What is Sclerotherapy?
Sclerotherapy is a minimally invasive procedure used since the 1930s to eliminate spider and varicose veins on the legs. Dr. Davis will inject a sclerosing (irritating) solution directly into your veins, causing them to shrink and eventually disappear. The blood normally carried by these weakened veins becomes re-routed to deeper, more competent vessels below. Sclerotherapy has surpassed laser therapy as the preferred treatment choice for these leg veins, fully eliminating them by three treatments in most cases.
Who is a candidate for Sclerotherapy from Dr. Davis?
Sclerotherapy is safe and effective for male or female adults of all skin colors who have either spider veins or varicose veins of the legs. Spider veins are small red or blue blood vessels that are found near the surface of the skin. They usually occur on the legs, but can also appear on the ankles, feet, chest, or face. Varying in size, shape, and color, some spider veins are linear while others may occur in a “sunburst pattern”. Varicose veins are larger, dilated blood vessels that can raise the surface of the skin. They can be deep blue, purple, or appear “green.” Sclerotherapy can be used to treat most spider and varicose veins on the legs, ankles, and feet that you find bothersome; regardless of the color of the vein.
Sclerotherapy is mainly used for cosmetic purposes - to lessen the appearance of these unsightly veins. It can also relieve some of the symptoms that are associated with veins, such as aching, burning, swelling, and night cramps. In fact, by treatment and elimination of the smaller spider veins, you can prevent many of these symptoms, which generally arise when veins become larger. You should not have Sclerotherapy if you are pregnant, nursing, or if another pregnancy is planned imminently. If you have small, fine, red sunburst vessels that are too fragile to treat with injection therapy, Dr. Davis can use either electrosurgery or laser to eliminate them (also in about three treatments). If your varicose veins are too large for sclerotherapy (if they are the size of your thumb or larger), then you might require an alternative procedure from a vascular surgeon. Sclerotherapy is for treatment of the majority of leg veins, which fall in between these in size.
What does a Sclerotherapy treatment from Dr. Davis consist of?
A Sclerotherapy treatment can be completed during a 20 minute office visit. The areas to be injected are first cleansed with isopropyl alcohol. Dr. Davis will then inject sotradecol, an FDA approved sclerosing solution, into the veins you would like eliminated (you can direct her to the veins you wish treated). After, the medical assistant will apply a sterile pressure bandage to each injection site to prevent infection and minimize bruising. These bandages are elastic, eliminate the need for cumbersome ace bandages, and should be taken off before bedtime and not reapplied. Many veins (20+) can be treated in this manner during each visit.
For many years we have been injecting sotradecol. In June 2010 Asclera, a widely used European sclerosing agent, will become available for use in the U.S.
How often do I need to have Sclerotherapy treatments from Dr. Davis?
The number of treatments necessary varies depending on the size and amount of veins you have. Most veins require about three treatments before they fade, although some (often the larger veins) will disappear after just one treatment. Follow-up treatments are usually at three week intervals for retreatment of the same veins. When the veins disappear, they will not come back. Once it is your tendency to develop spider/varicose veins, new veins may appear in the future, for which you can return for further treatment. Treatment of your existing veins does not encourage the formation of new veins. If you have an extensive amount of leg veins, we would be treating you weekly, working in different areas each week, until all areas have been treated for several rounds.
Will my Sclerotherapy treatment from Dr. Davis hurt?
The needle used to inject the sclerosing solution is very thin and rarely causes noticeable pain. You may feel a burning or cramping sensation for a few minutes during your treatment as the medicine passes through your blood vessels. This sensation grows in intensity depending on the size of the vein. Overall, the pain is minimal and dissipates quickly. During your treatment we can give you a “stress ball” to squeeze. Tylenol can be taken prior to your treatment if necessary, or afterwards. We prefer that you avoid aspirin, Advil, Motrin, Naprosyn, or any painkillers other than Tylenol (acetaminophen), since these can cause bruising to occur.
What are the side effects of Sclerotherapy?
