Faisal Siddiqi, MD

It’s not uncommon to see practitioners from various backgrounds doing vein procedures including spider veins. However, it’s imperative to make sure they have the proper experience.  For sclerotherapy, this also holds true.  Despite the ease of the procedure, one should make sure that the practitioner is using standard medications in the appropriate concentrations.  Additionally, they must have the proper equipment for any untoward events despite the rarity. The best choice generally is a reputable vein clinic that focuses primarily on veins as opposed to making it a small part of their practice.   Good luck and hope this helps!

Without knowing some of the finer details of your procedure, there are some situations where discomfort can linger after sclerotherapy.  Some of the important details to know are whether the pain extends to areas outside of where you received injections?  Did the session entail any foam sclerotherapy? Additional things to note are any areas of redness, tenderness , or swelling in the leg (whole vs specific areas) by physical examination. I encourage my patients to reach out directly to me with any concerns and come in for a quick visit so I can get a visual on the problem.   In most circumstances, there are easy solutions to help with areas of local phlebitis (inflammation of the vein).  I would encourage you to schedule your follow up with the treating clinic and be seen (if you have not done so already).   Ideally, any issues that are leading to slower healing and cosmetic improvements can be addressed. Thanks!

Thank you for this all too common question.  Looking at the pictures and from what you describe, there are some common explanations behind the appearance of the legs.  I suspect any of the commonly used techniques (venaseal, clarivein or ablation) will have dramatic results.   Importantly, the veins that are treated in this manner are unlikely to recur.  However, that does not mean other veins (which are generally less often to do so) cannot become an issue in the future.   These tend also to be very treatable and allowing vein disease to go unchecked can be worse depending on your symptoms.   In making a decision on treatment, I would focus on whether or not the symptoms are causing you enough bother to seek treatment.  If so, you should expect to be quite pleased with the results. 

A common scenario is when underlying vein disease gets worse during pregnancy.  Cosmetic veins typically during and after pregnancy show up on the lateral thighs.  In the case, you describe, I suspect a little more investigation will show an underlying cause such as venous insuffiency.  This is easy to identify in a single visit and readily treatable. If the pain persists, I would recommend seeing a board certified vein specialist.

I would feel reassured knowing that sclerotherapy has a continued improvement over a period of 4-6 weeks. Early on, it can appear worse than when you started.  With time, the treated area will gradually fade.  It is important to follow up with your doctor on the recommended schedule and see how the skin and vein are responding.  Also, it is wise to wear the compressions as guided and avoid heavy sun exposure during the healing phase.  

Its nice to see a positive review like this.  You and your doctor are on the right track and I appreciate you also understanding that treating cosmetic veins is not an overnight result, but rather a continued effort.  Stay well! Thank you for sharing!   

I am hopeful with a little extra time you may see this treatment had better effect than you initially expected, however in the event it does not, then the reasons are simple: There is feeder vein just below the surface that has not been treated.  These can be identified with ultrasound or special veinlites that we utilize in our clinics.  Once identified, the correct treatment often involves consideration of foam sclerotherapy as opposed to higher concentrations of liquid sclerotherapy.

Unfortunately, staining from sclerotherapy is not uncommon.  Several things may be done to minimize the occurrence.  First, it is important to be mindful of wearing compression stockings after treatment. Ideally, these are worn for 1 week post sclerotherapy.  The next thing is to be aware that lower concentration of sclerotherapy and lower volume are associated with better cosmetic results in the long run.  So, I am quite okay with leftover medication (it doesn't serve my patient's interest that I empty out all the syringes).   It is better to work up to the effective concentration then start high with the hope that one treatment will suffice.  In the event, results are less than expected, we can always increase the concentration the following session.  In our experience, this has led to much less incidence of hemosiderin staining, though not entirely avoided.  Finally, it is important that you visit a vein specialist who is able to search for venous insufficency and possibly explain spider and varicose veins before jumping to cosmetic sessions. If there is underlying venous insuffiency, then treating the source first (larger to then smaller veins) is definitely associated with less incidence of staining.  Hope that helps!