Cosmetic Sclerotherapy

What to expect during a sclerotherapy session?

Sclerotherapy or spider vein treatment is an office based procedure and takes 10 - 30 minutes to complete. While lying on an examination table, the treatment area of your legs will be cleansed with an antiseptic solution. The needles that are used for reticular and spider vein removal are very small, in fact the smallest available needle. A special skin illuminating device is used to illuminate the skin from beneath, allowing the sclerotherapist to locate even the tiniest veins as well as hard-to-find deeper reticular veins that serve as feeder veins for superficial thread or spider veins. The technique is known as transilluminated Sclerotherapy because the device transilluminates the skin making it translucent. Effective treatment of reticular feeder veins may improve the cosmetic result and reduce residual visible veins. Surface laser treatments act on the visible veins at the skin surface and do not address these deeper feeder veins, which is one reason results can be disappointing when the feeder veins are left untreated. Bring short pants to wear during your treatment and loose fitting long pants or a skirt for afterwards.

Your assessment is performed by Dr Johan Blignaut and includes duplex mapping before treatment is recommended. Treatment is selected according to your venous anatomy, not simply according to the veins visible on the skin.

Preparation and Recovery after sclerotherapy?

Tell us if you take aspirin, clopidogrel, warfarin, rivaroxaban or any other anticoagulant or antiplatelet medication. Do not stop prescribed medication unless specifically instructed to do so by your doctor or treating team. These medicines can increase bruising after sclerotherapy, but that is usually a minor and acceptable trade-off, and any change to them has to be a medical decision made with the doctor who prescribed them. Please also tell us about over-the-counter anti-inflammatories and supplements such as arnica, fish oil or high-dose vitamin E, which can have a similar effect. Avoid all tanning. Shaving or waxing your legs is a good idea, but do it at least a day or two in advance. On the day of your appointment, bring short pants to wear during treatment and long loose fitting clothing for after treatment. Afterwards avoid heavy lifting, strenuous exercise and hot baths for 2 days. Daily walking is very good and you are encouraged to walk at least 45 minutes every day for a couple of weeks. Compression therapy in the form of class 2 stockings will be provided afterwards and will improve results.

Foam sclerotherapy vs cosmetic sclerotherapy

Foam sclerotherapy is a mix of the sclerosant chemical and air, to produce a foam, that is injected. This is suitable for the treatment of bulging varicose veins or large veins.
Cosmetic sclerotherapy is a liquid based sclerosant solution that is injected into fine reticular and spider veins.

Who are good candidates for sclerotherapy?

Men and women of all ages who are suffering from unsightly spider veins and reticular veins(slightly larger blue veins) are good candidates for sclerotherapy. If you are pregnant or breastfeeding, it is advisable to postpone your sclerotherapy, as safety is not established. Read more on varicose vein management during pregnancy Many pregnant women experience dramatic and spontaneous improvement in the months following delivery, making their treatment simpler, and sometimes unnecessary. Patients who have an allergy to the sclerosant or who have a deep vein thrombosis (DVT) are not suitable candidates. Sclerotherapy has a well established place in modern practice, principally in the treatment of spider veins and their reticular feeder veins, and of residual or recurrent veins following other treatment.

Dr Blignaut will examine your legs, review your medical history and the severity of your condition to determine the best spider vein treatment procedure, or combination of treatments, for you.

What are the risks and is it safe?

In expert hands, sclerotherapy is very safe. Serious side effects like DVT, allergic reactions and skin ulceration are rare. More common side effects of sclerotherapy are mild and temporary, these include:

• Swelling, redness, tenderness and itching
• Minor bruising, retained dark blood in treated veins
• Brown pigmentation and matting

Brown pigmentation is reported in roughly 10 to 30% of patients¹. It resolves spontaneously in most cases, with around 70% clearing by six months and almost all within a year¹, although it can occasionally take longer. Light based treatments like IPL sometimes help expedite the process. Matting, sometimes called telangiectatic matting or neovascularisation, is a recognised side effect of sclerotherapy, reported in approximately 15 to 20% of patients in published series¹². Matting refers to the formation of many new micro-fine spider veins that are very difficult to treat. Matting is usually temporary and resolves over several months¹. Reported risk factors include higher body weight, hormone therapy, a family history of venous disease and a longer duration of spider veins². It is also more likely where there is undiagnosed underlying venous reflux, which is why a duplex scan is performed first. Where significant reflux is found, this is usually treated before the spider veins are addressed³.

Sclerotherapy cost and pricing

Cosmetic sclerotherapy for spider veins is not generally funded by medical schemes in South Africa, and is payable by the patient. Current session pricing is available from our reception teams at any of our centres.

Cosmetic sclerotherapy is performed by registered nurse sclerotherapists trained by Dr Blignaut, and is billed per session. Foam sclerotherapy is a different treatment, is performed by Dr Blignaut, and may be medically indicated in some patients; pricing is available on request and a consultation is required beforehand.

For more on how funding works, see our medical schemes and pricing page, or contact your nearest vein centre.

References

1. Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy: etiology, prevention, and treatment. Dermatol Surg. 1995;21(1):19–29. PubMed 7600016
2. Davis LT, Duffy DM. Determination of incidence and risk factors for postsclerotherapy telangiectatic matting of the lower extremity: a retrospective analysis. J Dermatol Surg Oncol. 1990;16(4):327–30. PubMed 1691217
3. De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. ESVS guideline

Spider vein Sclerotherapy video

Clinical case examples

View Gallery of Before and After Pictures

Read patient testimonials