Should my legs look like this 11 weeks after Sclerotherapy? (photo)

Question

I had sclerotherapy on February 3rd, it is now April 20 and my legs still look like this. I went for 2 follow-up apppointments, first after two weeks which I was told to wait to see if the trapped blood would clear on its own, the second appointment three weeks after that they drained the areas and did a second treatment of sclerptherapy around the discolored areas. I'm not sure if what I am seeing now is normal or if more treatments are necessary? Thank you in advance for any information.

Payman Kosari, MD, FAAD · Answer

This is either coagulum trapped in vessels and/or some possible hyperpigmentation.  Luckily these are transient findings and should resolve.  If coagulum, I usually express this content approximately two weeks after the procedure.  I laser can be used to treat the hyperpigmentation, although this can resolve with time alon

Andres Zavala, DO · Answer

Sclerotherapy is considered the gold standard in the treatment of spider and reticular veins but there are common side effects to consider.  Your pictures seem to show evidence of trapped blood and some hyperpigmentation (skin discoloration) which can occur with various sclerosant solutions.  Without seeing your legs in person it is difficult to tell whether draining additional trapped blood or simply waiting is the best approach.  Having said that, discoloration generally resolves on its own but it can take months or even a year in some cases.  Avoid sun exposure to prevent the discoloration from becoming permanent and see your treating physician to determine if you need additional treatment.

Nelson Lee Novick, MD · Answer

Sclerotherapy remains the treatment of choice for small lower extremity spider veins and "broken blood vessels."  In a recent October 2016 article on the subject in Practical Dermatology, regarding sclerotherapy, the author wrote  "For lower extremity telangiectasias and reticular veins, percutaneous lasers and non-coherent light, heavily financed and promoted by commercial interests, are often the driving force behind lectures at prestigious meetings and lengthy peer-reviewed articles. These modalities are less effective, more costly, and a great deal more painful than sclerotherapy, which is still the gold standard for treatment of small lower extremity veins."  Nevertheless, this does not mean that it is without its potential complications. Detergent sclerosants, such as polidocanol, and osmotic agents, such as hypertonic saline have been associated with post-treatment pigmentary problems--the latter with marked post-treatment hemosiderin (blood product) staining, which can be quite cosmetically unacceptable, and the former with postsclerotherapy hyperpigmentation in upwards of one-third of patients. Although not approved in the U.S., the least problematic vis-a-vis post treatment pigmentation is the chemical irritant sclerosant chromated glycerin, which has lately garnered increased interest. For spider and reticular veins, it appears to more effective than polidocanol, with fewer adverse reactions. Happily most hyperpigmentation will resolve over time, although this may take many months. Without clearer photos and more history, the best advice would be to return to your treating physician.to discuss measures for speeding the process of fading, if possible. Best of luck.

Hratch Karamanoukian, MD, FACS · Answer

You need to use some adjunctive measures after sclerotherapy to reduce post inflammatory hyperpigmentation. it is those that don't follow such instructions immediately following sclerotherapy, starting on day1 (next day) that seem to get retained hyperpigmentation. I recommend 2 creams: Scleroquin plus and Sclerovase and also Scler-X supplement to reduce post inflammatory hyperpigmentation (see link below) as well as compression stockings for at least 2 weeks.
H Karamanoukian MD FCS
certified vein specialist from ABVLM and double board certified surgeon

Michael Nguyen, MD · Answer

It could take up to 2 months or more to see full results after
sclerotherapy. However, if sclerotherapy is not giving you the results you are
looking for, consider a full venous reflux evaluation with a vein specialist
including ultrasound to scan your legs to determine if venous reflux is
present. Healthy leg veins contain valves that open and close to
help the blood return back to the heart. Venous reflux disease develops when
the valves that keep blood flowing out of the legs and back to the heart no
longer function, causing to pool in the legs and leading to signs and symptoms
like dilated veins that you can see close to the skin in your legs among other
symptoms you may or may not present. Your vein specialist can help
you make informed health care decision on the best treatment for you according
to the ultrasound results and according to your specific goals. If reflux is
present, you might need more than sclerotherapy and you can discuss this with your
physician about the type of treatment or combination of treatments right for you. 
All the best,

Should my legs look like this 11 weeks after Sclerotherapy? (photo)

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Should my legs look like this 11 weeks after Sclerotherapy? (photo)

Answers (8)

Answer: How should my legs look like after sclerotherapy?

Answer: How should my legs look like after sclerotherapy?

Answer: 11 weeks post sclerotherapy

Answer: 11 weeks post sclerotherapy

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Everything you need to know about Sclerotherapy

Our mission is to create a world where every investment in modern beauty is Worth It.