SPIDER VEIN TREATMENT
Millions of women are bothered by spider veins — those
small yet unsightly clusters of red, blue or purple veins that most commonly appear on the thighs, calves and
ankles. In fact, it's estimated that at least half of the adult female population is plagued with this common
cosmetic problem.
Today, many plastic surgeons are treating spider veins with sclerotherapy. In this rather
simple procedure, veins are injected with a sclerosing solution, which causes them to collapse and fade from
view. The procedure may also remedy the bothersome symptoms associated with spider veins, including
aching, burning, swelling and night cramps.
Although this procedure has been used in Europe for more than 50
years, it has only become popular in the United States during the past decade. The introduction of sclerosing
agents that are mild enough to be used in small veins has made sclerotherapy predictable and relatively
painless.
What are spider veins?
Spider veins — known in the medical world as telangiectasias or sunburst varicosities — are
small, thin veins that lie close to the surface of the skin. Although these super-fine veins are
connected with the larger venous system, they are not an essential part of it.
A number of factors contribute to the development of spider veins, including
heredity, pregnancy and other events that cause hormonal shifts, weight gain, occupations or activities
that require prolonged sitting or standing, and the use of certain medications. Spider veins usually take on one of three basic
patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central
point; they may be arborizing and will resemble tiny
branch-like shapes; or they may be simple linear and appear as thin separate lines. Linear spider veins are
commonly seen on the inner knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or
cartwheel distribution.
Varicose veins differ from spider veins in a number of
ways. Varicose veins are larger — usually more than a quarter-inch in diameter, darker in color and tend to
bulge. Varicose veins are also more likely to cause pain and be related to more serious vein disorders. For some
patients, sclerotherapy can be used to treat varicose veins. However, often surgical treatment is necessary for
this condition.
The best candidates for sclerotherapy.
Women of any age may be good candidates for
sclerotherapy, but most fall in the 30-to-60 year old category. In some women, spider veins may become noticeable very
early on — in the teen years. For others, the veins may not become obvious until they reach their 40s.
If you are pregnant or breastfeeding, you may be advised to postpone sclerotherapy treatment. In most cases, spider
veins that surface during pregnancy will disappear on their own within three months after the baby is born. Also,
because it's not known how sclerosing solutions may affect breast milk, nursing mothers are usually advised to wait
until after they have stopped breastfeeding.
Spider veins in men aren't nearly as common as they
are in women. Men who do have spider veins often don't consider them to be a cosmetic problem because the veins
are usually concealed by hair growth on the leg. However, sclerotherapy is just as effective for men who
seek treatment.
What to expect from sclerotherapy Sclerotherapy can enhance your appearance and your
self-confidence, but it's unrealistic to believe that every affected vein will disappear completely as a result of
treatment. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required
to achieve optimal results.
You should also be aware that the procedure
treats only those veins that are currently
visible; it does nothing to permanently alter the venous system or prevent new veins from
surfacing in the future. Before you decide to have sclerotherapy, think carefully about your expectations and
discuss them with your doctor.
Risks related to treatment. Serious medical complications from sclerotherapy are
extremely rare when the procedure is performed by a qualified practitioner. However, they may occur. Risks
include the formation of blood clots in the veins, severe inflammation, adverse allergic reactions to the sclerosing
solution and skin injury that could leave a small but
permanent scar.
A common cosmetic complication is pigmentation
irregularity — brownish splotches on the affected skin that may take months to fade, sometimes up to a year.
Another problem that can occur is "telangiectatic matting," in which fine reddish blood vessels appear
around the treated area, requiring further injections. You can reduce the risks associated with treatment by
choosing a doctor who has adequate training in sclerotherapy and is well versed in the different types of
sclerosing agents available. A qualified doctor can help you select which type of sclerosing medication is most
appropriate for your needs.
Planning your treatment.
During your initial consultation, your legs will be
examined. Your doctor may draw a simple sketch of your legs, mapping out the areas affected by spider veins
or other problems. During the examination, you will be checked for signs of more serious "deep vein" problems,
often indicated by swelling, sores, or skin changes at the ankle. A hand-held Doppler ultrasound device is
sometimes used to detect any backflow within the
venous system. If such problems are identified, your surgeon may refer you to a different specialist for further evaluation.
