sclerotherapy ineffective thus far despite four treatments with proper aftercare and certified cosmetic dermatologist

I recently asked before and made it clear I have tadpole thin skin, not varicose veins, but was told I should have a full venous evaluation, implying sclerotherapy isn't working due to a leak somewhere. But to be more concise, I have healthy yet prominent reticular veins. I have had now four treatments. My doctor insists they are improved but they aren't. They look very slightly lighter in colour, but are still just as visible. $1500 and no results, and no refund, despite doctor's optimism.

Doctor Answers 3

Sclerotherapy to veins

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I have some patients who have needed 10 or more sclerotherapy treatments because they had so many reticular veins. Others may need 2. It's hard to comment on this specifically, but it's pretty much impossible to not have results from sclerotherapy. As the vein is being injected, it goes away and blanches. Then it absorbs and goes away over time. So you can pretty much tell right away that you are getting results for a patient. Most patients who have big vericose veins and vascular sites also need sclerotherapy for the smaller veins too. That's pretty common.

Outcomes Following Sclerotherapy and Venous Insufficiency

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If the venous insufficiency is not treated, sclerotherapy results may be marginal at best or if they are successful, reticular and spider veins are at high risk of recurrence. It is not only important to check for truncal venous insufficiency but also look for and treat perforator venous insufficiency. The spider veins are the 'tip of the iceberg' as there is much much more disease below the skin - so treating the spider vein is only part of the treatment. The feeder veins, the perforator veins have to be treated for a successful outcome. This is an expensive endeavor in terms of time, resources, catheters, experience and money spent. 

Should have

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I agree that you should have a full venous evaluation with a venous reflux ultrasound.  Sclerotherapy is a process and can take anywhere from 2 to 10 treatments to have results.  However, after 4 treatments, there should be some noticeable improvement.  If there isn't, then I would be suspicious that you may have underlying saphenous valvular reflux contributing to the failure of the veins to resolve.  Think of your veins like a tree.  Sclerotherapy is treating the branches, but if the problem  is in the trunk, the branches will not get better.

John Landi, MD
Naples General Surgeon

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