Varicose veins and spider veins affect an estimated 40% of women and a smaller – but, significant, number of men. For some the problem is simply their unsightly appearance but others experience symptoms associated with these dilated veins. Fortunately, most of these unwanted veins – including large varicose veins – can be removed non-surgically by Sclerotherapy. Dr. Green has specialized in the treatment and management of varicose veins and spider veins for more than 25 years. During this time he has successfully treated thousands of women and men by Sclerotherapy. Dr. Green has lectured and educated other physicians on Sclerotherapy and the management of varicose vein disease locally, nationally and internationally and has had scientific articles on this subject published in prominent medical journals.

What is Sclerotherapy?

Sclerotherapy – introduced 150 years ago – is the most consistently effective non-surgical procedure to eradicate unwanted, non-functional varicose veins and spider veins. Although used primarily to remove veins of the legs and thighs, unwanted veins at other sites – including facial veins and prominent veins of the hands and feet – can also be treated by Sclerotherapy.

How is Sclerotherapy performed?

Using a very small needle, a sterile solution (called a sclerosant) is injected into the vein. The purpose of the solution is to produce irreversible alteration to the vein wall. If this is achieved, the vein will be absorbed, weeks to months after treatment, as is illustrated in the photos below.




Is there any harm in removing these unsightly veins?

No. Varicose veins and spider veins are non-functional and their removal does not adversely affect circulation. Their often dilated, tortuous and protruding appearance is indicative of their non-functional status. As such, they pool blood but are not active in its normal circulation. In fact, the removal of these unwanted veins may actually improve the local venous circulation by removing the veins that continuously pool blood.

Does the removal of varicose and spider veins by Sclerotherapy result in the appearance of new varicosities?

No. The removal of varicose veins and spider veins does not, in and of itself, stimulate the development of new veins. By the time varicose veins and spider veins have appeared, normal veins, in the same vicinity, have taken over their function without the need for the body to develop new veins in response to their removal. However, anyone who has had varicose veins and spider veins is likely predisposed to this condition and can expect new varicose veins and spider veins to develop in the future, whether or not pre-existing veins have ever been treated.

What solution is used for Sclerotherapy?

There are two solutions (called sclerosants) most commonly used for Sclerotherapy: sodium tetradecyl sulfate or polidoncal. Both are FDA cleared, specifically to remove varicose veins and spider veins.

Can anyone be treated?

With few exceptions, almost anyone with unwanted varicose veins and spider veins can be treated by Sclerotherapy. Women who are pregnant or nursing are, usually, not treated with Sclerotherapy. Treatment is postponed until after delivery and lactation are completed – except under unusual circumstances.

What can I expect after Sclerotherapy?

Usually mild redness, swelling and tenderness appear along the course of the treated veins. This may persist for a few hours, days, weeks or, rarely, longer depending upon the size and location of the underlying vein. Less commonly, there may be some bruising. After Sclerotherapy, the vein may be palpable as a firm cord within the skin until it has been completely absorbed – this can take weeks to months, depending upon the size of the vein.

Are there restrictions after Sclerotherapy?

No. After Sclerotherapy all normal activities may be resumed, without any limitations. There is no need for leg elevation or any specific exercise program. Compression hosiery may be required, for a one to a few weeks after Sclerotherapy.

How many Sclerotherapy treatments are required?

The number of treatments required depends upon the number and extent of unwanted veins. Usually a vein will respond after one treatment. However, because there is a limit to the quantity of sclerosant that can be administered during any one treatment, if there are numerous veins present, several treatments may be necessary. The number of Sclerotherapy treatment sessions required will be estimated at the time of your initial consultation.

How often are Sclerotherapy treatments performed?

If more than one treatment session is required, they can be scheduled at intervals of 24 hours.

How will I feel after Sclerotherapy?

You should not feel any different after Sclerotherapy and you may immediately resume normal activities. Many patients schedule their Sclerotherapy treatment during their lunch break and may return to work after leaving the office.

Is any testing necessary prior to Sclerotherapy?

Sometimes ultrasound testing is necessary to determine the extent of the varicose veins as well as the condition of the deeper veins that may not be visible. The need for such testing is based upon Dr Green’s findings at the time of your initial examination. Testing is recommended when indicated – it is not routinely ordered for everyone, avoiding unnecessary expenses. In the presence of uncomplicated spider veins, testing is rarely necessary before having Sclerotherapy.

Should I wait until after I have all of my pregnancies before treating my veins?

No, but this is a common misconception. There is no need to wait until having all of your anticipated pregnancies before beginning Sclerotherapy. In fact, it is wise to treat varicose veins and spider veins prior to pregnancy; otherwise, they usually become more apparent and more symptomatic as pregnancy progresses.

Are there any side effects associated with Sclerotherapy?

Sclerotherapy, as with any medical intervention, has the potential for unwanted side effects. Fortunately, serious side effects from Sclerotherapy are rare. The most common change associated with Sclerotherapy is temporary discoloration along the course of the treated vein. It appears as a tan or brown line and should be expected, to some extent, in almost everyone who is treated by Sclerotherapy. It disappears spontaneously, but can take months or longer. Less commonly, dilated capillaries or redness can develop adjacent to treated spider veins. These usually fade spontaneously and only uncommonly persist. A rare complication is the development of an erosion or ulcer at a treatment site, which can take weeks to months to heal, often resulting in a scar.

Is laser treatment an option instead of Sclerotherapy?

Vascular lasers that target blood vessels transdermally – that is, by shining light through the skin – are used to treat Dilated Capillaries (‘broken’ blood vessels, i.e., red, threadlike, that frequently appear on the nose, cheeks and often on the legs). They are sometimes used to treat Spider Veins.  However, Sclerotherapy is, usually more effective than laser for the treatment spider veins (blue or purple vessels that are wider than capillaries), wherever they appear. For further information about laser treatments see Laser Treatment of Vascular Lesions. There are vascular lasers and radiofrequency devices that target and remove varicose veins intraluminally – also known as Endovenous Ablation (EVA) – through a catheter that is placed within the vein. These procedures have all but replaced vein ligation and stripping to remove the Saphenous Veins that course along the inside of the leg and thigh (Great Saphenous Vein) and the back of the leg (Small Saphenous Vein). EVA, unlike vein ligation and stripping, is minimally invasive and can be done with almost no interruption in normal activities. For further information see Endovenous Ablation or Varicose Veins.

Is Endovenous Ablation an option instead of Sclerotherapy?

Sometimes. The introduction of Endovenous Ablation has made the need for surgery very rare. For varicose veins that are present along the posterior (back) of the leg and along the medial (inside) of the leg and thigh, Endovenous Ablation is often the treatment of choice. However, for most other varicose veins and their branches, Sclerotherapy remains a treatment of choice.

Why should I be treated by Dr. Green?

Dr Green has successfully treated thousands of women and men by Sclerotherapy. He has extensive experience treating – and managing problems associated with – varicose veins and spider veins, and has written and lectured extensively on this problem. Dr Green personally evaluates each person – this is not left to assistants. Most importantly, Dr Green administers all Sclerotherapy injections – these injections are never left to anyone else.


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10.32.09: Delegation and Assignment of Performance of Cosmetic Medical Procedures and Use of Cosmetic Medical Devices. This is a Maryland safety regulation which governs who can legally perform medical cosmetic procedures.  Dr. Green administers all injectable treatments (including Botox™, Juvederm™, Voluma™ , Kyblella™ and other fillers & Sclerotherapy) and laser treatments.

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