Sclerotherapy and Microsclerotherapy Information

Anyone can suffer with thread (red, spider or broken) veins, and they can appear on any part of the body. Microsclerotherapy is the technique of injecting thread veins with a special substance known as a sclerosant, usually a solution called sodium tetradecyl sulphate that causes swelling in the veins wall. If the vein is small enough, the swelling will destroy the vein over several weeks, making it much less noticeable or even invisible. It is mostly used for leg and other thread veins on the body but is rarely used on the face, where laser or IPL treatments are often favoured, owing to the small possibility of scarring that can occur with microsclerotherapy. In practice, most people require between 2 and 6 treatments at 4 to 8 week intervals, depending on the size of the veins, and 75% disappearance of the veins is expected. Private costs for microsclerotherapy can range from around £150 to £250 for treatment session. Total treatment costs depend upon the extent of the veins and the number of treatment sessions required for improvement.

Background

Sclerotherapy and Microsclerotherapy background information

Anyone can suffer with thread (red, spider or broken) veins, and they can appear on any part of the body. Although harmless, they can cause distress as the sufferer often feels self-conscious, particularly if the veins are on an exposed part of the body, such as the legs, which people can see.

Sclerotherapy treatment was developed in the 1920s for the treatment of varicose veins. This was refined for the treatment of thread veins, and this is what we now call microslerotherapy. Micro simply refers to the very small veins targeted by this procedure. Both these treatments are now very popular and successful.

Treatment of varicose veins is generally considered to be a medical matter and not one for a cosmetic surgeon and so patients are often referred by their GP to a vascular (vein) specialist. For further information on varicose veins and associated leg pump failure which explains the diagnosis and treatment options, please go to www.veins.co.uk.

To help you distinguish between thread veins and varicose veins the following may act as a guideline:

Thread veins

Usually very near the surface of the skin, red, blue, or purple in colour, and less than 1 to 2 mm in diameter.

They are not regarded as a serious medical condition but they can occasionally ache.

Varicose veins

Usually deeper beneath the skin, being skin coloured or bluish - green and more than 2mm in diameter.

They are more serious than thread veins. They can be painful and are a sign of leg pump failure.

Depending on where the thread veins are situated, different treatment options are available. These range from microsclerotherapy which is mostly used for leg and other thread veins on the body (but rarely the face) to microwave treatment and laser or IPL treatments and electro-coagulation or electrolysis. In this section, we are just concentrating on thread vein treatment by microsclerotherapy.

Sclerotherapy is the ninth most common non-surgical cosmetic procedure in the U.S., according to the American Society for Aesthetic Plastic Surgery (ASAPS), with just over 270,200 procedures estimated to have taken place in 2016, a decrease of 16.1% on 2015 statistics.

No reliable figures are yet available for the United Kingdom, but sclerotherapy is still a popular and effective procedure even though newer treatment options have recently become available.

If you are considering microsclerotherapy, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask your practitioner about anything you don't understand.

How Does It Work?

What is Microsclerotherapy and how does it work?

Microsclerotherapy is a technique of injecting thread or spider veins with a special substance known as a "sclerosant", usually a solution called sodium tetradecyl sulphate that causes swelling in the veins wall.

If the vein is small enough, the swelling will destroy the vein over several weeks, making it much less noticeable or even invisible.

Microsclerotherapy is normally used for the treatment of leg thread veins and is rarely used for the treatment of facial veins, where laser or IPL treatments are often favoured, owing to the small possibility of scarring that can occur.

 

Procedure

What happens during a Microsclerotherapy treatment?

The first time you visit a clinic, a detailed discussion with a practitioner should clearly highlight your expectations of the cosmetic effect from this treatment. The practitioner should then be able to tell you if this is how they see the treatment working for you. If your expectations and theirs do not match each other, do not proceed until you are entirely happy with what they are telling you.

The practitioner may then take a medical history to make sure that there are no reasons why you are not suited to be treated with microsclerotherapy. Then you would normally be asked to sign a consent form, which means that you have understood what the treatment may do, and the potential side effects.

Photographs may also be taken by the practitioner that can be used as a “before and after” comparison to show you how successful your treatment has been.

All this may happen in your first visit. If you are happy to proceed further, the practitioner may also go ahead with your first treatment at this time. Equally, you may decide to keep your treatment separate from the initial consultation and not begin the procedure until your next visit.

The procedure

There is usually minimal or no discomfort during microsclerotherapy injections due to the size of the needle and the superficial injection technique.

The solutions used may differ in strength slightly depending on the size of the vessel to be injected. Your physician will decide which solution is best for your particular case.

Following injections, a swab may be taped over the treated area, and often a special bandage and compression stocking is applied which may be worn for several days to help assist shrinkage of the thread veins.

Repeat procedures

A single blood vessel may have to be injected more than once, depending on its size.

Repeat injection sessions can be scheduled one week later, but it is better to wait one month between treatments.

In practice, most patients require between 2 and 6 treatments at 4 to 8 week intervals.

