Basic principles, Expectations and Potential Complications of Sclerotherapy

It is important to understand that sclerotherapy is a process. Most patients will need to undergo several treatments to meet their expectations.

If you want all your spider veins to disappear and your legs to look like you were sixteen again, you will be disappointed. If you want your spiders to fade so that they are less visible and unattractive, you most likely will be very satisfied with your decision to be treated.

Serious complications from sclerotherapy are uncommon but can occur

Staining: a brown discoloration (hyperpigmentation) that appears over the injected vein is not uncommon. In over 95% of cases, it will gradually fade on its own. As I tell patients, if your legs are covered with spider veins and they are fading away, it is unlikely you will care about a little bit of brown discoloration. If you are an eighteen-year-old red head with porcelain white skin and have one tiny thread like vein on your leg that temporarily turns brown, I will run for cover until it disappears!

Matting is a proliferation of tiny veins that appear after a spider injection. Matting is uncommon but difficult to treat if it occurs. It does respond to sclerotherapy, laser or a combination of both.

Both matting and occasionally hyperpigmentation can be due to an unrecognized feeding vein that when treated will facilitate resolution.

Matting highlighted by circle

Matting highlighted by circle

Skin ulcers are uncommon with the type and solutions used at AKCVLM. It is more typically a saline complication. The Australian Polidocanol Study demonstrated an ulcer incidence of 1/10,000 treatments with polidocanol, which is what we typically use. That said it could happen. At worse, it may take some “cleaning up” and could result in a light scar.


An example of an ulcer on the upper inner thigh after sclerotherapy

Who should treat you?

Many different types of practitioners treat spider veins from cosmeticians using laser to skilled physicians.

The initial consultation is extremely important. Beware of any practitioner who offers sclerotherapy without spending the time to explain the details, expectations and complications of treatment. Don’t be afraid to ask the person who will be treating you how long they have been doing sclerotherapy, how they were trained and what their credentials are e.g. medical assistant, RN or obviously, physician. It doesn’t hurt to see a diploma on the wall indicating they have undergone advanced training in sclerotherapy either!

Personally, I enjoy sclerotherapy. It is usually a nice break from an otherwise busy schedule and more complicated procedures. Most patients also enjoy the casual conversation that takes place with me and my staff during the session.

Like any medical treatment, do your homework before you make a decision to be treated.

How much will it cost?

Sclerotherapy for spider veins is considered a cosmetic procedure and not paid for by insurance, even if you are symptomatic. Ask how much each session will cost, duration of each treatment, solutions to be used and how frequent you can be treated. Beware of overtreatment. Spider veins take time to absorb and there is no benefit to have the same area treated any more frequently than every six weeks or so.

There are numerous “specials” on the Internet that are meant to entice patients into a vein clinic. There is nothing necessarily wrong with that. However, make sure the enticement is not being used as a “hook” after a brief ultrasound to talk you into more extensive procedures even if covered by insurance with free sclerotherapy offered as an incentive afterwards.

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