Diminishing Unsightly 'Spider Veins'
Millions of women are bothered by spider veins - those small yet
unsightly clusters of red, blue or purple veins that most
commonly appear on the thighs, calves and ankles. In fact, it's
estimated that at least half of the adult female population is
plagued with this common cosmetic problem.
Today, many plastic surgeons are treating spider veins with
sclerotherapy. In this rather simple procedure, veins are
injected with a sclerosing solution, which causes them to
collapse and fade from view. The procedure may also remedy the
bothersome symptoms associated with spider veins, including
aching, burning, swelling and night cramps.
Although this procedure has been used in Europe for more than 50
years, it has only become popular in the United States during
the past decade. The introduction of sclerosing agents that are
mild enough to be used in small veins has made sclerotherapy
predictable and relatively painless.
If you're considering sclerotherapy to improve the appearance of
your legs, this brochure will give you a basic understanding of
the procedure - when it can help, how it's performed and what
results you can expect. It won't answer all of your questions,
since a lot depends on your individual circumstances. Please ask
your doctor if there is anything about the procedure you don't
What Are Spider Veins?
Spider veins - known in the medical world as telangiectasias or
sunburst varicosities - are small, thin veins that lie close to
the surface of the skin. Although these super-fine veins are
connected with the larger venous system, they are not an
essential part of it.
A number of factors contribute to the development of spider
veins, including heredity, pregnancy and other events that cause
hormonal shifts, weight gain, occupations or activities that
require prolonged sitting or standing, and the use of certain
Spider veins usually take on one of three basic patterns. They
may appear in a true spider shape with a group of veins
radiating outward from a dark central point; they may be
arborizing and will resemble tiny branch-like shapes; or they
may be simple linear and appear as thin separate lines. Linear
spider veins are commonly seen on the inner knee, whereas the
arborizing pattern often appears on the outer thigh in a
sunburst or cartwheel distribution.
Varicose veins differ from spider veins in a number of ways.
Varicose veins are larger - usually more than a quarter-inch in
diameter, darker in color and tend to bulge. Varicose veins are
also more likely to cause pain and be related to more serious
vein disorders. For some patients, sclerotherapy can be used to
treat varicose veins. However, often surgical treatment is
necessary for this condition.
The Best Candidates For Sclerotherapy
Women of any age may be good candidates for sclerotherapy, but
most fall in the 30-to-60 category. In some women, spider veins
may become noticeable very early on - in the teen years. For
others, the veins may not become obvious until they reach their
If you are pregnant or breastfeeding, you may be advised to
postpone sclerotherapy treatment. In most cases, spider veins
that surface during pregnancy will disappear on their own within
three months after the baby is born. Also, because it's not
known how sclerosing solutions may affect breast milk, nursing
mothers are usually advised to wait until after they have
Spider veins in men aren't nearly as common as they are in
women. Men who do have spider veins often don't consider them to
be a cosmetic problem because the veins are usually concealed by
hair growth on the leg. However, sclerotherapy is just as
effective for men who seek treatment.
What to Expect From Sclerotherapy
Sclerotherapy can enhance your appearance and your self
confidence, but it's unrealistic to believe that every affected
vein will disappear completely as a result of treatment. After
each sclerotherapy session, the veins will appear lighter. Two
or more sessions are usually required to achieve optimal
You should also be aware that the procedure treats only those
veins that are currently visable; it does nothing to permanently
alter the venous system or prevent new veins from surfacing in
Before you decide to have sclerotherapy, think carefully about
your expectations and discuss them with your doctor.
Risks Related to Treatment
Serious medical complications from sclerotherapy are extremely
rare when the procedure is performed by a qualified
practitioner. However, they may occur. Risks include the
formation of blood clots in the veins, severe inflammation,
adverse allergic reactions to the sclerosing solution and skin
injury that could leave a small but permanent scar.
A common cosmetic complication is pigmentation irregularity -
brownish splotches on the affected skin that may take months to
fade, sometimes up to a year. Another problem that can occur is
"telangiectatic matting," in which fine reddish blood vessels
appear around the treated area, requiring further injections.
You can reduce the risks associated with treatment by choosing a
doctor who has adequate training in sclerotherapy and is well
versed in the different types of sclerosing agents available. A
qualified doctor can help you select which type of sclerosing
medication is most appropriate for your needs.
Planning Your Treatment
During your initial consultation, your legs will be examined.
