Spider Veins/Vascular - Sclerotherapy

NATURE OF THE PROCEDURE

This procedure was first performed in the 1940's and it has been so effective and easy, very little has changed since. We inject a sterile, fresh solution of highly concentrated salt water into the spider veins using a tiny needle. No anesthesia is necessary. In most patients, we can treat most of the visible, larger spider veins in one visit. The Sclerotherapy session lasts about 20 minutes, and 3 cc's of solution is injected. There is generally no down time, and you may quickly return to normal activities including work, school, and exercise. There is only mild discomfort, often slight local cramping, and this passes quickly by the time the procedure is finished.

Because the salt water is highly concentrated, it will kill the lining of the veins. As these cells die, the body scavenger cells come in and carry the dead vein away and the vessel begins to fade. This may occur over a period of 4-6 weeks, although often you may see some early results the next day. The result in all patients is variable, and no percentage of improvement per vein, per session overall is guaranteed. In many cases two treatment sessions will be necessary about a month apart, and then annual maintenance thereafter. After the veins die they simply fade away and you may begin wearing shorts and bathing suits again without embarrassment.

DR. COVERMAN'S BACKGROUND

Dr. Coverman trained at the University of Washington, one of the top 10 hospital programs in the United States. He is Board Certified in Internal Medicine and Dermatology.

Dr. Coverman has been recognized by the Austin Business Journal as Austin's Top Cosmetic Surgeon. He has trained many other local physicians including family practice doctors on how to perform sclerotherapy, Collagen injections, Botox treatments, and laser therapy. Dr. Coverman has served as laser instructor for Medical Alliance, and has taught plastic surgeons and dermatologists how to perform laser surgery on the skin.

In 1981, Dr. Coverman opened the first physician-supervised skin care clinic and spa in Austin, and in 1983, he was the first doctor in Austin to begin using lasers for the skin. Since then, he has usually been the first doctor in Austin to offer new procedures, new lasers, and new cosmetic therapies.

In 1981, Dr. Coverman became the first dermatologist in Austin to begin performing sclerotherapy for spider veins on the legs and face. He has now performed over 10,000 successful treatment sessions with no complications nor any lawsuits. He has lectured at the annual American Academy of Dermatology meeting, and has been a panel member at that meeting. Dr. Coverman has instructed other Austin physicians how to perform this procedure.

ALTERNATIVES

Alternatives to Sclerotherapy can include surgical stripping of offending veins, new treatment methods within the veins using cautery, and various other sclerosing solutions. Another alternative is laser treatment of certain spider veins, and Dr. Coverman has three different lasers available for this purpose.

LASER VEIN REMOVAL

In 1983, Dr. Coverman became the first doctor in Austin to use lasers on the skin. He now uses three different lasers for spider vein treatment. Lasers can be used to treat spider veins, but certain caveats must be kept in mind: the laser costs more, it is not faster, it is not less painful, and there are just as many potential side effects. Because of the inherent cost of the laser itself, the treatments are more expensive. There is a pinprick type of pain rather than a cramping pain, and each individual vein must be traced over. There are no shortcuts and this becomes more tedious. There is generally no advantage to using the laser unless one of the following conditions had been met:

1. Tiny veins too small for the needle or unresponsive to prior sclerotherapy.

2. The patient is hepatitis or HIV positive - the laser does not expose the doctor or staff to blood.

3. Past history of thrombophlebitis.

FEES

Each treatment session costs $250. This is not covered by insurance and we ask you to please pay on the day of your treatment. This fee is for the entire treatment session, not necessarily just one site.

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

SCHEDULING

Prior to your first treatment, you must have a visit with Dr. Coverman. There is a fee. He will examine your legs, discuss any post treatments if appropriate, and discuss laser vs sclerotherapy for you. He will discuss risks, benefits, alternatives and fees. In general, you will NOT be treated that day unless previous arrangements were made. The actual treatment fee will be IN ADDITION to your consultation fee.

You may call our office and schedule an appointment at any time. Please confirm that you have had your consultation visit with Dr. Coverman and you will be ready to go. The procedure itself takes about 20 minutes, and plan on being here one hour.

There is a $150 non-refundable fee for missed appointments without a 24 hour notice.

PRETREATMENT

HOW TO PREPARE FOR SCLEROTHERAPY:

1. Medications - You may continue with all of your current medications.

2. Shaving your legs - This is up to you - it is a little easier for Dr. Coverman to do this procedure if your legs are shaved.

3. Skin creams - Please don't use any skin creams, oils, or emollients - it makes the procedure more difficult because your skin is slippery.

4. Aspirin - Aspirin products prior to the procedure are okay - in fact, they may even prevent unwanted inflammation later on. Normal over-the-counter doses of aspirin, Aleve, Motrin and so forth are just fine. DO NOT TAKE IF YOU ARE OR MAY BE ALLERGIC!

Do not take any aspirin products if you have any of the following conditions:
5. Dress - BRING SHORT SHORTS WITH YOU - you will be wearing these during the procedure and you may wear them out or change back into whatever you wish.

