Bay Area Sclerotherapy doctors
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Robert Swanson, MD
Bay Area General Surgeon
350 Bon Air Road suite 300, Greenbrae |
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Steven H. Williams, MD
San Francisco Plastic Surgeon
4000 Dublin Blvd Suite 300, Dublin |
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1 answer |
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Donald M. Brown, MD
San Francisco Plastic Surgeon
2100 Webster Street Suite 429, San Francisco |
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Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
450 Sutter Street Suite 2433, San Francisco |
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Larry Fan, MD
San Francisco Plastic Surgeon
77 Van Ness Avenue Suite 302, San Francisco |
Recent Answers
I am scheduled to have sclerotherapy on the spider veins in my legs. A nurse practitioner for a plastic surgeon is doing the procedure. She said she would need to treat the "main" veins feeding the spider veins. I have seen nothing in the literature noting the need for this. Is this accurate? I don't want unneccesary or dangerous work done. I thought just the spider veins would be treated (?). Can you advise? Thanks!
She is right that you should have the reticular veins that drive the spider veins treated. Without doing that, the spider veins are likely to recur. The spider veins are in the skin, the reticular veins are under the skin. The reticular veins are not, however the "main veins". These have names like greater, lesser saphenous or perforating veins. When the treatment involves these veins, things can start to get dangerous. The danger comes from blocking off major outflow veins or from producing thrombosis in the deep venous system (DVT or Deep Venous Thrombosis).
A sclerotheraputic agent that will not cause these larger veins to thrombose is a real advantage. Polidochanol is such an agent.
So it really does depend on what "main veins" means.I hope this helps.
The most common complication of spider vein treatment is that the legs look worse before they look better. There can be bruising, scabs, and discoloration. All of these go away in a relatively short period of time.
The next complication of spider vein treatment is that the treatment may not work. the usual cause of failure of therapy is that the doctor does not treat the underlying problem. Spider veins are dilated veins in the skin. In the legs they are caused by abnormal pressure relationships - usually malfunctioning venous valves in the larger veins up stream from the visible spiders. The next level of veins are called reticular veins. If they are not treated, there will almost certainly be either a recurrence or the development of another complication called telangectatic matting - a diffuse red discoloration caused be vessels too small to inject. With proper visualization these feeding reticular veins can be satisfactorily obliterated, thus preventing recurrence and matting.
The worst complication is post treatment hyperpigmentation. This can be caused by blood that is trapped in the skin and leaves a pigment behind as it decomposes or by a darkening of the skin cause by minor injury to the skin in a process called post inflammatory hyperpigmentation. The first can occur in anyone and may or may not go away - it usually does. The second is more common in people with darker skin.
There is always the possibility of temporary bruising, and depending on the agent used in sclerotherapy or the laser used there is the chance of skin necrosis - death of a small patch of skin. Since I stopped using lasers and started using polidochanol for reticular veins I have not seen skin necrosis.
In the last 20 + years I have seen only 3 infections that required antibiotics.
That's the list of complications. With careful attention to technique these can be kept to a minimum and the treatments can be very effective.
I had an ultrasound and doplar study done that showed blockage in my greater saphenous vein from my groin to mid-calf. An interventional Radiologist will perform ELT on that leg.
I'd also like sclerotherapy on my other leg (and on the ELT leg after the healing is complete.) This will be performed by the same MD, the interventional radiologist, who works exclusively in the vein clinic.
Is this advisable or is it recommended that the sclerotherapy be done by a dermatologist or plastic surgeon? Which would mean going to a different clinic?
It sounds like you have significant venous disease. Not that it is dangerous, but it is more than a cosmetic issue. This requires the attention of a doctor who understands the pathophysiology of the venous system. That means either a phlebologist, vascular surgeon or a well versed interventional radiologist. It sounds like you have found a doctor that understands your problem. Stick with him/her.
