Visual (or Cosmetic) Sclerotherapy Dallas, TX
Visual sclerotherapy is a medical procedure used to treat visible diseased small superficial veins called reticular veins, and spider veins of the skin. When patients have advanced vein disease, cosmetic sclerotherapy is often the final treatment measure required, once all of the underlying problems have been corrected. In patients with mild or early vein disease sclerotherapy may be the only treatment required. Sclerotherapy treats the abnormal veins by injecting a sclerosing solution into the damaged veins under magnified visual guidance. The solution chemically irritates the lining layer of the vein, causing the vein to collapse and scar, thereby closing the vein. The scarring is not visible on the skin surface and the cosmetic result is excellent. The procedure is very safe, can be done in the office, and produces no disability other than the need to avoid strenuous physical activity for five to seven days.
Sclerotherapy is performed in the office and generally takes 15 to 45 minutes, depending upon the number of sites treated. No anesthesia is needed for this quick and simple procedure, and most patients experience only minimal pain and a mild burning sensation. The skin is cleansed with an antiseptic and a sclerosant material is then injected into the affected veins with a very small needle. Multiple injections are usually required. Polidocanol is one of the most commonly used sclerosant solutions as it is very effective and causes very little pain. Polidocanol is often used as a foam created by mixing the Polidocanol with a small amount of air. This creates microbubbles which displace the blood from the vein and stick to the lining layer of the vein, making the treatment more effective. Polidocanol is FDA approved for sclerotherapy, and has been used worldwide for many years with a good safety record. We limit the volume of Polidocanol foam injected to 10 milliliters a day in accordance with the recommendation of the Second European Consensus Meeting on Foam Sclerotherapy, which established this volume limit in 2006.
Recovery and Results
Patients can return home shortly after sclerotherapy, and most can return to work and other normal activities the same day. Exercise and strenuous activities should be avoided for 5-7 days. Compression and support bandages may need to be worn for a few days after the procedure (only during the day), and some patients may experience mild bruising and pigmentation after sclerotherapy. The pigmentation, often referred to as “staining,” occurs as a tan streak over the course of the treated vein due to the breakdown of blood trapped in the vein when it closes. Staining will usually resolve spontaneously, but the stain can be removed more quickly (or prevented) by draining pockets of trapped blood with a small needle prick 2-4 weeks after the sclerotherapy session. Complications with Polidocanol injection are rare, but the injection site can occasionally develop a small skin ulceration. This will usually heal over 6-12 weeks time. Blood clots in the deep veins following Polidocanol injection have been reported as a very rare event, but we have not seen this occur in our patients. Sclerotherapy for spider veins can be expected to eliminate about 85% of the veins treated. About 15% will require one or more additional injections for complete elimination. In general you can expect to see the final results of sclerotherapy in six to eight weeks.
Side Effects and Risks
Sclerotherapy is a safe and highly successful procedure that has been performed for many years. It is currently considered the state of the art for spider vein treatment. Mild discomfort may develop in the veins treated with sclerotherapy due to the inflammation produced by the sclerosant solution. The patient is more likely to be aware of the inflammation if the treated vein is very superficial, or close to the skin. The inflammation may also produce tenderness and small lumps beneath the skin surface. These symptoms can occur immediately or as a delayed reaction, up to six weeks after the sclerotherapy procedure. Another minor problem that can occur with sclerotherapy of superficial veins is skin staining. This is a rust colored pigment that gets deposited in the tissue as the blood trapped in the treated veins breaks down. All of these problems resolve with time and the symptoms are effectively treated with anti-inflammatory analgesics such as ibuprofen. Although blood clots in the deep veins of the legs produced by sclerotherapy has been a concern for many years, this complication is extremely rare. At Reeder Vein Institute we have extensive experience with chemical sclerotherapy and have not seen a significant deep vein blood clot produced by a sclerotherapy treatment. With proper instruction and appropriate activity following sclerotherapy, the risk of this complication should be very low. In addition, the sclerotherapy procedure should not be performed on pregnant women and must be used with caution in patients who have had a blood clot in the past. The staff at Reeder Vein will discuss these considerations in detail before treatment if sclerotherapy is recommended for your vein disease.