Cosmetic Sclerotherapy

Absolutely. Sclerotherapy has been performed for over 150 years, with continuous advancements in sclerosant agents and techniques making the procedure even more safe than it previously was.

We understand some patients are anxious about needles. Patient comfort is of paramount importance to us, so rest assured we use only the smallest needles available and have taken extensive measures to ensure a comfortable experience. Additionally, since spider veins are found in the top skin layer, injections are extremely shallow.

Most commonly, patients relate treatment to faint scratches or pinpricks with occasional mild stinging for a few seconds. There should be no concern for significant discomfort or excruciating pain. In our experience, the anticipation is worse than the actual procedure itself.

Cosmetic sclerotherapy is so minimally invasive that most patients return to their usual daily activities right away. We will recommend some mild exercise like walking to ensure good blood flow in your legs and decrease discomfort. Additionally, compression socks will be required to ensure excellent cosmetic outcomes.

• You do not need to stop your medications prior to treatment, unless otherwise advised during your consultation.
• Fasting is not required. If your procedure is scheduled for the morning, be sure to eat breakfast. However, try to avoid caffeinated beverages such as coffee and soda.
• Avoid shaving your legs immediately prior to your treatment.
• Wear loose clothing to the procedure appointment. Your leg will be wrapped in dressing material and compression stockings fitted after the procedure.

• Our patient care specialists will go over the post treatment instructions in detail and provide you with a copy to take home.
• Compression stockings will be worn continuously for the first 48 hours. Following this, the stockings should be worn for a minimum of 14 days during the day. They can be removed for showering and sleeping. The longer you wear them, the fewer the side effects and better the cosmetic results.
• You may immediately resume normal activities and work but avoid standing still for long periods of time.
• You will need to walk a minimum of 30 minutes each day for at least 3-4 weeks after the procedure. This is crucial to obtain the best results, avoid complications and make your legs feel more comfortable.
• You may continue exercising, except for strenuous or high impact exercises such as running and jumping. Walking is highly encouraged.
• Avoid hot baths, hot compresses, whirlpools, saunas for at least 3-4 weeks. The heat dilates blood vessels and may reopen treated veins.
• Avoid direct exposure of the treatment area to sunlight for at least 3-4 weeks to reduce skin staining – high SPF sunscreen is highly encouraged.
• Avoid taking anti-inflammatory drugs like ibuprofen or naproxen for at least 48 hours after the procedure.
• We believe in treating patients like family. You will have Dr. Poonawala’s after hours number should you have any questions or concerns.

The common side effects which are a normal response to the treatment, are harmless and transient. They are expected and should not be a cause for concern although they should be reported on follow up. 

• Mild discomfort – expected as a result of vein spasm and the body’s natural inflammatory response to the sclerosant. Pain is usually improved by walking, cold compresses or by taking acetaminophen in the first 48 hours. Anti-inflammatories such as Ibuprofen or Naproxen may be taken after 48 hours. Discomfort will typically be the worst for the first 1-2 days with gradual decrease and resolution thereafter. There is never a need for prescription strength painkillers.  
• Skin bruising – at the treated areas and is not a cause for concern. This will typically disappear within two or three weeks and can be minimal to extensive. 
• Darkening of Spider Veins – Treated spider veins frequently appear darker after sclerotherapy and will no longer blanch with pressure. This is representative of successful sclerotherapy and will gradually fade with time.
• Tender lumps –  commonly seen along the treated vein and represent hardened veins; the intention of sclerotherapy. These may present a week to a month after the procedure and can persist for a few months, with gradual spontaneous resolution. They may occasionally be tender and angry appearing when trapped blood has remained with the closed vein. This can be gently drained via a tiny needle prick, resolving tenderness and preventing skin pigmentation. Dr. Poonawala frequently utilizes a novel technique of tumescent-assisted cosmetic sclerotherapy to reduce this occurrence.
• Pigmentation – Light brown discoloration or dark shadow may occur along the treated veins and is related to skin deposition of hemosiderin from “trapped blood”, an iron containing blood breakdown product. This is more frequent with larger surface veins but can occur with spider veins. In most cases, complete resolution is seen within 12 months, rarely longer. Above mentioned drainage of trapped blood will prevent prolonged pigmentation.
• Matting – This is the development of fine red veins near the previous injection sites, and occurs shortly after treatment in less than 10% of patients. Matting most commonly presents in patients with extensive surface spider veins, overweight patients and those with very fair complexion. Typically resolves spontaneously although can persist for many months. Rarely, additional cosmetic sclerotherapy or surface laser therapy can be treatment considerations when persistent. 
• Phlebitis – Spontaneous inflammation of the treated veins after the initial healing process. This presents as red tender areas along the course of treated veins (similar to inflammation from trapped blood) and is treated with anti-inflammatories such as Ibuprofen and Naproxen, compression stockings and frequent walking. This is commonly mistaken for an infection and will not respond to antibiotic therapy. If extensive or progressing, a short course of blood thinners may be recommended.

Sclerotherapy has been proven to be remarkably safe and well tolerated in a large number of clinical studies, although complications can occur even with the best possible technique and attention to detail.

• Deep Vein Thrombosis (DVT) – development of a blood clot in the deep veins of the leg. This is a recognized complication although extremely rare with cosmetic sclerotherapy, especially if the compression stocking and daily walking regimen is followed. 
• Allergic reaction – Allergic reactions to sclerosing solutions are rare, with generalized rash, airway swelling and difficulty breathing the more common serious and life threatening symptoms. These obviously require immediate treatment with epinephrine and/or steroids. Less serious reactions such as minor rashes are generally treated with antihistamines or careful observation. Allergic reactions are slightly more common in patients with asthma. 
• Intra-arterial injection – rare complication occurring when an artery, rather than a vein, is inadvertently injected with the sclerosant. This can result in severe skin and tissue necrosis in the area the artery supplies. Treatments by a specialist who is well versed with intricate vascular anatomy will greatly reduce this risk.
• Skin ulcers –  extremely rare complication at the treatment site  (<1%), typically due to too strong a sclerosant concentration and leakage into the surrounding skin.

Since this is considered a cosmetic procedure, it is usually not covered by insurance companies. Some may cover in extenuating circumstances and extensive disease, but this is not common practice.