The most common and expected side effect of Sclerotherapy is bruising or raised red areas at the injection sites. These usually last just a few days, but bruising along a treated vein can last up to several weeks, depending on the size of the vein. Another side effect of treatment can be brown lines/spots that develop along an injected vein. This takes longer to resolve (generally three to six months), and can be prevented by using SPF 30+ sun block on treated skin daily after your sessions. If brown spots/lines appear, a prescription strength bleaching medication containing hydroquinone can be used to fade them faster or Dr. Davis can perform laser treatment. It would be rare to experience permanent brown lines/spots at an injection site.
Larger veins may become lumpy or hard before fading after several months. Rarely, Dr. Davis can puncture a vein to release a clot if necessary. Matting, new tiny blood vessels that form at injection sites days after a treatment, can appear but these should fade within three to twelve months. Laser treatments can eliminate these if you want them to heal faster.
If ulceration, redness, pain, or swelling occurs around an injection site, you should contact our office to come in for a post-operative visit as soon as possible to start treatment with a topical/oral antibiotic or prescription-strength healing medication. There is no charge for post-operative visits to assess or treat healing from a procedure that Dr. Davis performed. This includes laser treatments to help heal the red/brown areas that can result from sclerotherapy.
Is Sclerotherapy treatment by Dr. Davis safe?
Yes. Sclerotherapy has been used to treat spider veins since the 1930s and was used even earlier for the treatment of varicose veins. Dr. Davis has been performing Sclerotherapy for over 20 years and has vast experience with this procedure and its complications. She has revised her protocol over the years to offer the most up-to-date improvements in technique and after care.
How do I prepare for Sclerotherapy?
We recommend that you wear dark loose pants or a longer dark skirt to your treatment as you will be leaving the office with compression bandages that you will want to hide. Should there be any bleeding, the dark fabric will also be more “forgiving.” Do not use any moisturizers on your legs the day of your appointment. Lotions/creams/oils will prevent the pressure bandages from sticking. We can use various “stripping solutions” to remove these if need be; but we want adherence to be as strong as possible.
There are also certain steps we recommend implementing for a week prior to your procedure. These will help reduce bruising and bleeding both during and after your procedure.
Avoid the following:
- All pain relievers except Tylenol: avoid Aleve, Aspirin, Ibuprofen, and even low dose baby aspirin (unless recommended by your physician).
- Vitamin E and all multi vitamins containing Vitamin E. Foods high in Vitamin E should also be avoided such as: sunflower seeds, dry roasted almonds, olives, papaya, spinach, arugula, broccoli, blueberries.
- Cinnamon and horseradish
- Herbal remedies such as St. John’s Wort, Ginkgo Biloba, Ginger Root, Fish Oil, etc.
- Alcoholic beverages (optional)
Take the following:
We recommend that you purchase Arnica tablets, which can be bought at Metro Drugs, Whole Foods or other health food and vitamin stores. Follow the instructions on the package; you can start as early as a few days before your procedure. We suggest that you take them at least the day before and the day of the treatment. You may also want to take them after. Do not purchase Arnica gel, which is not nearly as effective.
An alternative supplement to minimize bruising after the treatment is Bromelain (Pineapple extract). You can take 500mg twice a day for 3 days following a procedure. You should begin taking Bromelain the day of your treatment, after the procedure has been completed. Bromelain can be taken in addition to or instead of Arnica tablets, though Bromelain should not be taken before the treatment, only after.
What activities are allowed after my Sclerotherapy treatment from Dr. Davis?
On the evening after the procedure, you may engage in light exercise such as walking or swimming, which does not cause excessive strain or heavy sweating. However, it is important to avoid any work-outs which involve jumping, pounding, or lifting activities (aerobics, bicycling, running or weight training) for 48 hours. These activities may induce bruising, swelling, and discomfort in the legs. It is also advisable to avoid saunas, “steam rooms,” massages, jacuzzi and bath tubs in the first 48 hours, as these may also encourage infection. The following day, you may wash as you normally would with soap and water; but do not scrub the injection sites with a loofa or wash cloth. Band-aids should not be reapplied. Sun avoidance is recommended after your treatment since the sun can cause pigmentation of the treated area(s). Although this can be treated it is best to avoid strong sunlight if possible. If you will be exposing your legs to sunlight, applying SPF 30 or higher sun block is advised. A waterproof product is recommended if you will be sweating or swimming.