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Everything you wanted to know about Sclerotherapy

Sclerotherapy - injection therapy for unwanted blood vessels

Unwanted blood vessels - smaller ones are called thread veins - have a red or bluish colour and appear on the surface of the body, particularly the legs and occasionally the face or elsewhere.

They may be visible as short, unconnected lines each about the size of a large hair, they may be connected in a scraggly, sunburst pattern, or they may resemble a spider's web or with branches. In some people, they occur in a small area and are not particularly noticeable. In others, they may cover a large area of skin and be quite unsightly.

Larger unwanted blood vessels may be raised above the skin surface and serpentine, they may occur in association with thread veins. These large veins are also called varicose veins, but differ from the more commonly known varicose veins which frequently occur in association with a poorly working valve in a large vein.

A characteristic of unwanted blood vessels in some sufferers is occasionally pain, ranging from a dull throbbing pain to a burning sensation.

Though unwanted blood vessels do carry blood, the great majority, especially thread veins are not necessary to the circulatory system. Thus, if their presence is distressing, they can be treated by injection of a solution that will cause them to disappear or at least become much smaller. The chance of a greatly improved appearance is about 80%, particularly if the physician is experienced in their treatment.

What causes these blood vessels to become visible?

The cause is not known, except that in many cases they seem to run in families. Identical twins, in fact, may be affected in the same area of the body and to the same extent. The condition can also occur as part of a large number of different diseases, both genetic and non-genetic.

Thread veins occur in both men and women, but more frequently in women. The hormone oestrogen may play a role in their development, because puberty, birth control pills or pregnancy often seem to bring them on. During pregnancy the enlarged uterus may restrict blood flow contributing to their development. They may also occur after a blow to a certain area of the body or as a result of wearing tight girdles or hosiery held up with tight elastic. In addition, spider veins may occur in association with underlying large varicose veins.

When they occur on the face, thread veins may be related to chronic sun exposure. They tend to occur on either the nose or the cheeks of fair skinned persons.

Can they be prevented?

There is no known method of prevention. Wearing support hosiery may prevent some unwanted blood vessels from developing in some people. Maintaining a normal weight and regular exercise may also be helpful. Protection from the sun is important to reduce the number of unwanted vessels on the face.

How are unwanted blood vessels on the legs treated?

Microsclerotherapy is the removal of red veins by injections. It is the gold standard in vein removal for all areas of the body BUT advanced electrolyis would be a better solution for facial areas. In microsclerotherapy, a chemical called sclerosant is injected into the thread vein with a very fine needle. It causes the thread vein to close and fade over the course of several weeks. It is not a perfect treatment and you will not get perfect skin - but it gives improvement in the majority of cases. This procedure has been used for thread veins since the 1930's and long before that for larger veins. The solution irritates the lining of the vessels, causing it to swell and stick together and the blood to coagulate. Over a period of weeks, the vessels turn into scar tissue that fades from view, eventually becoming barely or not as well visible.

It is very likely that the treatment area will look worse before it looks better and this is to be expected. You can help the healing process by wearing the specially fitted support stockings that are included in the price of your treatment.

Depending on its size, a single blood vessel may have to be injected more than once, some weeks apart, but in one treatment session a number of vessels can be injected.

Occasionally larger varicose veins underline spider veins. In such cases, Physicians believe these vessels should be treated before the thread veins, by a surgical procedure carried out by a surgeon.

How successful is Sclerotherapy?

After several treatments, most patients can expect a 50% to 80% improvement in treated vessels. However, the fading process is gradual and perfection is seldom achieved. A course of 3-4 sessions separated by 12 weeks is usually needed to achieve the required degree of fading. Sclerotherapy is not a permanent cure and other thread veins can develop. Most people need a top up session of treatment every 2-3 years.

Can Sclerotherapy by used on all skin types?

Yes. All skin types and skin colours respond equally well.

How much to treatments cost?

The cost per 30 minute treatment is £175-£200. A course of 3-4 sessions separated by 12 weeks is usually needed. Recuperation time is not necessary and it is possible to proceed with normal activities immediately.

Are there side effects to Sclerotherapy?

There are a number of possible side effects, including the following:
· Stinging or pain at the sites of the injection, swelling of the ankles or feet, muscle cramps. All of these usually go away within 10 - 15 minutes after injection.
· Red, raised areas at the site of injection. These should disappear within a day or two.
· Brown lines or spots on the skin at the site of treated blood vessels. Probably composed of hemosiderin, a form of iron stored in the blood, these pigment areas may result when blood escapes from treated veins, more often in patients who have larger veins treated. In most cases, they disappear, within a year, but in about 5% of patients they may persist for years.
· Formation of small painful ulcers at treatment sites either immediately or within a few days of injection. Sometimes these occur because some of the solution has escaped into the surrounding skin. These can be effectively treated but it is necessary to inform the nurse immediately. The most common place for ulcers to appear is in the ankle area.
· Bruises at the site where the needle penetrated the skin. These will disappear in a few weeks and are probably related to the fragility of blood vessel walls.
· Allergic reactions to certain sclerosing solutions. Although on rare occasions such reactions may be serious, they can be treated by immediate injections of epinephrine. Less serious reactions are treated with antihistamines.

Will treated veins recur?

Larger veins are likely to recur unless support hosiery is worn. Thread veins may recur. Often however, it may seem that a previously injected vessel has recurred, when in a fact a new thread vein has appeared in the same area.

Are there any medical conditions that would prevent treatment?

Treatment is not recommended in the following circumstance:

1. If surgery has been performed on varicose veins in the previous 3 months.
2. If visible varicose veins are present.
3. If there is a medical history of pulmonary embolus.
4. If previous allergy to the treatment has been experienced.
5. If medication, such as Warfarin, has been taken to thin the blood.
6. If the prospective patient is pregnant.

What do I do prior to treatment?

Avoid applying a moisturiser to the area being treated. Wear loose clothing if legs are being treated.

What do I do after treatments?

Taped compress dressings are sometimes applied immediately after treatment but can be removed after two hours. All patients are instructed to walk as much as possible in the days following the procedure so that blood will be pushed through other vessels. You can help the healing process by wearing the specially fitted support stockings that are included in the price of your treatment.

After treatments

Expect tenderness and nettle rash appearance on the leg area for up to one week.
Do not undertake strenuous activity for at least two days. If the leg area has been treated, avoid swimming for two days. Avoid hot baths for two days after treatment. (Take a shower or a tepid bath). Avoid the use of sun beds for one week after treatment.

Facial veins

It is recommended that advanced electrolysis is used to treat facial thread veins. It is very rare that we treat facial areas with microsclerotherapy.


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