| Spider Veins / Sclerotherapy |
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| By David F. Jaffe
M.D. |
Diminishing
unsightly 'spider veins'
Millions 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 dermatologists 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.
If you're considering
sclerotherapy to improve the appearance of your legs, this web page will give
you a basic understanding of the procedure - when it can help, how it's
performed and what results you can expect. It won't answer all of your
questions, since a lot depends on your individual circumstances. Please ask Dr.
Jaffe or his associates if there is anything about the procedure you don't
understand.
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.
Spider veins on the
leg usually appear in one of three patterns: (a) simple linear (b) arborizing,
which appear branch-like, and (c) spider, which appear as a cartwheel shape with
a dark center point.
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 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, Dr. Jaffe may advise you 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 Dr. Jaffe.
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.
Before
treatment, spider veins are quite noticeable, contrasting sharply with the
surrounding skin.
Planning your treatment
During your initial
consultation, your legs will be examined. Dr. Jaffe 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.
If such problems are identified, Dr. Jaffe 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.
Our office staff 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 Dr. Jaffe and his
staff 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, sunblock 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 Dr. Jaffe's Havre de
Grace office, an outpatient setting.
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, Dr. Jaffe or his assistant 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 chat with
Dr. Jaffe and his assistant. 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 pain is usually minimal.
The skin is held taut while the injection of sclerosing solution is
administered under bright light and magnification.
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.
A cotton ball and compression tape are applied to each treated
area. Elastic bandages or stockings may be used to help further the action of
the injected medication.
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 be aware 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.
One month after the first treatment, spider veins are
distinctly lighter, yet still somewhat visible.
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 long skirts and slacks
to hide your spider veins, you'll now be 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 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.
After two or
more treatments, the leg appears noticeably clearer and more attractive.
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