Injection Sclerotherapy

Spider Veins, known medically as telangiectasia, are dilated skin capillaries and are frequently an inherited tendency.  While they may be red (arterial capillaries) or blue (venous capillaries), most people have both types.  The micro-injection technique consist of instilling a solution into these tiny capillaries using needles so small that surgical magnifying glasses are required.  This irritates  the inner lining of the capillaries so they cease to carry blood and the body slowly replaces them with scar tissue.  under the skin that you can not see.  This procedure does not harm circulation.  Several injections may be needed for a specific area of telangiectasia.  The rare pure venous type are more difficult to abolish.  Some brown discoloration may appear after injection which gradually fades, but a small amount may be permanent.  The goal is to produce about 75-80% improvement.  Pain during injections is reported by patients as very slight.  Most patients describe mild stinging and itching of the areas treated.  Some also report muscle cramping.  Fading of the spider veins is a slow process and maximum improvement may require many months.

Charges relate to the amount of time spent by the doctor and the amount of medication required.  Actual injection is done only by Dr. Smith rather than a nurse or assistant.  The average cost per session is $250.  The average person requires 3 - 6 sessions for maximum improvement.  Payment is required at the time of treatment.

Appointments are required in advance and office staff must be informed when scheduling the appointment that you desire spider vein injections.  This is necessary because extra time is allowed so that Dr. Smith will have adequate time to treat you.

Results of treatment cannot be guaranteed, but most patients are very pleased with the cosmetic improvement.

Most Frequently Asked Questions:

  1. What do you use?
    A concentrated saline solution (salt and water), AET Aethoxysklerol (Hydroxypolethoxy), Sclerodex (salt, sugar and water), or Fibrovein (a sulfur compound).  Dr. Smith will determine which solution is best for you.
  2. How does it work?
    The solution works by drying out the tiny cells which line the blood vessels.  The blood can no longer flow through these irritated vessels and the vessels die.  The body replaces the dead vessels with scar tissue that you can not see under the skin.
  3. What are the side effects?
    A. Bruising.  These bruises can last for several weeks.
    B. Slight blistering.  When small amounts of solution seep into the skin, it may blister.  This blistering heals quickly but can leave a hyperpigmented spot (brown freckle-like).  These spots can be appropriately treated with bleaching agents or Photoderm ( a medical device similar to a laser).
    C. Swelling.  This swelling is never dangerous, but occasionally must be treated with elevation and compression dressings.
    D. Brown discoloration. Some discoloration may be left on the skin after the vessels fade.  This can persist for several months to 2 years but is never permanent.  This is thought to be caused from iron in the blood.  It can be removed more quickly by using methods described above in (B).
    E. Blood clot. This is very rare but is a possibility.  Usually the treatment for this is surgical removal of the clot.
    F. Superfical thrombophlebitis. This is an irritation of the vessels closest to the skin.  It sometimes must be treated with anti-inflammatory agents and bed rest.  This probably occurs in less than 1 case per 1000.
  4. How soon will the vessels disappear?
    Each vessel will require 2-3 injections.  Usually the vessels disappear over a period of two weeks to two months.  Recurrences can occur over a period of one to five years.  This treatment does not prevent new telangiectasia from occurring.
  5. How long has this procedure been in existence?
    This procedure has been performed since the 1930's.  Dr. Smith started doing sclerotherapy in the early 1980's.
  6. I understand that injections don't always work.  Are there other methods?
    A. Photoderm - a pulsed light therapy similar to a laser.  Dr. Smith also performs this procedure and is sometimes done in combination with the injections.
    B. Electrodesiccation - a small electric current is applied to the vessels using tiny needles.
    C. Surgical ligation or stipping.
  7. How much does it cost?
    The cost is related to the amount of time spent and the amount of medication injected.  It varies from $100 - 200 per session.  The longer the session the greater the cost.
  8. Will my insurance pay for this procedure?
    This procedure is generally not covered by insurance.  It is considered a cosmetic or elective procedure.  We do not file insurance for sclerotherapy.  Payment for this procedure is required at the time of service.
  9. Why do spider veins exist?
    It is not known for sure what causes spider veins.  We think that some families are predisposed to get these.  There are also other factors such as female hormones, pregnancy, sudden changes in weight, standing or sitting for prolonged periods of time, and trauma such as falls or blows.
  10. Are there ways to prevent them?
    Some authorities feel the use of support hose is helpful.  Reducing your weight and regular exercise also seem to help.
  11. Are there special instructions after the procedure?
    The major concern after the procedure has to do with bleeding.  Sometimes pressure dressings should be worn until bedtime.  Strenuous physical activity or prolonged periods of standing should be avoided for the first 24 hours.  Support hose are recommended during the first 48 hours.  Hot showers or baths should be avoided for 24 hours.  Exposure to the sun or tanning beds should be avoided for 2 weeks after a treatment.
  12. How often can I be treated?
    It is preferred to wait 4 weeks between sessions.
  13. How often does it have to be done?
    It varies with the severity of the spider veins as well as response to each injection.  It usually takes 2 - 3 injections to obliterate any vessel.  The average person will require 3 - 6 sessions; very severe cases may require 6 or more sessions.
  14. How should I dress for the procedure?
    It is advisable to wear shorts or a loose skirt during a treatment.  Please wear something that you will not mind getting stained because the spider veins usually bleed.
  15. Are there certain kinds of spider veins that can't be treated?
    Generally speaking, the larger the vessel the more difficult it is to eradicate.  The blue / green vessels, which are very small varicose veins, can also be treated but will require frequent treatments.  Some vessels are smaller than the needle we use to inject with, these vessels respond better with Photoderm (pulsed light therapy) or electrocautery.

Treatment Tips

  1. Do not use moisturizers on your legs 24 hours before the procedure.
  2. Bring shorts or a loose fitting skirt to wear during the treatment.
  3. Don't wear tight clothing on the day of treatment.  A full skirt or loose fitting pants are ideal.
  4. Circle your worst veins or the veins that bother you most with a ball point pen.
  5. Avoid prolonged sitting or standing, or strenuous exercise for the first 24 hours after a treatment.  During this period try to elevate your legs.
  6. Speed up recovery after 48 hours by walking or exercising while wearing fitted support hosiery.  The best results are often obtained when this hosiery is worn almost continuously for the 48 hours and as much as possible for 3 weeks following treatment.
  7. Avoid hot showers or baths 24 hours after a treatment.  Luke warm showers and baths are allowed.
  8. Avoid sun exposure or visits to the tanning bet for 2 weeks after a treatment.

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