Article by Lorrie Klein, MD
Laguna Niguel Dermatologic Surgeon
Sclerotherapy consists of injecting solutions into veins, causing them to disappear. In our office we use both Asclera (polidocanol) and hypertonic saline (HTS). Asclera has been safely used in Europe for over 50 years and was approved in the U.S. in 2010, The advantages of Asclera over HTS are:
1. Asclera is nearly painless. While HTS works well and we have been using it successfully for over 20 years, it does sting and burn when injected. Other than the minor prick from the needle, Asclera doesn’t hurt.
2. Asclera treats reticular and varicose veins more successfully than HTS. Reticular veins are the blue veins that do not bulge but are larger than spider veins. Varicose veins are the largest type of veins that bulge (stick out) when standing. We treat spider and reticular veins with Asclera. Due to a higher risk of side effects, we do not usually treat varicose veins in our office.
Dr. Klein is an expert in sclerotherapy, performing this treatment since 1989. She is one of the top physicians performing this treatment in Orange County, attracting patients from all over Southern California. Although Dr. Klein is an expert in lasers, she uses sclerotherapy for leg vein treatment, as it is still considered the “Gold Standard” in leg vein therapy. No laser has yet been developed that works as well.
How does sclerotherapy work? Sclerotherapy works by drying out the tiny cells which line the blood vessels. This damages these unnecessary vessels, causing them to close up and then be absorbed naturally by your body.
Length of treatment: Each area requires several treatments to disappear. Treatments are scheduled two to four weeks apart. Veins fade gradually and usually require two or more visits. The average number of visits is 3-6, but patients with numerous veins or veins that have been present for many years may require more sessions. As this is a gradual process, you must be patient! But while these veins have taken years to develop, removing them takes only weeks or months.
Types of appointments available: Dr. Klein can perform up to 80-100 injections during a 15 minute session. This is considered a “Full Session.” Your first treatment is always scheduled as a Full Session. On subsequent visits, when few veins are present or when veins are almost gone, a “Half Session” may be scheduled.
What to expect and potential side effects:
1. HTS only: stinging and some discomfort are felt for several minutes after each injection.
2. Bruising is commonly seen after treatment. This may last for one to two weeks.
3. Occasionally swelling of legs, more common if standing for long periods of time within 1-2 days after treatment.
4. Occasionally a brown, freckle-like spot can occur at an injection site. This usually fades within several months. With Dr. Klein’s technique, this almost never occurs in our office.
5. Sometimes a superficial (close to the surface) clot can develop in a treated blood vessel. These are not dangerous and if removed in our office within two weeks will heal faster.
6. Superficial thrombophlebitis occurs in less than 1000 patients. This is an irritation of the blood vessels close to the surface of the skin. It is usually treated with bed rest and anti-inflammatory agents. A deep vein thrombosis is extremely rare but can be dangerous. Luckily this almost never occurs with sclerotherapy of spider veins.
7. An ulceration can rarely occur at the injection site. This heals with a scar. This is very dependent on the expertise of the person treating you. Dr. Klein, as of this writing, has never had a patient develop an ulceration.
8. Asclera only: a very rare risk of anaphylaxis (a severe allergic reaction similar to what could happen if you were allergic to bee stings or an antibiotic.) Usually only seen when larger volumes were used, as in the treatment of multiple varicose veins. In a recent study of 6444 treatment sessions, no anaphylactic reactions were reported.
Preparation for your appointment: It is very important that you not wear moisturizers on your legs on the day of your treatment. You may want to wear loose pants or a long skirt. You can wear shorts, during the treatment if you desire.
Aftercare and Prevention: During the first 48 hours after treatment prolonged periods of standing, and high impact or strenuous exercise should be avoided. Walking is allowed and recommended. Cotton balls taped to the areas can be removed after three hours. If larger veins are treated, support hose worn all day for one week after treatment is recommended. Sclerotherapy does not prevent future veins from forming. Support hose may help prevent new veins.