When should I see results after sclerotherapy?

Thank you for your question. The veins usually turn dark in the 2 weeks after treatment, and will darken when closed. If you press on the vein, and there is blood flow, it is not closed. Typically, a darker vein is a closed vein. I hope this helps!

You
should see results in 30 days. If you continue to have issues, please schedule a follow up with your provider. We usually use 20-30 mmHg compression
hose for our patients.

I have performed sclerotherapy for more than 15 years.  There are a few considerations in achieving good results from this treatment.  I like to use Asclera or polidocanol because it is gentle (unless the solution went outside the vein, then it will burn).  The results are highly dependent on the injector.  So be sure to do your research as who performs the actual treatment and if they have had complications.  Most patients require 2-3 treatment sessions so don't expect the veins to be gone with one treatment.  Thorough treatment will lead to better longer term results (lasting years instead of weeks or months) but results are not permanent since the treatment does not address underlying cause of these veins, mostly genetics.  Darker veins have more blood flow and will bruise more.  The treated veins will look worse because of the bruising, then it will fade over a few weeks or couple months (depending on the extent of bruising), and you will see final results.  So I recommend planning ahead if you have special plans to show off your legs.  Larger veins can get blood trapped in the vein and may form small knots at the area, they are harmless but if it's tender, you should notify the physician.  I always ask patients to show me the areas that they want me to prioritize and I draw an arrow by the area so I make sure those are treated first.  Certain patients skin type are at high risk for postinflammatory pigmentation, including Asian, Hispanic, African-American.  Those patients will likely develop brown discoloration over the treated veins which will take several months or 1-2 years to fade, regardless of treatment method (injection or laser).  So I typically offer those patients a small test treatment to make sure they are comfortable with the extent of discoloration (which will take a long time to fade) prior to doing large treatment areas.  Certain medications can cause pigmentation and should be avoided during sclerotherapy treatments including minocycline, doxycycline.  Compression stockings help to minimize veins from refilling and bring faster and better results. One last but most important factor would be physical inspection of the legs with patient standing to look for bulging varicose veins.  Patients with bulging varicose veins often have underlying blood flow issue with the veins known as venous reflux.  If the venous reflux is not treated, the surface veins treatment with sclerotherapy will be less effective or not work at all.  Seek a qualified vein specialist who treats venous reflux if you have bulging ropy varicose veins.  Treatment of venous reflux are mostly covered by insurance.

Sclerotherapy is a process and I usually recommend 6 weeks between treatments since this is about how long it takes to see the full results of treatment.  It is impossible to get every vein with one treatment and it is not uncommon to require several sessions of sclerotherapy to achieve results. I recommend 20-30 mmHg compression for 48 hours.

If the vein is 'too large', sclerosant solution may have 'washed through' and not been effective. She may not have missed it after all. It may require a second round of sclerotherapy or microphlebectomy. Side effects are hyperpigmentation which fades away eventually and this is something we dwell on when we get consent from all patients prior to sclerotherapy. It is the natureal process of healing and thromboobliteration of the vein and your body's ability to clear the hemosiderin deposition in the vein and around the vein from leakage of the sclerosant solution and blood. It is imprtant to wear compression stockings for a minimum of 2 weeks and I recommend 3 months to my patients. There are  some creams that you can apply to reduce hyperpigmentation like VenaQuin and VenoLucent, among others. Sclerotherapy is not 100% successful and multiple treatments are required in some patients. Overall, sclerotherapy is performed in > 98% of cases in our offices and in large vein practices for most patients with spider vein, reticular veins and varicose veins. Some patients may need additional topical laser treatments (long pulse Nd YAG or KTP) for spider and reticular complexes. Other side effects of sclerotherapy are phlebitis, thrombophlebitis and very rarely deep vein thrombosis. Bruising always occurs and resolves in most instances. I would return to her and pay for another session of sclerotherapy if it is appropriate for the larger vein that failed therapy. She/he may consider microphlebectomy if it is too large for successful sclerotherapy.