procedure, avoid aspirin, ibuprofen, and other anti-inflammatory medications for 48 hours. Tylenol can be used if pain relief is needed. You must also avoid hot baths, saunas and extensive hot showers for seven days. You must also not apply hot compresses or any other form of heat to the injected areas.
It is extremely important to avoid direct exposure to sunlight (including sun tanning and tanning beds) for 14 days following your procedure to prevent hyperpigmentation (brown spots) from developing on your skin.