Your doctor may draw a simple sketch of your legs, mapping out
the areas affected by spider veins or other problems. During the
examination, you will be checked for signs of more serious "deep
vein" problems, often indicated by swelling, sores, or skin
changes at the ankle. A hand-held Doppler ultrasound device is
sometimes used to detect any backflow within the venous system.
If such problems are identified, your surgeon may refer you to a
different specialist for further evaluation. Problems with the
larger veins must be treated first, or sclerotherapy of the
surface veins will be unsuccessful.
Your doctor will ask you about any other problems you may have
with your legs, such as pain, aching, itching or tenderness. You
will also be asked about your medical history, medications you
take, or conditions that would preclude you from having
treatment. Individuals with hepatitis, AIDS or other blood-borne
diseases may not be candidates for sclerotherapy. Patients with
circulatory problems, heart conditions, or diabetes may also be
advised against treatment.
It's important to be open in discussing your history and
treatment goals with your doctor. Don't hesitate to ask any
questions or express any concerns you may have. Your doctor
should explain the procedure in detail, along with its risks and
benefits, the recovery period and the costs. (Medical insurance
usually doesn't cover cosmetic procedures.)
Preparing For the Procedure
You will receive specific instructions from your physician on
how to prepare for your treatment. Carefully following these
instructions will help the procedure go more smoothly.
You'll be instructed not to apply any type of moisturizer,
sunblock or oil to your legs on the day of your procedure. You
may want to bring shorts to wear during the injections, as well
as your physician-prescribed support hose, and slacks to wear
When scheduling your procedure, keep in mind that your legs may
be bruised or slightly discolored for some weeks afterward. You
probably won't be comfortable wearing shorts, a swimsuit or a
mini skirt until after your legs have cleared up a bit.
Where Your Treatment Will Be Performed
Sclerotherapy of spider veins is a relatively simple procedure
that requires no anesthesia, so it will be performed in an
outpatient setting, most likely your doctor's office.
A typical sclerotherapy session is relatively quick, lasting
only about 15 to 45 minutes. After changing into shorts, your
legs may be photographed for your medical records. You will be
asked to lie down on the examination table and the skin over
your spider veins will be cleaned with an antiseptic solution.
Using one hand to stretch the skin taut, your doctor or nurse
will begin injecting the sclerosing agent into the affected
veins. Bright, indirect light and magnification help ensure that
the process is completed with maximum precision.
Approximately one injection is administered for every inch of
spider vein - anywhere from five to 40 injections per treatment
session. A cotton ball and compression tape is applied to each
area of the leg as it is finished.
During the procedure, you may listen to music, read, or just
talk to your practitioner. You will be asked to shift positions
a few times during the process. As the procedure continues, you
will feel small needle sticks and possibly a mild burning
sensation. However, the needle used is so thin and the
sclerosing solution is so mild that pain is usually minimal.
After Your Treatment
In addition to the compression tape applied during the
procedure, tight-fitting support hose may be prescribed to guard
against blood clots and to promote healing. The tape and cotton
balls can be removed after 48 hours. However, you may be
instructed to wear the support hose for 72 hours or more.
It's not uncommon to experience some cramping in the legs for
the first day or two after the injections. This temporary
problem usually doesn't require medication.
You should be aware that your treated veins will look worse
before they begin to look better. When the compression dressings
are removed, you will notice bruising and reddish areas at the
injection sites. The bruises will diminish within one month. In
many cases, there may be some residual brownish pigmentation
which may take up to a year to completely fade.
Getting Back to Normal
Although you probably won't want to wear any leg-baring fashions
for about two weeks, your activity will not be significantly
limited in any other way from sclerotherapy treatment.
You will be encouraged to walk to prevent clots from forming in
the deep veins of the legs. However, during the period of time
to complete your treatment program, prolonged sitting and
standing should be avoided, as should squatting, heavy weight
lifting and "pounding" type exercises, including jogging.
A one-month healing interval must pass before you may have your
second series of injections in the same site. After each
treatment, you will notice further improvement of your legs'
Your New Look
Most patients are pleased with the difference sclerotherapy
makes. The skin of your legs will appear younger, clearer and
more healthy-looking. If you've been wearing long skirts and
slacks to hide your spider veins, you'll now be able to broaden
your fashion horizons. Often, patients are surprised at the
dramatic difference in appearance between a treated leg and an
Although sclerotherapy will obliterate the noticeable veins for
good, it's important to remember that treatment will not prevent
new spider veins from emerging in the future. As time passes,
you may find that you need "touch-ups" or full treatments for
new veins that surface. But even if you choose not to have
further sclerotherapy, your legs will look better than if you
never had treatment at all.