Problems with the larger veins must be treated first, or
sclerotherapy of the surface veins will be unsuccessful.
Your doctor will ask you about any other problems
you may have with your legs, such as pain, aching, itching or tenderness. You will also be asked about your
medical history, medications you take, or conditions that would preclude you from having treatment. Individuals
with hepatitis, AIDS or other blood-borne diseases may not be candidates for sclerotherapy. Patients with
circulatory problems, heart conditions, or diabetes may also be advised against treatment.
It's important to be open in discussing your history and treatment goals with your doctor. Don't hesitate to
ask any questions or express any concerns you may have. Your doctor should explain the procedure in
detail, along with its risks and benefits, the recovery period and the costs. (Medical insurance usually doesn't
cover cosmetic procedures.)
Preparing for the procedure.
You will receive specific instructions from your physician on how to prepare for
your treatment. Carefully following these instructions will help the procedure go
more smoothly. You'll be instructed not to apply any type of moisturizer, sun block
or oil to your legs
on the day of your procedure. You may want to bring shorts to wear during the injections,
as well as your physician-prescribed support hose, and slacks to wear
home. When scheduling your procedure, keep in mind that your legs may be bruised or slightly discolored for some
weeks afterward. You probably won't be comfortable wearing shorts, a swimsuit or a mini skirt until after your
legs have cleared up a bit.
Where your treatment will be performed. Sclerotherapy of spider veins is a relatively simple procedure that requires no anesthesia, so it will be performed in an outpatient setting, most likely your doctor's office.
The procedure. A typical sclerotherapy session is relatively quick, lasting only about 15 to 45 minutes. After changing into shorts your legs may be photographed for your medical records. You will be asked to lie down on the examination table and the skin over your spider veins will be cleaned with an antiseptic solution. Using one hand to stretch the skin taut, your doctor or nurse will begin injecting the sclerosing agent into the affected veins. Bright, indirect light and magnification help ensure that the process is completed with maximum precision.
Approximately one injection is administered for every inch of spider vein — anywhere from five to 40 injections per treatment session. A cotton ball and compression tape is applied to each area of the leg as it is finished.
During the procedure, you may listen to music, read, or just talk to your practitioner. You will be asked to shift
positions a few times during the process. As the procedure continues, you will feel small needle sticks and
possibly a mild burning sensation. However, the needle used is so thin and the sclerosing solution is so mild that
I pain is usually minimal.
After your treatment.
In addition to the compression tape applied during the
procedure, tight-fitting support hose may be prescribed to guard against blood clots and to promote healing. The
tape and cotton balls can be removed after 48 hours. However, you may be instructed to wear the support
hose for 72 hours or more.
It's not uncommon to experience some cramping in the legs for the first day or two
after the injections. This temporary problem usually doesn't require medication.
You should beware that your treated veins will look worse before they begin to
look better. When the compression dressings are removed, you will notice bruising and
reddish areas at the injection sites. The bruises will diminish within one month. In many cases,
there may be some residual brownish pigmentation which may take up to a year to completely fade.
Getting back to normal. Although you probably won't want to wear any
leg baring fashions for about two weeks, your activity will not be significantly limited in any other way from
sclerotherapy treatment. You will be encouraged to walk to prevent clots from forming in the deep veins of the legs. However, during the
period of time to complete your treatment program, prolonged sitting and standing should be avoided, as
should squatting, heavy weight lifting and "pounding"
type exercises, including jogging. A one-month healing interval must pass before you
may have your second series of injections in the same site. After each treatment, you will notice further improvement
of your legs' appearance.
Your new look. Most patients are pleased with the difference sclerotherapy makes. The skin of your legs will appear younger, clearer and more healthy-looking. If you've been wearing skirts and slacks to hide your spider veins, you'll now able to broaden your fashion horizons. Often, patients are surprised at the dramatic difference in appearance between a treated leg and an untreated one.
Although sclerotherapy will obliterate the
noticeable veins for good, it's important to remember that treatment will not prevent new spider veins from emerging in
the future. As time passes, you may find that you will need "touch-ups" or full treatments for new veins that surface.
But even if you choose not to have further sclerotherapy, your legs will look better than if you never had
treatment
at all.