Spiders. They’re scary when we spot one climbing up the living room drapes, but they’re even more terrifying when they start to take up precious real estate on our lower limbs. Thankfully, there’s an effective aesthetic fix for the unsightly “spider veins” that can mar our legs and undermine our confidence. Expertly-performed sclerotherapy, a treatment that’s been around for decades, but has recently undergone a substantial facelift, is among the best options for patients itching to rock swimwear, shorts, and skirts sans insecurity.
[Editor’s note: As always, talk to your provider before getting any new treatment.]
What is sclerotherapy?
In a nutshell, sclerotherapy is an in-office treatment in which a liquid chemical solution, or “sclerosant,” is injected into a vein via a fine-gauge needle. It irritates the lining to such a degree that the vein collapses and dissolves. According to newly released statistics from the American Society of Aesthetic Plastic Surgery, there were 323,234 sclerotherapy procedures performed in 2018.
Who benefits from sclerotherapy?
If you’re a sclerotherapy “virgin,” you might be thinking, Wait, don’t I need my veins? The short answer: not all veins are created equal. “It’s important to know that the veins we’re treating are useless,” says Beverly Hills-based dermatologist Harold Lancer, who treats four to five sclerotherapy-seekers every day. “They don’t serve a purpose. Patients always ask, ‘Do I need these?’ And the answer is no.”
Occurring more frequently in women than men, spider veins are also genetic. “Heredity certainly plays a critical role in your chances of developing spider veins, but there are many other factors to consider as well,” adds New York City dermatologist Dr. Howard Sobel. “Hormonal changes, pregnancy and menopause have been proven to lead to spider veins.”
Aging is another key factor in the development of spider veins. “At 16, nobody has [spider] veins — or at least very few people,” notes phlebologist and general surgeon Luis Navarro, founder of the Vein Treatment CenterTM and creator of EndovenousTM Laser Ablation (EVLT), a minimally invasive treatment for large varicose veins which, though due to the same cause, visibly bulge under the skin. “By age 30, maybe 20 percent. By 50, close to 50 percent. And then after that, [by age 80, about 80 percent of women] have spider or varicose veins.”
In terms of lifestyle causes of those itsy bitsy spiders, any profession requiring you to stand on your feet for long stretches (think: retail, food service, etc.) is not optimal. Excessive sitting is also bad news. Essentially, both standing and sitting can disrupt blood flow and trigger blood pooling, and that ramps up pressure on our veins to push the blood to the heart. Eventually, all that pooling and pressure weakens the valves, triggering spiders and varicose veins. While there is no way to completely prevent varicose veins, plenty of exercise, staying at a healthy weight, and elevating your legs whenever possible (especially while sleeping) can help.
So why is sclerotherapy experiencing a resurgence?
One key reason sclerotherapy is regaining popularity: The word is getting out that now, depending on the sclerosant a practitioner uses, it can be less painful than it used to be. Back in the day, when hypertonic saline was the most common option, pain was the post-treatment norm. (Perhaps you’ve heard that expression about “pouring salt into a wound?”) “Hypertonic saline sometimes caused minor ulcerations if any of the solution leaked out into the skin,” adds Sobel. But with the advent of an alternative sclerosant — polidocanol — patient wincing has been greatly reduced, and injection-site ulceration is a less common issue.
In some practices, like the Vein Treatment Center in New York City, the use of a kinder, gentler sclerosant is coupled with cryosclerotherapy, ratcheting the ouch factor down even lower. “The most important advancement in sclerotherapy, at least at my office, is that we do it painlessly,” says Navarro. The treatment works twofold, according to Dr. Navarro. “One, we blow cold air into the area we’re going to inject,” he explains. “And then we use mechanical pressure. Between the cold air and the mechanical pressure, we overload the sensory fibers that carry the pain.”
