Microscopic Assisted Sclerotherapy
Microscopic Assisted sclerotherapy is useful to treat larger branch veins that are not visible to the naked eye.
Microscopic Assisted Sclerotherapy
Dr. Kolegraff at re*be® has been using the assistance of the surgical binocular microscope to assist inserting the tiniest needles we have into the smallest veins possible. The technique is successful in veins that previously were not amenable to sclerotherapy as they are often smaller than the needle. Using the microscope to assist the sclerotherapy procedure seems to work and may allow access to smaller veins adding some improvement in technique but is still in the developmental stages. If your veins could benefit from this approach, it may be offered to you but for now this service is only available at re*be® of Okoboji. Sclerotherapy with ultrasound is used for the larger deeper vessels that cannot be seen with a vein light or the naked eye. Visual Sclerotherapy is used for smaller vessels that are closer to the skin surface.
Cosmetic sclerotherapy what you should know
re*be is the area's busiest and most credentialed varicose vein treatment center. Cosmetic sclerotherapy patients are screened for more serious varicose vein problems using a diagnostic ultrasound. There are some medical conditions that sclerotherapy with foam may not be a good idea. The procedure is done by the physicians at re*be. Dr. Kolegraff has an experience of many thousands of sclerotherapy sessions. The procedure works if you do not follow any of our after care recommendations however the results we believe are better if you do. Sun tanning or sun burns to the treated areas after sclerotherapy will greatly increase the chances of long lasting stains in your skin. We would recommend staying out of public pools, hot tubs or swimming holes until after the scabs come off the needle pokes. Tylenol® works well for the minor pain after the procedure as does getting up and walking around. Medication such as Ibuprofen especially right after sclerotherapy can protect your veins from the treatment. This should be stopped a week or more before your treatment and not started back for 3 or more days after the sclerotherapy. Follow up touch up sessions are common especially if you are looking for 'perfection'. Good results can be obtained and will usually be stable for months to years as long as you do not have hidden problems with deeper veins. Failure of sclerotherapy to control the appearance of your surface veins can indicate a more serious problem with your deeper veins.
Preparing for a Cosmetic sclerotherapy visit
Stop taking aspirin or ibuprofen (Advil® Motrin® and other NSAID names)
Medication such as Ibuprofen especially right after sclerotherapy can protect your veins from the treatment. These medications should be stopped a week or more before your treatment and not started back for 3 or more days after the sclerotherapy.
Be sure your skin is clean.
Sclerotherapy involves injections with very tiny needles. For cosmetic sclerotherapy these are the same size we use for our Botox® injections and are about the size of a very tiny wire. A break in your skin will need to heal. Showering the morning of your appointment with antibacterial soap is a good idea.
Do not apply cream or lotion.
Several days before your visit it is a good idea not to cream or lotion your legs. Cream and lotion contains many substances. When the needle passes through your skin during sclerotherapy, the lotion can be injected under the skin. This generally is not harmful just more irritating and can cause tiny red bumps that persist for several weeks after the procedure.
Shaving your legs is not necessary.
We will prepare your skin with alcohol based solution and fresh shaving scratches can be uncomfortable. No one at re*be will be offended by a day or two of leg hair growth.
Wear clean and washable clothes and underwear.
Cosmetic sclerotherapy patients are screened for more serious varicose vein problems using a diagnostic ultrasound especially on your initial visit. We will use a water based ultrasound gel to do this exam and it can get on your clothes and underwear.
Bring your compression stockings.
After sclerotherapy, if you compress the veins the treatment is more effective. Firm support stockings should be worn for two weeks after the procedure. Those of us at re*be prefer to use thigh high or panty hose prescription strength (Class II 30-40 mmHg). We will try to sell you a pair if you do not already have some. The non-prescription socks will work but the compression is not as complete. If you are planning on several sclerotherapy sessions, owning a pair of compression stockings is a good investment. There are some medical conditions that sclerotherapy with foam may not be a good idea.
Wear comfortable walking or running shoes.
After your sclerotherapy session, we will ask you to walk on our treadmill for 20 min. You may choose to walk outside or in a shopping mall as well. Walking after the procedure is important to get your circulation moving, get your socks comfortable and to reduce the chances of a deep vein clot.
