Sclerotherapy Frequently Asked Questions

Our 5 physicians often answer questions from people like you posted on Realself.com about sclerotherapy.  We thought some of their answers might be useful for you.

Q: Is there anyway to speed up healing and pigmentation fading after sclerotherapy?

A: It’s very common to experience slight discoloration following sclerotherapy as a result of the injected sclerosing agent traveling through your veins. To determine what is causing your pigmentation problems and bumps, it’s important to seek the help of an experienced cosmetic laser dermatologist with proper experience in sclerotherapy. Options for correcting the issues you are describing may range from topical creams, laser treatments, and possibly draining any clotted blood. Please enlist the services of an expert sclerotherapy doctor to assure you receive the best treatment.

Q: Is itching following sclerotherapy a sign of an allergic reaction?

A: Itching is common immediately after a sclerotherapy treatment. Which is why we apply a potent topical corticosteroid immediately after treatment under the graduated compression stocking. Though itching after sclerotherapy may be a sign of an allergic reaction, there are also several other reasons for what you are experiencing. If you are overly concerned, I’d recommend seeking help from your treating physician or get a second opinion from an experienced cosmetic dermatologist specializing in sclerotherapy. Because the natural reaction of the body upon injection of the sclerosing agent may be to release histamine, itching can ensue. If you are experiencing other symptoms like swelling, discoloration, or severe discomfort, it’s important to seek help. As a double board certified dermatologist and cosmetic surgeon, I would suggest that you make sure you speak with a professional.

Q: Sclerotherapy was performed just days ago, and now I have a swollen leg and toes. Is this normal?

A: After undergoing sclerotherapy treatment for leg veins, it’s very common for patients to experience leg swelling, especially if they do not continue to wear their compression garment as advised. Typically, compression garments should be worn around the clock for the first several days. I do not recommend compression dressings but graduated compression stockings. If a compression dressing is not properly applied with the correct bandage, the compression can make things worse.

Though it is rare, swelling may be a sign of a blood clot, and if it continues, you may want to visit your doctor or seek a second opinion. As a cosmetic laser dermatologist in San Diego and a pioneer of sclerotherapy treatment, I would advise you to contact your doctor to make sure you are healing correctly.

Q: I was born with a blue vein between my eyes, as I have gotten older the vein has become more noticeable and thicker. How can I get rid of it? Will Sclerotherapy work?

A: I typically do not recommend injecting central veins in the face as they have connections cranially to the cavernous sinus, unlike veins that are more laterally on the face.  When they are more laterally I use a laser, such as the Nd:YAG which is very effective.

Q:  I plan on getting spider vein removal treatments and I was told that they use Sclerodex. Is this the best injectible solution that will achieve the best results?

A: Spider veins are typically stemming from a blue underlying vein, which is typically treated with one of 2 FDA-approved solutions, Sodium Tetradecyl Sulfate (STS) or Polidocanol (either as a solution or foam).  In that same session the small spider veins can then be treated successfully with either polidocanol or glycerin.  If the underlying reticular veins (blue veins feeding the spider veins) are not treated, the spider veins will most likely not resolve.

Q:  Can matting that occurs after sclerotherapy be eliminated?

A: Matting can occur after sclerotherapy and sometimes the best treatment is a tincture of time.  They can sometimes take some months to resolve on their let own, otherwise I sometimes use a combination of an Nd:YAG laser with a pulsed dye laser to treat them.

Q: I have a few varicose veins on inside calf area of right leg. Should I be looking specifically for vascular surgeons to effectively treat this? What treatment would be most effective? What treatment should I definitely stay away from?

A: You should see a dermatologic surgeon or vascular surgeon who specializes in endovenous vascular closure, which essentially uses a small laser fiber to close off the great saphenous vein. They will need to first ultrasound your leg to confirm reflux and then provide you with a plan.  I personally would avoid stripping.

Q: How are spider veins under the eye treated?

A:  We treat these veins with a long-pulsed Nd-YAG every day. It is not dangerous if the proper eye protection and technique is used. I would see a board-certified Dermatologist with laser experience to perform the treatment.

Q: How do I Treat Bulging Vessels on my Hands?