Other leaps forward in sclerotherapy in recent years, says Navarro, are the use of ultrasound and Doppler to see deeper into the skin and identify “problem” veins during the initial consultation, and magnification and polarized light during the actual treatment. “Listen, there are thousands of spiders,” says Navarro. “Usually, you don’t even notice them, but I’m looking through magnification and polarized light [to see them].”
Also new: the use of foam sclerotherapy. “Sometimes, if we want a little power, more ‘oomph,’ we foam it,” he says. “We use two syringes to create a foam, like shaving cream.” The upside to a foam sclerosant, according to Navarro, is that it’s “in touch with the inner lining of the vein for a much longer period of time, so you can treat larger veins.” There is a downside, however: If it’s used on a vein that’s too small, foam can overpower it, leaving pigmentation in its wake that can last up to a year or more. “You need to know when to use it,” Navarro says. “It’s like when you get a new, faster car – you have to be careful.”
What happens during a sclerotherapy procedure?
First and foremost, lining up an excellent practitioner is of paramount importance. They should have a pristine record, i.e., no complaints lodged against him or her. You can browse the Federation of State Medical Boards to check board certifications, education, licenses, and more.
If you’re going to go with a phlebologist, Navarro recommends seeking out a provider certified by the American Board of Venous & Lymphatic Medicine. He also states that there are highly-trained dermatologists who are experts in the treatment of veins. “You need someone who has an ultrasound, who knows about veins, who can see what the problem is and has practice doing it,” he says, warning, “You see vein treatment centers advertised all over. There are a lot of scam artists.”
Although regulations vary by state, registered nurses and physician assistants can also practice sclerotherapy. Again, it’s smart to seek out someone with major experience in this field. Ryan MacDonald, PA-C, for example, has been on staff at Advanced Vein Care Center in Springfield, MA, since 2015, has trained under vascular surgeon K. Francis Lee, and has performed more than 2,000 vein procedures. “On any given day, I can be treating 10 to 18 patients, including consultations, evaluations, procedures and follow-up appointments,” MacDonald says.
No matter which route you go, be sure to seek out personal recommendations and a provider who is truly in the sclerotherapy trenches. “If your doctor doesn’t do at least five patients a day, you should, as a potential patient, pick up and go somewhere else,” says Lancer. “You want to go to a highly trained clinic that at least a dozen of your friends have gone to for this particular problem.”
After a thorough diagnostic examination by your highly vetted practitioner, depending on your medical history and/or any medications you’re on, you may be asked to refrain from taking certain ones in advance of your treatment, as they may cause increased bleeding. (Always be upfront with your practitioner about everything you’re taking, including over-the-counter supplements.)
Sclerotherapy requires no anaesthesia or numbing, so once you’re cleared for treatment, your practitioner will dive right in, administering multiple injections of the vein-collapsing solution in a single visit. Per 2018 statistics from the American Society of Plastic Surgeons®, you can expect an average cost of $336 per treatment.
What about sclerotherapy aftercare?
Immediately afterward, your leg(s) will be bandaged for the trip back home and, depending on your case — and practitioner — you may be asked to wear compression tights. These garments can help keep those treated veins collapsed and aid in speedier healing. You can expect post-treatment redness and injection-site bruising. In rare cases, there can also be pigmentation that lasts longer, fading over the course of months.
But by that point, you’ll may have already been back for your second or third session. Yes, you read that right; many sclerotherapy patients have multiple treatments. While it may be for a “re-treat” of the same vein, the sheer number of spiders (in people who have a propensity for them) may dictate a series of treatments.
“It’s not [always] a ‘one and done’ thing, and even when it’s done well, there will be new vessels that develop,” says Lancer. “Even if the old vessels don’t come back, and they were done first-class, the biologic genetics are such that new vessels [may] form.” You could decide that after two or three sessions, enough of those spiders are gone. Or, you might opt to go in for a touch-up five years down the road — it’s your call. If you’ve picked your doc with plenty of due diligence, there’s a good chance that you’ll get your “leg confidence” back.