Those big, bulging purple veins on the legs are known as varicose veins, with the smaller visible veins called spider veins. Varicose veins occur in over 30 per cent of the population, with women affected more commonly than men.
Varicose veins are enlarged veins that appear as blue, red, or flesh-coloured cords that may be twisted and bulging. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy, varicose veins can develop on the female external genitalia (vulva). These may settle down after pregnancy, but may persist.
Spider veins are red or blue veins that are closer to the skin surface and much smaller than varicose veins. They are often associated with slightly larger and deeper reticular veins.
Sclerotherapy is the treatment used at ENRICH clinic to eliminate small varicose veins or spider veins. Sclerotherapy is mainly for smaller veins and is not an appropriate treatment for large varicose veins.
Contact our Melbourne staff today to book a consultation to discuss all your treatment options.
Why do we get varicose veins and spider veins?
The appearance of varicose veins and spider veins is largely due to genetics and what pressure your body is under. If one of your parents or grandparents had varicose veins, you may end up with them. Some people experience varicose or spider veins more than others but there are other factors involved in an individual.
The main two causes of varicose veins are age and family history. Other causes might be pregnancy, menopause, and any medications that contain hormones like the oral contraceptive pill. Being overweight or obese can also contribute to varicose veins and spider veins.
During pregnancy, there is an overall increase in blood volume in the body. This extra blood, plus the grams that turn into kilograms of a growing baby, put pressure on your blood vessels and venous system. Veins can start to bulge and become visible through the skin.
Anyone who sits down for long periods of time can become prone to varicose veins. Sitting or standing still puts pressure on veins to get blood from point A to point B and back to the heart.
Varicose vein development – how it works
Veins are blood vessels that take blood from the limbs towards the heart. Blood does not travel downwards or outwards from deep veins since there are one-way valves inside vessels that block the blood from going the wrong way. This ‘no return’ safeguard keeps blood going in one direction – from the heart, back around to the heart.
When the one-way valves fail in a blood vessel, blood can go the wrong way down the vein, particularly when gravity has its way upon standing. These blood vessels are deemed ‘incompetent’; they are not doing their jobs effectively.
When some one-way valves stop working properly, pressure in the vein develops and they become swollen – varicose. The process of a vein becoming varicose can take many years. Not every vein that has faulty valves becomes a varicose vein, but with high pressure, especially in the legs where blood has to travel quite some distance up to the heart, varicose veins can develop.
Because it takes some time to occur, usually varicose veins become more prominent as we age. Not all varicose veins should or can be treated, but your dermatologist will be the best judge of your individual needs.
Spider vein and varicose veins treatments
At our Melbourne clinic, the most effective varicose vein treatment is sclerotherapy, a treatment devised in the 1920s and still widely used today. Sclerotherapy is a special fluid injected into an incompetent vein that irritates the blood vessel wall, causing it to close. The fluid is called a sclerosant and is usually a saline solution.
During the treatment, you may feel mild discomfort and cramping for one or two minutes, particularly for larger veins. Sclerotherapy treatments – depending on the number of veins being treated – can take about half an hour. A trained dermatologist performs sclerotherapy.
Once the blood vessel is closed, the blood in it clots and the vessel walls stick together. As time goes by, the vessel becomes scar tissue which is invisible to the eye from the outside of the skin, thus we say the varicose vein has been treated successfully.
What varicose veins treatment looks like
An initial consultation is required to ensure you are suitable for sclerotherapy treatment. We may take an ultrasound of the veins before treatment commences. This ultrasound shows us if any deep veins are also damaged or not functioning correctly, a condition known as deep venous insufficiency.
If you have deep veinous insufficiency, surface varicose vein treatment is pointless, as the problem will recur. We need to treat the deeper veins to stop the problem, correct the functioning of the veins, and then approach the other varicose veins.
Special considerations regarding sclerotherapy treatments
You need to plan in advance for your sclerotherapy treatments, since you will be unable to take domestic flights for two weeks and international flights for 4-6 weeks. Long car trips should also be avoided, but if they are unavoidable, you should get out and walk around for at least five minutes every hour.
Avoid application of moisturiser prior to your sclerotherapy treatment, and wear loose clothing so that your compressions stockings can be immediately applied after your treatment. These compression garments are used for about two weeks to reduce the risk of a vessel reopening and to help avoid deep vein thrombosis (DVT). Any pigmentation issues can often be avoided with the use of compression garments.
You may need to avoid some medications, but talk to your doctor. Medications can be drugs, supplements, or herbal medicine you are taking that can cause blood or blood vessels to behave in an unexpected way. Some dermatologists will ask you to avoid any aspirin, ibuprofen, or other anti-inflammatory drugs, since your body’s natural inflammation process is what the doctor is utilising to close the vein.