Bring your insurance cards and insurance plan information.
Cosmetic sclerotherapy is not likely to be covered by your insurance. The doctors at re*be will examine you and take a medical history. If other conditions that are covered by insurance are recognized, you may be offered treatment for them. It is common to find an abnormal skin mole and a biopsy can easily be done on this at the time of your cosmetic sclerotherapy visit.
After Care Instructions
Wear your socks.
Wear them three days, night and day. You may shower with your socks on. Wash them with soap and water like your skin, rinse them as well. They will dry in about 20 min. Sclerotherapy greatly irritates the inside of the vein. It is very important to stop the flow in the blood vessels that were treated with sclerotherapy. If any flow returns to the treated veins they will heal up and the sclerotherapy will not be effective. The compression stockings are designed to stop the flow in the treated veins and also serve to support them after treatment. This makes the treatment more effective and comfortable.
Do not apply cream or lotion.
Several days after your visit it is a good idea not to cream or lotion your legs. Cream and lotion contains many substances. When the tiny scabs over the needle pokes come off, creams and lotions can then be safely applied. This well usually be 2-5 days.
Shaving your legs is not necessary.
When the tiny scabs over the needle pokes come off, shaving can then be safely done. This well usually be 2-5 days.
Tylenol® works well for the minor pain.
After the procedure, we will have you walk for 20 minutes. Walking with support stockings on works well to help reduce the discomfort. Medication such as Ibuprofen will not be a good idea for the first three days after the procedure. These compounds can actually protect the veins from the sclerotherapy and reduce the effectiveness of the treatment.
After sclerotherapy, if you compress the veins the treatment is more effective. Firm support stockings should be worn when walking for two weeks after the procedure. Walking is good for you, helps with the pain and may reduce swelling somewhat.
Do not wear high heels. The muscles in your calf and foot need to relax to pump blood effectively through the deep veins in your leg. High heels do not allow this pump to work effectively.
Do not tan.
After sclerotherapy, staining of your skin from the breakdown of the blood and treated veins produce iron oxide. Iron oxide is commonly known as rust and is a brown color. Sun damage can cause staining of your skin like a tattoo with the iron oxide. Sun damage causes numerous other health problems and should be avoided for those reasons as well. Sun tanning after the bruising, redness and discoloration from the treatment is resolved will be less likely to cause staining. Spray tan or cream lotion tanning is not a problem once the needle pokes have healed.
After sclerotherapy, alcohol will dilate the veins. If blood flow is not stopped in the veins, they will return. Alcohol is not recommended for this reason. This recommendation should be followed for at least the two weeks the socks are warn. Alcohol is bad for you anyway for many other reasons.
Avoid warm bath or showers.
After sclerotherapy, warm water will dilate the veins. If blood flow is not stopped in the veins that are treated, they will come back. Cooler than normal shower is recommended for this reason. This recommendation should be followed for the two weeks the socks are warn.
Stay out of lakes, rivers, and public Jacuzzis® and pools
When the tiny scabs over the needle pokes come off, the risk of an infection from these sources is very low. This well usually be 2-5 days when this recommendation should be followed.
What's normal after sclerotherapy?
The sclerotherapy medication is irritating and is designed to be that way. It is normal to get hive-like swelling in the area around the injections sites. These hives usually clear within hours and are much less irritating as soon as your compression socks are on. Treated veins close to the surface of your skin also will get red. This clears with time but can take several weeks.
Lumpy sore veins.
Sclerotherapy clots the vein and this causes lumps. These lumps can be tender and can get red. They also can appear out of nowhere even several weeks after a sclerotherapy session. The lumps generally resolve over weeks to months. If they are very uncomfortable or the skin over the lump swells, turns black or gets shiny draining the lump can be necessary.
Some of your injection sites will develop bruising. This is normal and does not indicate a problem. It will be more intense and the bruises bigger if you are taking aspirin or ibuprofen or some other blood thinner. Bruising should generally clear in 2-3 weeks or less.
