Maximizing sclerotherapy's cosmetic results

Key Points

Baltimore - Adequate physical examination prior to treating telangiectasias and varicose veins and applying a timely compression post-treatment are important components of a successful vein procedure. Both can contribute to better and longer-lasting cosmetic outcomes, according to one expert.

"Aside from the obvious cosmetic issues a patient may have with varicose veins, the main goal of treatment for these veins is to eliminate the sources of reflux causing venous hypertension in the superficial venous system," says Margaret A. Weiss, M.D., Maryland Laser, Skin & Vein Institute and assistant professor of dermatology, Johns Hopkins University School of Medicine. "This can readily be achieved by using Duplex sonography, and we routinely use this very useful and reliable diagnostic tool to pinpoint the location of the reflux prior to treating larger varicose veins."

Important caveats

"These veins are under the direct influence of the great saphenous vein, and if patients have a lot of telangiectasias in this area, you should be somewhat suspicious of possibly incompetent veins below the surface. I usually listen for reflux with a hand-held Doppler and listen for reflux augmentation with a Valsalva maneuver. Duplex sonography can be used for more accurate imaging," Dr. Weiss tells Dermatology Times.

Treating telangiectasia

One of the solutions Dr. Weiss often uses to treat telangiectasias is 72 percent glycerin, which she says can achieve very pleasing cosmetic results.

She usually uses this solution to treat those spider veins that are 1 mm or less. The benefits of 72 percent glycerin over other solutions reportedly include significantly less post-procedural matting and hyperpigmentation. When injecting the solution, Dr. Weiss says that it does not sting or cause discomfort to the patient.

Telangiectatic matting is an unwanted yet possible side effect of sclerotherapy. These new, multiple 0.1 mm to 0.3 mm telangiectasias usually occur on the medial aspect of the leg, just above or below the knee. They are very difficult to treat as their diameter is less than a 30-gauge needle. If matting should happen to occur, Dr. Weiss says these vessels can be treated quite successfully with the help of a dual polarizing light device for microsclerotherapy.

Dr. Weiss also uses sodium tetradecyl sulfate in the treatment of telangiectasias and varicose veins. She says this solution can get better results than 72 percent glycerin in larger-diameter veins (>0.6 mm).

"This is a detergent-based sclerosant that can be foamed to increase the contact with the endothelium. Increasing the surface area of the detergent molecules increases the effectiveness of the solution, which allows you to use a lower concentration of the solution. The downside is that there is a higher risk of hyperpigmentation," Dr. Weiss explains.

Avoid hypertonic saline

Though there is no risk of an allergic reaction, Dr. Weiss advises physicians to steer clear of using hypertonic saline in sclerotherapy.

"It is so unforgiving if you extravasate just a little bit, which can cause ulceration. Hypertonic saline is one of the solutions that gave sclerotherapy the reputation of being really painful," she says.

Dr. Weiss says that immediately following a sclerotherapy procedure, she has her patients wear compression stockings. These are to be worn all day for two weeks and only taken off at night, as needed.

According to Dr. Weiss, compression can positively enhance the results of sclerotherapy, helping to maximize cosmetic results. She says compression stockings can significantly reduce the hyperpigmentation sometimes seen in post-sclerotherapy patients.