How effective are sclerotherapy treatments?
Some studies have found that sclerotherapy has a success rate of between 50 and 80 per cent for each injected vein. Less than 10 per cent of those undergoing sclerotherapy have no response whatsoever to the injections, in which case other strategies will be utilised.
Spider veins tend to take between three and six weeks to disappear, with larger veins taking up to four months. Once a vein has been treated, it will not reappear, but new veins may appear at the same rate.
Post-sclerotherapy treatment care
Each day you’ll need to walk for half an hour, and avoid standing still for long periods of time. Exercise should be avoided for two weeks. You should also avoid having hot baths or applying hot compresses since these cause blood vessels to dilate, which could encourage your blood vessels to open, rather than stay closed. These guidelines apply to hot spas or saunas too. Direct sun should be avoided.
Frequently Asked Questions
We’ll know how many treatments you need after your injections because we need to see what appears/doesn’t disappear after treatment. You may find that new, smaller veins emerge around the injection site or that there are clots in the vein. Some veins survive the procedure and remain visible, but thinner and weaker.
Hardy veins can be re-treated in a follow-up appointment. There is an expectation that one treatment offers an improvement of about 50-60 per cent.
There are a few key elements to keep in mind when preparing for sclerotherapy treatments:
- Avoid tanning in the weeks leading up to your treatments to avoid pigmentation issues
- Do not take non-steroidal anti-inflammatory drugs like ibuprofen, vitamin E, some herbal medicine and supplements like fish oils that may increase bruising
- Avoid shaving 24 hours before your treatments – it can cause stinging when we apply the cleansing solution
- Wear loose clothing or shorts/skirt to your appointment for easy access to limbs
Sclerotherapy is a very low-risk, effective procedure, with few side-effects. Any side-effects are likely to be temporary and easy to tolerate, including itching, tenderness, bruising and pigmentation at the injection site. Fine blood vessels may develop in the treatment area.
Serious complications like allergic reactions, ulcers and clots are rare. Your doctor will explain everything to you before your treatments and inform you of what to look for in case something is going awry.
Sclerotherapy is one of our oldest successful medical treatments, used for over 100 years. Most medical treatments don’t last over time, being superseded by newer, better treatments. Still, sclerotherapy has made it through to modern medicine intact.
Sclerotherapy is safe for most people; however, there are some medical conditions and medications that don’t mix well with sclerotherapy. Speak to your doctor.
Yes, spider and varicose vein removal is cosmetic only, so their removal is primarily for smooth, clear skin, rather than a medical purpose.
However, it’s important to remember that some varicose veins may be a sign of deeper venous issues that should be investigated by your doctor and not ignored. If you notice a lot of varicose veins or spider veins on your limbs or they appear suddenly, see your doctor.
You will need to wear compression garments, but other than that, you can behave normally. The sclerotherapy injection will do its work, and soon enough, your visible vein will disappear.
You will be in the clinic for 30-60 minutes having treatments. You may need to repeat procedures for some veins.
Some smaller veins disappear quickly; however, larger veins can take up to four months to disappear. Your vein will look worse before it looks better, so be prepared!
Yes, compression garments are necessary to help swelling go down and to support your body to heal.
Compression garments are understood to improve the efficacy and safety of the treatment by ensuring trapped blood cannot stick around in the treatment area for long. Trapped blood can lead to pigmentation issues, and may also cause pain and inflammation.
Compression garments improve circulation to the treatment area, reducing the risks of a clot. Compression garments make the treatment more comfortable.
Some people with specific health conditions shouldn’t get sclerotherapy, since the body may respond poorly. Those with cardiovascular disease or anyone who has undergone a heart bypass surgery is not a good candidate for sclerotherapy. We cannot perform sclerotherapy on anyone who is pregnant or has a history of blood clots.
No. Sclerotherapy is mainly for smaller veins and is not an appropriate treatment for large varicose veins. There will be other options offered to you.
You can return to work immediately after treatment. You’ll come into the clinic, have your procedure, and can then drive yourself away. There is no need to rest after sclerotherapy treatment, but you will need to wear compression garments.
Each of you will need different numbers of veins treated, so the cost will vary based on what you present to the clinic wanting treated. Call the clinic for a cost estimate and a consultation to get an accurate quote.
We will get you back into the clinic for a checkup a few weeks after your treatments to ensure everything is going according to plan. You can call anytime if you are concerned or want advice.
The main reason sclerotherapy might hurt is in the hands of an inexperienced doctor. The pain should be minimal, with some spots more sensitive than others. Most people tolerate the injections easily, even those who have a needle phobia. Most of our patients remark how comfortable the procedure is in terms of what they were expecting.
