NATURE OF PROCEDURE
This procedure was first performed in the 1940’s, and very little has changed since. A sterile, fresh solution of highly concentrated salt water is injected into the spider veins using a tiny needle. No anesthesia is necessary. In most patients, most of the visible, larger spider veins can be treated in one visit. The Sclerotherapy session lasts about 20 minutes, and up to 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, usually slight local cramping, and generally this passes quickly.
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 or overall is guaranteed. In many cases two treatment sessions will be necessary about a month apart, and then annual maintenance thereafter. There is a fee for each visit. After the veins die they simply begin to fade away and you may begin wearing shorts and bathing suits again without embarrassment.
Alternatives to Sclerotherapy can include surgical stripping of offending veins, radiofrequency heating of the inside of veins, and various other sclerosing solutions. Another alternative is laser treatment of certain spider veins, and Dr. Coverman has different lasers available for this purpose.
LASER VEIN TREATMENT
In 1983, Dr. Coverman became the first doctor in Austin to use lasers on the skin. Lasers can be used to treat spider veins, but certain caveats must be kept in mind: the laser treatment 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:
- Tiny veins too small for the needle or unresponsive to prior sclerotherapy.
- The patient is hepatitis or HIV positive – the laser does not expose the doctor or staff to blood.
- Past history of thrombophlebitis.
In general, Dr. Coverman has tried many lasers for leg veins and none of them seem to work well, despite enthusiastic advertising and hype. Dr. Coverman has found that either they don’t adequately eliminate the vein or they may leave pigmentary changes where the traced over vein is either darker (and worse than the original purple spider vein in the first place) or lighter and whiter. Unfortunately, these changes may be permanent. We have seen many patients at our office that went to “clinics” or “spas” for laser vein treatment, and unfortunately wound up with permanent pigmentary changes. For this reason, Dr. Coverman generally does not recommend any laser for any vein on the legs – in his opinion it just doesn’t work!
For small spider veins on the cheeks and face, particularly the chin and nose, lasers do work and work extremely well! Sclerotherapy or salt water injections is not recommended for the face and either FotoFacial and/or laser therapy works great in this area.