How Effective is Sclerotherapy?

I have had Sclerotherapy injections for several years in an attempt to combat the spider veins which are in greatest concentration around my shin and ankle areas.

My physician has told me that there is a limit as to what can be done to eradicate these veins, as they are so tiny and numerous. Is there any hope for me to ever have lower legs and ankles that don't look red and blotchy?

Doctor Answers (15)

Sclerotherapy effectiveness

+5

In general, some patients and areas need more sclerotherapy sessions than others. Its just an individual dependent issue, like any medication the response is different in some people. The only was to really tell, would be a physical exam, but in general, there should not be any issue that cannot be resolved.


New York General Surgeon
5.0 out of 5 stars 4 reviews

There are several choices with sclerotherapy

+2

Sclerotherapy involves the injection of a chemical irritant directly into the small spider veins. These spider veins are completely out of the circulation and do nothing other than look bad. There are two main chemicals that can be used to perform sclerotherapy, hypertonic saline and sodium tetradecyl sulfate. Each has its advantages and disadvantages. In my experience some times one chemical seems to work better than the other. If your veins seem resistant to one it is possible that a test area using another one may be beneficial. Injecting the very small veins of the lower legs can be technically challenging and skill levels can vary from one physician to another. If the veins are too small then it is possible that sclerotherapy is not the best choice for you.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Sclerotherapy is my preference

+2

There has been several scientific studies comparing sclerotherapy to laser for small leg vessels. Sclerotherapy is more effective with fewer treatments. The ankle area is a risky area if the sclerosant is injected outside the vessel becasue necrosis can occur and this area is very slow to heal. Your age, the vessel size, and your medical history are all important in this decision, so please go to someone experienced and comfortable treating this tricky area.

Mary Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 8 reviews

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Sclerotherapy and small blood vessels of the legs and ankles

+2

I agree that the small vessels of the legs and ankles can be resistant to treatment with sclerotherapy. Furthermore, when the vessels are so small, even the best practitioner may have difficulty injecting these vessels.

Vascular lasers are options to consider including the ND:YAG 1064, v-beam (pulsed-dye) and IPl/fotofacial.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 4 reviews

Yes there is more than hope.

+2

Sclerotherapy is very effective. It is important to be aware that several treatments may be needed, and over time you will tend to form more spiders.

That said, it is important also to know that sclerotherapy (injections) has limits- spiders that are too small can't be injected because the needle is too big!

For these, you may want to look into laser or other non-injection treatments.

sek

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

Yes

+2

Sclerotherapy has a very high satisfaction rate as you might judge from its sitting pretty close to the top of the poll on this site.

Your physician is correct as the small vessels can be very difficult to eradicate. The more times sclero is done the harder it is to get rid of the remaining vessels. I thought that was just me until I went to a meeting and that was pretty much the universal feeling of all the participants. The vessels may develop some sort of resistance. Also, logically we try to knock off the larger and more obvious ones first. Finally, there is a matting effect. That means that sometimes when a vessel is successfully destroyed the body grows new ones at its periphery.

It might be time for the 1064 ndYag laser. I feel that injections are the gold standard and that places that only offer laser do so because the physician is not trained to do sclero with injections. Laser is easier, sounds more high tech, and the doctor can charge more. But injections are the gold standards.

The laser is better at "cleaning up" those small, pesky lingering veins and I would recommend it at this point.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
5.0 out of 5 stars 7 reviews

Sclerotherapy is the gold standard.

+1

For the treatment of leg spider and reticular veins, sclerotherapy is the gold standard.  The treatment  of spider veins, however, is a process and spider veins  tend to be a recurring problem so you should think in terms of long term maintenance to control these.  There are other things to also consider which improve the treatment of spider veins.  We now have very small needles (32 and 33 gauge) which can get into small veins and we also have better solutions such as polidocanol which can be used as either liquid or foam.  In addition to this, if your spider veins are recurring soon after treatment, you should consider a venous  reflux exam to look for malfunctioning (refluxing) valves of the saphenous system which may be the cause of the spiders and which can be treated.  You should be evaluated by a vein specialist.

John Landi, MD
Naples General Surgeon
5.0 out of 5 stars 2 reviews

Sclerotherapy is the best treatment for spider veins

+1

I have been injecting leg veins for many years and have been very happy with the results of sclerotherapy.  Sclerotherapy works well but it takes repeated treatments.  After each treatment, the veins will look temporarily worse than before.  It can take several treatments, especially around the ankles to look better.  To maximize the results, it is always best to wear compression stockings for a week after the procedure.  Find a board certified dermatologist with a great deal of experience in these procedures before starting treatment. 

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 27 reviews

Sclerotherapy

+1

For spider veins on the legs, the best treatment would be doing sclerotherapy.  There is an increased risk with treating the veins around the ankles and lower leg.  If the sclerosant is injected outside of the vessel, this may lead to necrosis of the tissue.  

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 136 reviews

Sclerotherapy is effective if done on the proper patinet

+1

Sclerotherapy is very effective if done on the correct patient. Your sclerotherapy doctor should have assessed the deeper veins in your leg to assess for what is termed "venous reflux". If venous reflux is present sclerotherapy may make the veins worse. It is important that your vein doctor have the ability to assess for venous reflux, this requires the ability to perform Ultrasounds of the lower leg in the office. In addition, they should have the skill set to treat the reflux with an ablative laser procedure that can be done in the office. This ability differentiates a physician that dabbles in veins with sclerotheraphy and one that has a true vein practice.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.5 out of 5 stars 15 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.