These are my results after 8 sessions with Asclera. I had EVLT in December of 2015. Treatments are making veins worse. Help?

I had EVLT in my right and left legs in December 2015. Veins stripped in my right leg (calf). After spending $2100 on 8 sclerotherapy treatments my results are awful. My veins got worse following the EVLT and with every sclerotherapy session more spider veins appear. I am 35 years old and embarrassed to show my legs. I workout 4 times and week and eat very clean. I had the surgery done by a board certified vascular surgeon and he doesn't even know why the treatments aren't working. Please help?

Doctor Answers 7


Generally when a patient complains that they are developing more spider veins even after treatment there is an underlying vein issue that needs to be addressed. An ultrasound will reveal whether there is reflux occurring in your superficial veins and deep veins which can be the root cause of these spider veins. Before spending on anymore treatments please get an ultrasound done. A doctor will then be able to map out the origin of this problem. 

Asclera vs. lasers for spider veins

Your condition is often a frustrating one being that there may be more than one factor that is lending to a lack of improvement or sustainable improvement.  As the other panel members mentioned, having a current diagnostic ultrasound to assess for any contributing factors with your vasculature will be a good start before investing in more treatments.  If there are no underlying concerns, you  may want to consider laser treatments vs. sclerotherapy.  In our practice, the Lyra (a long pulsed YAG laser) is a good option when Asclera is not or in conjunction with sclerotherapy.  Both are good tools; however, when one is not ideal, it's prudent to consider a different treatment plan before too much time and expense is involved.  

See below link for before/after photos and more information

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Foam sclerotherapy works amazingly well

You need to reevaluate your veins with ultrasound. I continue to see excellent results with both EVLT and foam sclerotherapy. 


Dr. Karamanoukian

Los Angeles vein expert

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Sorry, but you need a dedicated ultrasound

I'm so sorry to hear that you havent gotten the desired results.  In fact, many patients complain of the same issue.  In my experience, the lack of improvement is due to persistent reflux in either the major veins (ie. GSV, SSV) or in untreated tributaries/perforators.  You should seek out a very experience dr who has specific expertise in vein disease.  In my office, I personally perform all the ultrasounds to ensure that it is done correctly and to really investigate the cause of the varicose veins/spider veins.  Hopefully, you will find relief and satisfaction.

Aaron Shiloh, MD
Philadelphia Physician
5.0 out of 5 stars 5 reviews

Spider veins not responding to Asclera

If your spider veins are not responding to Asclera you have options you can discuss with a physician including:
  1. Trying a different sclerosing agent 
  2. Laser treatment 
  3. Repeat ultrasound to check for continued reflux of larger veins

If you are getting matting (new fine red vessels) from the sclerotherapy sessions then definitely consider laser treatments.  Get an opinion from someone that focuses on sclerotherapy first. 
Dr. Norcom

Derek Norcom, MD
Portland Physician
4.9 out of 5 stars 13 reviews

EVLT results

I am so sorry to hear about your experience.  I would recommend further evaluation for other contributing causes.

Jose Almeida, MD, FACS
Miami Vascular Surgeon

Other consideration

often times when one has closed their great saphenous vein by a heat method and is not having satisfactory results will follow up sclerotherapy; it is wise to consider if other branch veins may be contributing. Depending on the location of the problem area the anterior accessory saphenous vein or the small saphenous vein may be contributing. additionally the great saphenous can remain open despite treatment in up to 8% of patients and that should be checked in such a situation.   Lastly sclerotherapy can fail to treat large varicosities and surgical adjuvants may be necessary.

Jordan Knepper, MD
Ann Arbor Vascular Surgeon

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.