6. Ace wraps - If Dr. Coverman does extensive areas or larger vessels he may wrap with ace wraps, generally overnight. You might want to wear skirts so that the ace wraps can be applied and you can wear them under the skirt. We will supply these at our cost or you may bring your own.

7. Please try to eat a reasonable meal at least one hour before coming in. Not to the point that you are stuffed and sick, but just to have something in your stomach.

8. Antihistamines - We will give you an antihistamine in the office - usually Claritin or Claritin D or Allegra. If you have these at home, we would prefer that you take one. Take this medicine 2 HOURS prior to coming to the office. Sometimes this procedure can cause histamine release which can cause wheezing. The wheeze is not dangerous, but may be annoying. If you have any "asthma" inhalers at home, bring one with you. This may help prevent that.

9. Leaving the office - You may drive yourself home. You won't be sleepy or in any way incapacitated. You may even go back to work. Some patients may even exercise the day you are treated.

TREATMENT DAY

WHAT YOU CAN EXPECT DURING YOUR OFFICE VISIT:

1. We will ask you to change into shorts at the time of your treatment.

2. Consent form - You should have already READ and SIGNED a consent form. If not, please mention this to Dr. Coverman or his staff.

3. Health history - Dr. Coverman does not perform this procedure on anyone with a history of the following:

a. History of thrombophlebitis
b. Pregnant
c. Severe heart or blood pressure problems
d. Any blood borne diseases such as hepatitis B or C, AIDS, or HIV positive, or syphilis. You will be asked to fill out a form regarding the following:

a. Any symptoms you may have regarding your leg veins.
b. Any obvious signs of disease that you have noticed.

4. Veins - Dr. Coverman will ask you to point out the veins that you would specifically like treated. He may treat others nearby at his discretion.

5. Position - You will be lying down, wide awake, and able to talk to Dr. Coverman at all times. We may play soft music or you may watch TV.

6. Skin preparation - Your legs will be prepped with simple rubbing alcohol.

7. Needle - All of our equipment is fresh out of the package, sterile, and discarded after use on you. No product is ever used on any other patient, and all of your products will be discarded at the end of the procedure including the needle, the syringe, and the actual solution that we used. Each patient gets their own fresh bottle. The needle is the tiniest we can get.

8. What you will feel during the procedure:

a. Cool alcohol swabs
b. Multiple brief needlesticks (our smallest needle!)
c. A brief warm sensation
d. Cramping or burning - This passes quickly. It only lasts a few minutes and by the time you leave the office, the cramping should be completely over with. Dr. Coverman can stop and give you a rest if you wish or can stop and massage the area that is cramping.

POST TREATMENT

1. We will do the following upon completing the procedure:

a. Clean your legs
b. Apply an antibiotic ointment
c. Wrap if necessary
d. Give you a receipt

2. What you can expect when you go home:

a. First few days

1. Pinpoint bruising
2. Some swelling
3. Some aching
4. You may temporarily look worse

b. The first week or two, some swelling of the ankles due to:
1. Poor lymphatic drainage in that area
2. Gravity
3. Normal daily activities
c. First month - slow fading of the vessels d. Second month - even more fading

3. What you should do at home:

a. Usually you may resume normal activities; sometimes you may prefer to have your legs elevated higher than your heart.

4. If you have problems, call our office, or call the Medical Exchange at 458-1121 after hours.

a. If there is persistent or increasing pain, redness, or swelling. b. If there is a sore or ulcer greater in size than a pencil eraser. c. If you have unexplained cough, fever, chest pain, or shortness of breath. d. If there is a red, tender streak anywhere on your legs.

COMPLICATIONS

There can be a sore, a scar, and an ulcer if the solution leaks. Dr. Coverman has never had this happen with 22 years of experience and over 10,000 treatment sessions. There can be light tan pigment over where the veins used to be - if it happens it would be more likely in older women and tends to fade and can be bleached. Sometimes there can be a blush of faint pink vessels where the old ones used to be - perhaps the body is sensing that those vessels have been destroyed and it is trying to make new ones. In general, the blush is always lighter than the original purple spider veins were in the first place, and this tends to fade. It can be reinjected.

There is some temporary cramping which only lasts minutes and should be fully clear by the time you leave the office.

A rare complication can be a deep vein thrombosis (clot). To Dr. Coverman's knowledge, he has never had this happen in ANY patient.

CALL OUR OFFICE AT 345-9411 OR THE MEDICAL EXCHANGE AFTER HOURS/WEEKENDS 458-1121.

Please remember - do not expect dramatic results the first day or even the first week. What you may interpret as an unsuccessful procedure at the third week may have dramatically improved results by the sixth week.

Please also remember that this is intended to gradually fade your vessels - no one treatment session is guaranteed to clear all of your vessels or any given percentage thereof. Certain areas may clear dramatically and other areas may clear less so or even not at all. Usually more than one treatment session is expected, and this will be always at additional full charge.

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