Microsclerotherapy
What is Microsclerotherapy?
Microsclerotherapy keyfacts:
- Multiple treatment sessions may be required for complete removal of spider veins. Most patients can expect at least a 70%-80% improvement in the appearance of their legs
- It takes usually 3-4 months to achieve a maximum benefit may and perfection cannot be guaranteed
- The product that we use for spider vein removal is Fibrovein (Sodium tetradecyl sulphate)
What should you do before microsclerotherapy?
- If possible, please do not take aspirin for 7 days before treatment. You can resume the treatment one day after the treatment.
- Avoid sun exposure and tanning for 1-2 weeks before and after treatment to avoid pigmentation problems
- Do not apply creams, oils, lotions, or shave or wax your legs 24 hours before the treatment.
- Wear loose fitting clothing and sandals or loose shoes to allow for the thickness of the stockings applied after treatment.
- Treatment should not be considered if you intend to fly overseas or go to sunny places within the following two weeks.
What happens during microsclerotherapy session?
While you are lying down on a treatment couch, very fine needles are used to inject a solution into the spider veins in the treatment area. The solution irritates the lining of the vein, causing the two opposing sides to seal together. The total number of injections during one session varies from 1-2 to 30 depending on the response of the veins to the therapy and the number of veins requiring treatment.
During the treatment, you may listen to music, read, or talk to the practitioner.
The compression stockings are applied immediately after the treatment and you will take a brisk 10 min walk immediately after the treatment.
What should I do after Microsclerotherapy treatment?
Thereafter, wear your support during the day for 7-14 days, you may take them off at night.
Avoid extreme temperature for 14 days (very hot baths, sauna, steam rooms, sunbeds)
Avoid sun exposure for 4 weeks.
Avoid high impact exercise such as running, for 2 weeks after treatment since this increases the risk of blood flow returning into the treated veins.
Avoid waxing of the legs for 6 weeks.
Elevate your legs as much as possible for the first 2 weeks.
Consider wearing support hosiery long term to minimize thread vein recurrence.
Maintain normal daily activities, but avoid standing still for long periods.
You are required to avoid any flights of longer than 2-3 hours duration for 2 weeks and any flights of greater than 4 hours duration for 4 weeks after treatment.
If travel is unavoidable, then an anticoagulant should be administered prior to the flight.
Depending on the treatment performed, the length of time you will need to wear the stockings will vary and you will be advised at the time of treatment.
If larger veins are treated, stockings would typically be worn continuously for 3-7 days.
Then they would be worn through the day, removing them at night and replacing them in the morning after the shower for the next 7 days (depending on the severity of disease).
If limited spider veins are treated, then the stockings may only have to be worn for 3 days continuously and 7 days during the day only.
Compression stockings role as a part of the treatment
- Reduce pigmentation
- Reduce the number of treatment sessions needed
- Reduce the risk of deep vein thrombosis
- Reduce the frequency of recurrence
What can be expected following microsclerotherapy?
The following symptoms are expected, they are not a cause for concern although they should be reported at review:
Mild pain or discomfort may persist for several days, it means that the injections are working. The degree of discomfort is mostly related to the size of the treated veins and can be relieved by walking or by taking Paracetamol or Ibuprofen. Rubbing from the stocking can create soreness behind the knee.
Tender lumps and discolorations are usually experienced early on and resolve with the time.
Red raised areas over treated veins are due to “trapped blood” and usually disappear within four to six weeks. At the first review (two weeks after the treatment) these areas may be pricked to release the trapped blood. It is a common symptom that happens as part of treatment, however doesn’t occur in every patient and is a sign that treatment has been successful.
Phlebitis, or inflammation of the treated veins, can occur due to reaction to the injected solution. It is treated by further compression, anti-inflammatory medication and regular walking. It does not represent infection and does not require treatment with antibiotics.
Migraines may be provoked by the injection solution in patients who are known migraine sufferers. These patients should take their usual migraine treatment an hour or so prior to treatment in order to prevent the onset of a migraine.
What are the possible complications after microsclerotherapy?
- Deep vein thrombosis (DVT).
A blood clot can form and extend into the deep veins. The risk is less than 1:2000.
This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed.
Although DVT post procedure is most uncommon, we can refer our patients to the Vein Specialist to perform Duplex scans to exclude this complication. - Swelling of the leg or ankle (2:100)
This is a temporary symptom and is due to inflammation related to the injected fluid. - Hyper Pigmentation (1:10)
Brown marks may appear near or along a treated vein and are due to hemosiderin, a form of iron from the blood. Most discolorations disappear within 3-12 months but in about 5% of patients, this can persist over 12 months. This is of cosmetic importance only and persistent pigmentation may respond to laser or chemical peel. - Nerve injury (3:1000)
Irritation of surface sensory nerves rarely occurs and will disappear within a few weeks. - Skin ulceration occurs because solution has escaped into the surrounding skin or because of an abnormal connection between small veins and arteries. Most ulcers are small and heal over a few weeks, leaving sometimes a small pale scar.
Microsclerotherapy
Treatment for the small surface spider veins
Microsclerotherapy involves injecting a fluid “sclerosant” directly into each vein with very fine needle. Less painful solutions for removal of surface veins ( spider veins) have been introduced and investigated in thousands of patients in UK.
The product that we use for spider vein removal is Fibrovein (Sodium tetradecyl sulphate).
Microsclerotherapy is used to treat small to very small veins on legs.
