Hi, Dr. Adam Goldman of the Metropolitan Vein and Aesthetic Center. I would like to talk to you today about spider veins and the treatment known as sclerotherapy. Spider veins are quite common; in some studies, up to 88% of women experience them before the age of 50, and even men up to 79%. It’s probably one of the most common problems that we see people seeking treatment in the Metropolitan Vein and Aesthetic Center. I’d like to go over what the preparation for the procedure is, what to expect, and the aftercare.
Let’s go ahead and get started.
Preparation
So, the preparation is fairly simple. Basically, normal bathing. There is bacteria that live on our skin and with soap and water, we reduce the counts of the bacteria, which reduces the risk of infection. So, it’s important to bathe normally.
Number two, if you are prescribed any medications for your blood pressure, for your thyroid, if you’re prescribed blood thinners for a clotting disorder, it’s very important to take these medications and continue them both before and after the procedure. The risk of bleeding is minimal. And if they were prescribed, we do want you to take them to prevent any complications.
Number three, if you did take an aspirin or Motrin, which is technically a blood thinner or an Advil or naproxen, there’s no real risk of bleeding. Small amounts will not cause a problem. So we can go ahead if you did take it with the scheduled procedure.
Procedure
So the first step is to clean the skin with an antiseptic and next we can start. Basically, what’s done is that there is a tiny needle, which is a 30-gauge needle, which is used by diabetics, for example, to give themselves insulin daily and other injectable medications. So it is not a very painful process. We will need to use that needle many times to inject the vein. First, we go ahead and start inserting the needle into the vein and then we start injecting the sclerosant. In our clinic, we use predominantly polidocanol or glycerin, but there are many agents that could be used. We find that the risk profile and the effects and results are superior in our opinion. The sclerosant is actually mixed with an anesthetic. So once we start injecting, you will feel the initial pinch but then you will feel a numbing effect.
This is done starting at the bottom of the leg at the ankle and moving upward in quadrants: first on the inside of the leg, then the front, the side, and the back until we’ve injected all the veins.
It is very important to inject the veins carefully because you need to be inside the lumen of the vein, and sometimes these veins are as small as a hair or smaller. You have to be very precise when you do the injection to get any kind of real results. This is sometimes an uncomfortable procedure, and in another video, I will go over strategies to minimize the discomfort.
Aftercare
Once the procedure is done, we give the leg a final clearing and then we go ahead and place an ACE bandage. We recommend you wear the ACE bandage that day, sleep with it overnight, and the next morning take it off and shower normally. Then you want to go ahead and put the compression stockings on.
Compression stockings are very important to help clear the veins after the procedure. We usually recommend at least a week of daily use. The healing of the veins takes some time, sometimes four to six weeks. If you are very motivated and you have a large number of veins, it is a good idea to wear the compression stockings even longer, anywhere up to four weeks. At least a week is definitely indicated.
You may resume all your normal activities; however, you should avoid strenuous or sweaty exercise after the procedure. Also, you don’t want to be immersed in water, such as tub bathing or swimming, for the first three days. There is a higher risk of infection as we have inflamed the skin and made a lot of little holes. Avoiding these things for the first three days is very important. After three days, everything is pretty healed up and you can go ahead and do any activity, including sweaty exercise, without a problem.
Managing Discomfort
After the procedure, you may find you have a little discomfort. It’s not very uncomfortable, but sometimes it feels a little sore. Taking either Tylenol, Motrin, aspirin, Advil, or naproxen should work. Generally, the pain or discomfort is very minimal. Sometimes you may notice some swelling. It’s very important to use compression stockings for that, as well as elevating the legs at night or when lying down to help drain the fluid and speed the recovery process.
What to Expect
It does take time for the veins to be reabsorbed by the body. The first thing you may notice is that the veins have not gone away. That is normal because they are closed but still there, and the body will slowly remove them over time. Legs, in general, heal very slowly. Expect at least four weeks, but sometimes four to six weeks, to see the final result.
The body sometimes wants these veins there. At first, inflammatory veins may grow around where we injected. If you notice a red, fine spider-like web of veins after the injections, it is not uncommon, and most of these will resolve. I generally recommend wearing the compression stockings for an additional time if you see this, which will help resolve the problem.
After four to six weeks, you will see the final result. Sometimes, the body grows a new vein right next to the original vein. These often look finer, more red, or almost like a bruise. This is called neovascularization.
It is normal for even perfect injections to remove approximately 70–85% of veins. Similarly, you may notice neovascularization where the body has grown new veins. One series of injections may not be enough to remove all veins. After four to six weeks, if you are happy with the results, no further treatment is needed. If veins are still present or new veins have formed, a second set of injections can be done. Very rarely, some veins may regrow despite multiple injections.
Long-Term Considerations
Veins will continue to grow throughout life, due to standing, gravity, hormonal effects such as pregnancy or menstruation, and aging. It is normal to expect some veins to eventually return. They grow slowly, so significant new veins may take a long time to appear. The procedure can be repeated as needed.
Consult Metropolitan Vein and Aesthetic Center to Discuss Vein Treatment Options
If you are experiencing spider veins and would like to find out what you can do about it, please come see us for a free consultation at the Metropolitan Vein and Aesthetic Center. We will discuss your options for treatment and what to expect. Thank you.
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