Swelling after cosmetic sclerotherapy should resolve quickly. The swelling also should be around the immediate area of the treated veins. Swelling that involves the entire foot, calf or ankle is not normal and could indicate a deep blood clot. Deep clots are dangerous and should be checked by a Doctor.
Staining after cosmetic sclerotherapy should resolve over time. Minor staining in very surface veins is normal also should be around the immediate area of the treated veins. Staining that lasts longer is more common in individuals with heavier pigmented skin. Unfortunately there is no good treatment for staining after sclerotherapy but most cases do get better with time. Again avoiding sun exposure especially soon after sclerotherapy can minimize this problem.
Some veins will remain.
Sclerotherapy for cosmetic purposes is very effective, in some cases 80% of the vessels treated will go away. Not all the treated vessels will go away and follow up sessions are necessary for further clearing of any unwanted veins.
Numbness after cosmetic sclerotherapy should be rare and is likely due to the needle poke bruising or cutting small nerves in the skin. This type of numbness should be in the area just at the treated vein or below it. When the numbness resolves, the nerves get very irritable just before they recover completely. Tincture of time is the best treatment usually.
What's not normal after sclerotherapy?
The sclerotherapy medication is irritating and one if the signs of irritation is a low grade fever. A temperature of 100.5° or less is usually not an indication of a serious infection. If you have a fever higher than this in the week after sclerotherapy, especially when associated with redness and marked pain, a more serious infection can be present. This would require medical attention.
The sclerotherapy medication is irritating and is designed to be that way. It is normal to get hive-like swelling and red in the area around the injections sites. Redness that spreads way beyond the injection site especially when associated with marked pain that is not relieved by walking or Tylenol® can be a sign of an infection. This requires medical attention.
Lumpy sore veins with shiny or black skin over them.
Sclerotherapy clots the vein and this causes lumps. These lumps can be tender and can get red. Lumps that do not resolve, or you cannot get comfortable with can need to be drained. If the lumps cause enough painful pressure on the overlying skin that the skin turns dusky or dark, generally will do better if the vein is drained. This is a minor office procedure but does require medical attention.
Some of your injection sites will develop tiny amounts of drainage. Bleeding after sclerotherapy that does not stop is not normal and does indicate a problem requiring medical attention.
In the past and in those clinics that are still using a lot of hypertonic saline injections ulcers of the skin were common following sclerotherapy for any reason. With the switch to soap based foams for the sclerotherapy solution ulcers can and still do occur but are usually rare, small and heal with little or now difficulty. If you do get an ulcer or scab at an injection site that is slow to heal, we would like to see this at your next visit. Ulcerations unfortunately can leave small scars on your skin that are difficult to improve once they are healed.
Swelling of your lower leg or foot.
Swelling after cosmetic sclerotherapy should resolve quickly. Swelling that goes way beyond the treated veins is not normal and can be a sign of a more serious problem. Swelling that involves the entire foot, calf or ankle could indicate a deep blood clot. Deep clots are dangerous and any significant swelling after cosmetic sclerotherapy should be checked by our staff at re*be.
Spider veins fail to clear.
Sclerotherapy for cosmetic purposes is very effective, in some cases 80% of the vessels treated will go away. If an abnormal number of veins fail to clear, this can be an indication of more significant problems in veins that are deeper and do not show on the surface. It is important to go to a certified peripheral venous diagnostic center like re*be to check for abnormal vein valves.
Staining after cosmetic sclerotherapy should be minor resolve over time. This photograph is a foot that was sunburned during a trip to Mexico shortly after sclerotherapy. The deep dark stains are rust (iron oxide), they behave like a tattoo. When this occurs, it is expected to lighten up eventually but takes much longer (1-2 years maybe more).
Numbness after cosmetic sclerotherapy should be rare and is likely due to the needle poke bruising or cutting small nerves in the skin. This type of numbness should be in the area just at the treated vein or below it. When the numbness resolves, the nerves get very irritable just before they recover completely. Tincture of time is the best treatment usually however if the irritability gets worse with time and it is not possible to get comfortable medical attention is necessary. A condition called reflex sympathetic dystrophy is very rare but treatment early can make a difference so medical attention is a good idea.
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