Multiple treatment sessions may be required for complete removal of spider veins. Most patients can expect at least a 70%-80% improvement in the appearance of their legs.
It takes usually 3-4 months to achieve a maximum benefit may and perfection cannot be guaranteed.
What should you do before microsclerotherapy?
- If possible, please do not take aspirin for 7 days before treatment. You can resume the treatment one day after the treatment.
- Avoid sun exposure and tanning for 1-2 weeks before and after treatment to avoid pigmentation problems
- Do not apply creams, oils, lotions, or shave or wax your legs 24 hours before the treatment.
- Wear loose fitting clothing and sandals or loose shoes to allow for the thickness of the stockings applied after treatment.
- Treatment should not be considered if you intend to fly overseas or go to sunny places within the following two weeks.
What happens during microsclerotherapy session?
A microsclerotherapy session at our clinic takes between 30 and 45 minutes.
While you are lying down on a treatment couch, very fine needles are used to inject a solution into the spider veins in the treatment area. The solution irritates the lining of the vein, causing the two opposing sides to seal together. The total number of injections during one session varies from 1-2 to 30 depending on the response of the veins to the therapy and the number of veins requiring treatment.
During the treatment you may listen to music, read, or talk to the practitioner.
The compression stockings are applied immediately after the treatment and you will take a brisk 10 min walk immediately after the treatment.
Post Treatment
Wear your support hosiery day and night for 48 hours (2 days and nights)
Thereafter, wear your support during the day for 7-14 days, you may take them off at night.
Avoid extreme temperature for 14 days (very hot baths, sauna, steam rooms, sun beds)
Avoid sun exposure for 4 weeks.
Avoid high impact exercise such as running, for 2 weeks after treatment since this increases the risk of blood flow returning into the treated veins.
Avoid waxing of the legs for 6 weeks.
Elevate your legs as much as possible for the first 2 weeks.
Consider wearing support hosiery long term to minimize thread vein recurrence.
Maintain normal daily activities, but avoid standing still for long periods.
You are required to avoid any flights of longer than 2-3 hours duration for 2 weeks and any flights of greater than 4 hours duration for 4 weeks after treatment.
If travel is unavoidable, then an anticoagulant should be administered prior to the flight.
Depending on the treatment performed, the length of time you will need to wear the stockings will vary and you will be advised at the time of treatment.
If larger veins are treated, stockings would typically be worn continuously for 3-7 days.
Then they would be worn through the day, removing them at night and replacing them in the morning after the shower for the next 7 days (depending on the severity of disease).
If limited spider veins are treated, then the stockings may only have to be worn for 3 days continuously and 7 days during the day only.
Compression stockings are an essential part of treatment, as they:
- Reduce pigmentation
- Reduce the number of treatment sessions needed
- Reduce the risk of deep vein thrombosis
- Reduce the frequency of recurrence
What can be expected following microsclerotherapy?
Usually the veins look worse for a period of time before they start to look better and improvement is usually seen in a couple of weeks. Mostly 6 – 12 weeks may be needed to show the maximum effect.
The following symptoms are expected, they are not a cause for concern although they should be reported at review:
Mild pain or discomfort may persist for several days, it means that the injections are working. The degree of discomfort is mostly related to the size of the treated veins and can be relieved by walking or by taking Paracetamol or Ibuprofen. Rubbing from the stocking can create soreness behind the knee.
Tender lumps and discolorations are usually experienced early on and resolve with the time.
Red raised areas over treated veins are due to “trapped blood” and usually disappear within four to six weeks. At the first review (two weeks after the treatment) these areas may be pricked to release the trapped blood. It is a common symptom that happens as part of treatment, however doesn’t occur in every patient and is a sign that treatment has been successful.
Phlebitis, or inflammation of the treated veins, can occur due to reaction to the injected solution. It is treated by further compression, anti-inflammatory medication and regular walking. It does not represent infection and does not require treatment with antibiotics.
Migraines may be provoked by the injection solution in patients who are known migraine sufferers. These patients should take their usual migraine treatment an hour or so prior to treatment in order to prevent the onset of a migraine.
What are the possible complications after microsclerotherapy?
Complications can occur even with perfect technique.
- Deep vein thrombosis (DVT).
A blood clot can form and extend into the deep veins. The risk is less than 1:2000.
This potentially serious complication is very uncommon if the protocol of compression and regular daily walking is followed.
Although DVT post procedure is most uncommon, we can refer our patients to the Vein Specialist to perform Duplex scans to exclude this complication. - Swelling of the leg or ankle (2:100)
This is a temporary symptom and is due to inflammation related to the injected fluid. - Hyper Pigmentation (1:10)
Brown marks may appear near or along a treated vein and are due to hemosiderin, a form of iron from the blood. Most discolorations disappear within 3-12 months but in about 5% of patients, this can persist over 12 months. This is of cosmetic importance only and persistent pigmentation may respond to laser or chemical peel. - Nerve injury (3:1000)
Irritation of surface sensory nerves rarely occurs and will disappear within a few weeks. - Skin ulceration occurs because solution has escaped into the surrounding skin or because of an abnormal connection between small veins and arteries. Most ulcers are small and heal over a few weeks, leaving sometimes a small pale scar.
Author:
Dr Margaret Grabicka
General Medicine and Aesthetic Medicine Doctor with expert experience in dermal fillers, anti-wrinkle injections, i.v infusions, lifting threads and body contouring treatments.