It is common for around 75 percent or more of your veins to vanish, but you should be aware that 100 percent disappearance of all veins may not be achievable.

Recovery

How long will it take to recover from Microsclerotherapy?

The whole treatment should usually take no longer than half an hour or so – depending on how many veins require treatment.

You can normally drive immediately and go about your usual daily activities following this treatment.

Side Effects and Risks

What are the risks and potential complications from Microsclerotherapy treatment?

Some pain or burning at the injection site may occur following injections, and some patients experience restlessness in their legs during the first few nights. This is due to the swelling of the walls of the veins.

For a month or so, the vessels may appear more prominent. The injection sites look like insect bites, and may occasionally itch. The veins gradually begin to fade and continue to improve for up to 8 weeks. After this time, a brownish discolouration of the skin may continue and may take many months to fade away.

Complications following microsclerotherapy are very rare, but the solution can sometimes escape from the veins and cause inflammation in the skin surrounding the treated area. There is also a small risk of the development of tiny ulcers, which may leave a small pink or white scar on healing.

Occasionally you may also find new veins developing in the treated areas, or even old veins flaring up again.

Post-Treatment Advice

What should you do after a Microsclerotherapy treatment?

As we have said, your life can proceed as normal following a microsclerotherapy treatment session, but as with all medical procedures, it is wise to observe the advice of your practitioner as closely as possible to ensure that you get the full benefit of the treatment, and avoid complications.

Post-treatment advice may include:

  • keeping the compression stocking dry and you may be asked to try and raise your legs as much as possible during the first 24 hours;
  • removing the stocking and cotton wool pads after 24-48 hours. Short walks are fine, but try to avoid vigorous exercise for a few days;
  • wearing your compression stockings if advised, for four weeks after the last treatment;
  • avoiding Aspirin-based painkillers and replacing them with paracetamol for six weeks after the last treatment;
  • contact your practitioner immediately if you notice any signs of infection or a sudden increase in pain.

Contra-indications

Who should not have a Microsclerotherapy treatment?

You cannot have sclerotherapy or microsclerotherapy if you:

  • have a known allergy to sclerosants;
  • are pregnant;
  • are taking the contraceptive pill;
  • have a local skin infection;
  • have heart disease requiring surgery;
  • have varicose veins caused by pelvic tumours;
  • have an uncontrolled disease e.g. diabetes;
  • have weak valves in your heart which require surgery;
  • are unable to walk.

Who Can Do It

Who can perform Microsclerotherapy?

Manufacturers recommend that only medically qualified practitioners should use these treatments. Thus you will find many nurses, as well as general practitioners, dermatologists, and surgeons using this treatment.

Manufacturers do not recommend that beauticians or any other person outside the medical profession use microsclerotherapy.

For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.

NHS Availability

Is Microsclerotherapy available on the NHS?

It is highly unlikely that anyone considering microsclerotherapy for the treatment of thread veins would be able to access this free of charge on the National Health Service.

However certain regions do make special cases, and we would always recommend that you visit your General Practitioner before embarking upon a cosmetic procedure involving surgery.

As well as their advice and guidance they may also be able to refer you to a local NHS Hospital who can treat you.

Price

What is the average cost of Microsclerotherapy?

Private prices for microsclerotherapy can range from around £150 - £250 for a one hour treatment session.

Total treatment costs depend upon the extent of treatment and the number of sessions required to make an improvement.

Conclusion

Summary of advice for Microsclerotherapy

Microsclerotherapy is still a widely used treatment and is considered by many clinicians as the treatment of choice for leg thread veins.

Newer alternatives such as lasers and IPL and microwave machines are now available.

Results with this type of equipment are improving and can be comparable to those achieved with microsclerotherapy. As a result of this, and due to the small potential for scarring with microslerotherapy, these alternatives are certainly becoming more popular for the treatment of facial thread veins.

Laser and IPL machines are more suitable if you have large areas of your legs affected by thread veins, and microwave treatment may be a better option for very small thread veins that are difficult to inject.

In general, microsclerotherapy is now mainly used for the treatment of leg thread veins, and most patients require between 2 and 6 treatments at 4 to 8 week intervals.

The success rate is usually as high as 75% or more, but don’t expect to be rid of every single thread vein as 100% disappearance of all veins may not be achievable.

Before and After Pictures

Before and after photographs of Microsclerotherapy

Legs veins before sclerotherapy treatment
After sclerotherapy treatment
Thread veins in the leg before sclerotherapy
After sclerotherapy treatment on leg veins

Images above show thread or spider veins in the legs of females over the age of 40.

Images above so resolution of leg thread veins following sclerotherapy treatment.


Photographs courtesy of Vascular Sugeon, Dr Haroun Gajraj FRCS,

 

Leg thread veins before microslerotherapy treatment.

Improvement in leg thread veins following a course of microsclerotherapy treatment.

Leg thread veins before microslerotherapy treatment.

Improvement in leg thread veins following a course of microsclerotherapy treatment.

Photographs courtesy of Dr David Eccleston, MediZen Limited


Before and after photographs are real patients, your results may differ.