I have these bulging blood vessels of the backs of my hands that I really don’t like. What can be done about them? Can I have them injected with sclerotherapy? Is it safe to do so?

A: How to Treat Bulging Vessels on Hands

Sclerotherapy of hand veins can be safe and effective when the appropriate technique, sclerosing agent, and sclerosing concentration are used. Treatment is sometimes not necessary if appropriate hand volume restoration is achieved, rendering prominent hand veins imperceptible.  I like to use either radiesse or autologous fat to revolumize the back of the hands when indicated.

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Q: Best Sclerotherapy Solution?

I had Sclerotherapy done 3 years ago with great results, and then again six weeks ago and I can´t notice a change. I don’t know which solution works best. In your opinion, which solution works best and is better to use?

A: Asclera and Sotradecol

It can take up to 8 weeks to appreciate the results from your sclerotherapy treatment. Asclera and Sotradecol are the only 2 FDA approved agents for the treatment of small uncomplicated varicose veins of the legs.  Studies trying to compare the difference between these two agents and hypertonic saline have not shown a significant difference in effectiveness, but hypertonic saline tends to be more painful with injection and has a greater risk for ulcerations.  One must treat the underlying blue veins that feed the superficial spider veins, or treatment of the superficial spider veins will not be proven successful.  Results are dependent on the technique, compression, and sclerosant concentration used for the vein size being treated.

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Q: Is Itching Following Sclerotherapy a Sign of an Allergic Reaction?

Why would itching occur after sclerotherapy? How often does it occur in patients?

A: Itching after sclerotherapy

Local itching at sites where sclerotherapy was performed can be common after the procedure.  As the point of the procedure is to induce a local inflammatory reaction in the vessel, that can result in histamine release, which causes us to itch.  This is typically why in our practice we apply a topical steroid to the legs immediately after sclerotherapy, to mitigate this reaction.  Although rare, if you are having itching beyond the areas of injection (rest of your body), you should notify your treating physician as this may be a sign of an allergic reaction, especially if it is accompanied by a rash.

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Q: Would Sclerotherapy Work to Get Rid of These Veins on my Feet or is It Only for Legs?

I’m wondering if sclerotherapy or another procedure would be able to get rid of these veins, as they look really ugly.

A: Sclerotherapy, phlebectomy, or lasers are a treatment options for foot veins

Veins on the feet are VERY different from veins on other body areas including the legs. While sclerotherapy can be effective for foot veins less than 1mm in diameter, treating larger veins with sclerotherapy will cause the foot to swell for weeks after treatment. Another possible treatment for larger veins on the feet is ambulatory phlebectomy. This procedure, performed under local anesthesia removes the veins permanently through tiny incisions that leave little if any scars. Finally a variety of long-pulsed 1064 nm Nd:YAG lasers are very effective for smaller veins on the feet. Since there are a variety of methods which may be appropriate for veins on the feet, it is best to go to a physician who is experienced using all of these techniques so that he/she can choose the best procedure for your specific problem.

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Q: I Get Vericose Veins from Pregnancies. Should I Wait to Repair Veins Until I Am All Done Having Children?

I have had had one EVLT surgery done and it did not seem to help much. It actually seemed to worsen the situation because a new varicose vein emerged directly over my knee cap which is very painful. I have lots of spider veins on my foot and ankle area….I read that there is a limit to the amount of times a doctor can do sclerotherapy. My fear is that If I go ahead now and clear up my ankle and foot that it may all come back my last pregnancy and then they will not be able to repair it. Advice?

 A: Treat varicose veins before pregnancy to prevent new problems

Varicose and other veins which occur during pregnancy tend to go away or at least become smaller within 2 months of delivery. Those veins that remain after 2 months will become worse with the next pregnancy and lead to the development of even more veins. I therefore recommend treating leg veins BEFORE pregnancy. Treating veins before they are made worse will PREVENT new veins from arising as well as make the pregnancy go more smoothly. Why have aching legs during pregnancy when they can feel great if they are treated before.

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Q: How soon should I see results after sclerotherapy? 

I would like to know how fast I will see results after the sclerotherapy procedure and after a laser treatment? Which among the two is more effective?