Pain perception is subjective, but your comfort is our top priority during treatments. The main factors affecting how your treatments feel are the skill of your doctor, your pain sensitivity, the type of needle used, the solution used and anaesthetic use.
Some areas are more uncomfortable than others; for example, the ankle, foot, shins and back of the knee can feel a little worse than other areas. If your veins ache before your treatments, it’s likely to be more uncomfortable than veins that do not ache.
There is no right or wrong time to have sclerotherapy. However, during the colder months, you will feel more comfortable in your compression garments. During the recovery period, your treated veins look worse for a while. It may feel more comfortable for you personally to have treatments when you can wear clothes that cover the bruising and pigmentation.
Healing takes several weeks. We recommend having sclerotherapy treatments whenever you feel ready, taking the compression garments and visibility of your treated areas into consideration.
There are several elements to clearing a vein, including the solution used in the injection, the thickness/density of the vein, and your skin type. The technique of injection may also be a factor. We expect that you’ll start to notice changes as soon as two weeks, but it could take several months. Some veins will take two or more treatments to fully clear.
Anyone pregnant cannot get sclerotherapy. We don’t treat pregnant women for several reasons. First, we’re unsure of what effect the solution will have on the foetus. Secondly, pregnancy-driven varicose or spider veins often resolve on their own once the blood volume returns to normal and the pressure on the venous system dissipates.
Those who are unable to move around should avoid sclerotherapy since good circulation is essential for healing and preventing adverse outcomes. Anyone with blood clots should not have the treatments.
If you’re planning to be out in the sun (on holiday at the beach, for example) in the weeks before or following sclerotherapy, you should reschedule your appointment. Tanning after sclerotherapy increases the risk of pigmentation, both in the weeks prior and after treatment. Once bruising has disappeared, you can get a little (safe) sun. Spray tans do not affect sclerotherapy.
Laser treatments are not a substitute for sclerotherapy, with lasers sometimes being more painful and often less effective. Alternative treatments will emerge over time, but at this stage, laser treatments are not as useful as regular sclerotherapy for spider veins.
It is uncommon, but not rare, to get pigmentation spots after sclerotherapy treatment. Up to 30 per cent of patients will see pigmentation occur in treated areas. The factors involved in post-treatment pigmentation are the skill of your doctor, the technique used, the solution used, and the nature of the blood vessels treated. Your skin type also makes a difference.
Pigmentation will usually disappear after a few months; however, at ENRICH, we have alternative treatments for any bothersome pigmentation such as IPL.
Clinics use one of three options:
- Saline solution
- Sodium tetradecyl sulfate
- Chromated glycerine
There are other less commonly used solutions including ethanolamine oleate, hypertonic saline/dextrose, sodium morrhuate and polyiodide iodine.
What to expect – side-effects and complications of varicose vein sclerotherapy treatment
Your legs will look worse before they start to look better, so you should expect to be unimpressed at the beginning. Side-effects may include (rarely) an allergic reaction to the sclerosant liquid, bruising at the injection sites (resolves itself over weeks), along with some redness and swelling around injection sites. You may find your legs itch for a few days.
Some veins may appear much darker after treatment, and skin colour changes can occur due to iron pigments being released from a vein that has been treated. Discolouration will disappear over a few weeks as the pigment is reabsorbed into the body.
A tender lump or two may appear in the treated vein, a sign that the sclerotherapy treatment has been a success. Walking around helps soften these lumps.
Sometimes, a collection of small capillaries may appear, called matting. Matting may resolve on its own, but if not, it will require further treatments. Scarring and DVT is rare. You will be able to drive yourself home after varicose vein treatment.
Sclerotherapy treatment is considered a safe procedure, so risks are minimal when a good practitioner is performing the treatment. We have experienced, specially-trained dermatologists performing sclerotherapy treatments at ENRICH in our Melbourne clinic, so you can rest assured you are in safe hands.
Laser vein removal is becoming a new method of treatment, however each case is treated individually. Speak to your dermatologist about alternatives to sclerotherapy.
Facial veins and facial vein treatment
Facial veins can be treated with laser vein removal treatments. Facial veins typically appear for different reasons than varicose or spider veins, and may require alternative treatments.
Contact our friendly clinic staff today to book a consultation.
*Results may vary from person to person
Spider vein treatment at ENRICH in Melbourne
Our doctors are specially trained in treating small spider veins and nearby reticular veins that are commonly associated with spider veins. A phlebologist can treat other deeper venous problems you may be experiencing, so we can continue on with spider vein or varicose vein treatments.
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Contact our highly qualified ENRICH team today to book a consultation to discuss all your treatment options.