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If you’ve been dealing with spider veins or varicose veins, you may be familiar with the term “sclerotherapy” in conjunction with possible treatment options for your veins.

What is sclerotherapy?

How is it performed?

Can it really help improve the appearance of spider and varicose veins?

This short guide will provide an overview of sclerotherapy so you can determine if it’s right for you.

What Is Sclerotherapy?

In the simplest terms, sclerotherapy is a technique doctors perform to eliminate spider veins and varicose veins, usually from the legs. The term, “sclerotherapy”, comes from the medical term to sclerose – in this case, sclerosing or collapsing a vein. Sclerotherapy involves a series of injections of a sclerosing agent – historically a saline, or salt, solution, but currently, an FDA approved medication like polidocanol or sotradecol – into the affected veins. The solution causes scarring within the vein, rerouting the blood through healthier veins and eventually leading to collapse and reabsorption of the affected veins by the body. 

Sclerotherapy is a cosmetic procedure aimed at reducing the texture and the dark color of the veins. Most patients with smaller networks of veins can expect a reduction in appearance in four to six weeks, while larger treatments may take as many as three or four months.

How is Sclerotherapy Performed?

This hour long procedure is performed in a physician’s office and it does not require anesthesia. In most cases, your doctor will ask you to lie on your back and will elevate your legs slightly.

First, the doctor cleans the treatment area with an alcohol solution before using a fine needle to inject a saline solution. Once the solution has adequately filled the vein, the needle is withdrawn; the doctor will apply compression to the insertion point to prevent bleeding and may massage the area to ensure even distribution of the liquid. 

This process continues until your doctor has treated all veins in the network. The process typically takes an hour or less but your treatment time will vary depending on the size and number of veins you are treating. Afterward, your doctor will likely provide compression stockings or other bandages for you to wear for the next few weeks.

You will be able to get up and move after the procedure, and it is important that you maintain movement after treatment to prevent blood clots. However, your doctor will likely ask that you refrain from strenuous exercise for a few weeks after sclerotherapy. 

Actual patient. 33 year-old mother of 3. Single treatment.

How many treatments of sclerotherapy are needed?

Many patients ask how many treatments will be required to treat their spider veins. In the past, when saline was used regularly, people had to endure ten or twelve treatments to clear their legs. Our office uses Asclera, the only name brand FDA medication for spider vein sclerotherapy. Dr. Malvehy, the top rated sclerotherapy expert in California, will use the entire vial towards your treatment. Most patients require 1-2 treatments to achieve substantial improvement in the way their spider veins looks. Treatments take 20-30 minutes. 

Does it hurt?

Saline injections were quite painful – they are like putting salt in a wound. Dr. Malvehy uses Asclera, a gentle medication which does not sting or hurt when injected properly. The needles used to inject are quite small and patients regularly mention how the treatment didn’t hurt anywhere near what they were expecting. The needles we use are the smallest ones available and generate minimal discomfort. 

Do I have to wear compression stockings after?

We recommend patients use compression stockings for 2-3 days after treatment. Usually, they sleep in them the first night and then take them off to shower and to sleep beginning the day after treatment. 

Does Insurance Cover Sclerotherapy?

No insurance covers treatment for the cosmetic treatment of spider veins with sclerotherapy. While some similar treatments, namely chemical ablation with foam, may be covered by insurance, they are reserved for larger varicose veins which are symptomatic. 

 Sources & Resources:

Dr. Albert Malvehy

Dr. Albert Malvehy

M. Albert Malvehy, MD, RVT, dABVLM is a top-rated East Bay vein doctor serving the East Bay and greater San Francisco, California area. One of the few physicians in the country who devotes his practice exclusively to vein disease, Dr. Malvehy performs over 500 major varicose vein treatments using laser vein treatment and 1,000 spider vein treatments with sclerotherapy every year.

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