A: Sclerotherapy is a much better leg vein removal option than laser treatments 

Laser and dermatologic surgeons have been trying to develop lasers to treat leg veins for over 25 years. Lasers sound scientific and sexy but they have never and will never replace or improve upon the results of properly performed sclerotherapy.

Yes, sclerotherapy uses a needle and injects a medicine into the vein. But the newer FDA-approved solutions like Sotradecol™ and Asclera™ are virtually painless and the needles used at the size of a hair. Lasers are VERY expensive and hurt MUCH MORE than injections. Some doctors still use hypertomic saline for the injection and that is VERY painful. I would advise seeing a doctor who ONLY uses FDA-approved sclerotherapy solutions (Saline is only approved to induce abortions!)

While I treat over 500 leg vein patients each year and have over 30 diferent lasers in my office, I only use a laser maybe 5 times a year for leg veins. When I choose to use a laser, it is to clean up any tiny veins that have not responded to sclerotherapy.

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Q: How long do I have to wear the compression stockings after sclerotherapy?

Are the compression socks needed for the best long-term results from sclerotherapy or mainly to manage the swelling or circulation?

A: Compression stockings after sclerotherapy

You should wear your compression stocking for 24 hours a day for 7 days, even in the showers and during sleep. Then just during the day for another week or two. It is important for you to wear the compression stockings because it will decrease any and all adverse effects and makes the procedure more effective.

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Q: When can normal exercise resume after sclerotherapy?

When sclerotherapy of calf and thigh of both legs is needed, is the rest and recover time more than a week?

A: Exercise after sclerotherapy

You can exercise immediately after your sclerotherapy treatment for your legs. In fact, I recommend that patients walk as much as possible for 2 weeks after the treatment to allow the medication to flow through the veins.

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Q: What kind of laser treatment would be best for blue veins on the breasts?

These are not pregnancy related. Thanks.

A: Sclerotherapy is best for blue veins on the breasts

The appearance of superficial blue veins on the breasts occurs especially after breast augmentation. We have been treating these over the last 20 years with sclerotherapy and have published are results in the Journal Dermatologic Surgery.

The procedure takes less than 15 minutes is almost painless and works very well with over 90% of our patients very satisfied after 1 treatment. Two treatments may be necessary to get complete removal.

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Q: Discoloration after vein treatment

How Long is It for the Discoloration to Be Gone After I Done the Vein Treatment?

A: 90% of pigmentation after sclero will resolve within 6 months

In our 25 year experience in over 20,000 patients, 90% of pigmentation after sclerotherapy, if it ever occurs will resolve within 6 months and the other 10% within 1 year. If it is stubborn, we recommend the q-switched ruby laser which vaporizes out the brown iron staining.

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Q: How effective is sclerotherapy?

I have had sclerotherapy injections for several years in an attempt to combat the spider veins which are in greatest concentration around my shin and ankle areas. My physician has told me that there is a limit as to what can be done to eradicate these veins, as they are so tiny and numerous. Is there any hope for me to ever have lower legs and ankles that don’t look red and blotchy?

A: Sclerotherapy is very effective at treating leg veins 

The major problem with sclerotherapy is that any physician or nurse can pick up a needle, syringe and solution and inject it into a vein. But, to get a safe and effective treatment you must see a dermatologic surgeon who knows which veins to treat in which order with the appropriate type of solution.

My patients usually require only ONE treatment to eliminate >90% of their veins. Two treatments gets us to >99%. The reason is that unwanted leg veins on the legs are ALL interconnected to each other. So, the most effective treatment is to treat ALL the veins in a single session. My patients ALWAYS wear support stockings 24 hours a day for 7 days without EVER taking them off. This closes the veins very effectively and allows the body to resorb the veins completely. If you do not wear medical graduated support stockings (that your doctor fits you for) after the treatment, the veins usually come back and require many treatments. Also, if your doctor or nurse does not treat all of the veins at one time and does not treat the feeding veins, many treatments are required.

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Q: Does sclerotherapy work on tiny facial capillaries?

I have very fair skin and lately have noticed that my capillaries are becoming increasingly noticeable. I have tried several types lasers to treat my facial veins (underlying my acne scars, surrounding the nose) to no avail.

In fact, lasers often leave additional scars and capillary matting. The bottom line is that lasers do not work as my capillaries seem to require an intensity that my skin cannot tolerate. Are there other options? Can sclerotherapy target tiny facial capillaries?

A: Facial capillaries are best treated with a laser 

Facial capillaries are best treated with a laser. They always go away when the right laser with the right power is used. I have over 30 different lasers in my office and each one is specially used for certain indications. There is no ONE laser that can treat everything. So, if your doctor’s laser does not work, you need to see a dermatologic surgeon who has a variety of lasers so that s/he can use the BEST laser for your specific indication.

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Q: Pigmentation following sclerotherapy?

I had sclerotherapy done a year ago to remove a blue vein. This caused hyperpigmentation. The doctor used tromboject. How do I know whether my pigmentation is due to hemosiderin or melanin? When I pinch the skin above the pigmented area, the pigmentation disappears. When I let go, it shows up again. Almost as if something underneath the skin is causing it to look brown. What can I do to get rid of the pigmentation faster and is there a different solution I should use next time?

A: Pigmentation and sclerotherapy 

It is first important for patients to ONLY receive FDA-approved solutions. Thromboject is NOT FDA approved. The FDA approved solutions to treat leg veins are Sotradecol and Asclera.

Pigmenation can occur from any sclerosing solution and in my practice goes away in 99% of patients within a few months.

The way to prevent or minimize pigmentation is to treat the feeding reticular blue veins BEFORE treating the smaller veins. In addition, I recommend that ALL patients wear medical graduated 30-40mm Hg compression stockings 24 hours a day for 7 days after the procedure and then only during the day for another 2 weeks. Stockings must be worn for the first 7 days even in the shower.

If pigmentation does occur, it can be drained or treated with a q-switched ruby laser. Pigmentation is usually due to hemosiderin or iron from blood that has leaked out of the vein.

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Q: Get rid of varicose veins?

What’s the best varicose vein removal procedure?

A: Best treatment require the best doctor 

There are many treatments for varicose veins. Go to a dermatologic surgeon who has the ability to treat the unwanted vein with sclerotherapy, ambulatory phlebectomy or intravascular lasers. A surgeon who has the ability to perform all of these treatments is best able to choose the treatment that works best for your veins.

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Q: Can sclerotherapy treat facial veins? 

I have a vein under my eye that I would like treated. This is a single larger vein, not spider veins.  Is facial sclerotherapy a possiblity?

A: Sclerotherapy is not recommend for the face

Depending on the size of the vessel and the color, there are at least 3 different lasers that I would consider using. The problem with sclerotherapy around the eye is that the product that is being injected can cause vision loss or blindness, and this has been reported in the medical literature.

Care must be taken when using lasers around the eyes as well, but this is why it is extremely important that you go to a dermatology or plastic surgery office that specializes in these procedures. The physician should be performing the treatment and not delegating the procedure to someone else in his office (i.e. nurse, PA, technician).

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Q: Sculptra in Hands 

I am considering in having Sculptra in my hands, due to my veins showing, I have very Very thin skin, and in the summer its worse. I am very concern about this because I am only 29 year old. Should I wait a little longer? Any advise? I have been to two doctor and due to my very thin skin they dont want to do it. Help

A: Sclerotherapy or Radiesse injections are better than Sculptra for your hands 

There are many ways to limit the appearance of veins in the hands. Sclerotherapy will remove or decrease the diameter of hand veins and works very well. Injections of Radiesse or fat into the dorsal hands also works well. I do not recommend using Sculptra on the back of the hands. I have found that Sculptra has a high likelihood of causing hard bumps in the hands do to the constant movement of the tendons that control finger movement.

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Q: Sclerotherapy Recovery

What can I expect after sclerotherapy in terms of recovery and downtime? Will I need to take time off of work?

A: Remain Active after Sclerotherapy

There is no downtown time after sclerotherapy treatments. In fact, I strongly encourage my sclerotherapy patients to walk and remain active after their sclerotherapy treatment.

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Want more information about Sclerotherapy?

Please contact Goldman Butterwick Fitzpatrick Groff & Fabi, Cosmetic Laser Dermatology at 858.657.1002 for more information on sclerotherapy and to schedule a consultation. We are located in the UTC area of San Diego, minutes from La Jolla, Del Mar, and Downtown San Diego.