Micro sclerotherapy for leg veins
Thread veins versus varicose veins
Thread veins should not be confused with varicose veins which bulge under the skin looking lumpy and twisted. Varicose veins may ache and throb while thread veins are cosmetic blemishes causing no physical pain or discomfort. Most patients presenting for treatment of thread veins do not have varicose veins. However, thread veins and varicose veins may develop in the same individual and occasionally thread veins appear after varicose vein surgery.
What causes leg thread veins?
The exact cause remains unknown but it is agreed that thread veins tend to run in families (genetic predisposition) commonly appearing during pregnancy (high oestrogen levels may be a factor). Other factors include increasing age, excessive sun exposure and prolonged steroid treatment. As mentioned previously, thread veins may develop following varicose vein surgery.
Do thread veins respond to creams or herbal medications?
Lotions making claims of, “a unique blend of active ingredients”, are frequently advertised on the internet and in women’s magazines. These include horse chestnut extract, vitamin K and other so-called “active ingredients”. There is no scientific evidence to support the claim that these preparations strengthen the walls of the capillaries and provide any improvement.
Would concealers help?
In skilled hands, make-up can be effective in concealing thread veins. There are many preparations available such as covermark, dermablend and boots covering cream. Sun tanning and fake tan can also reduce the prominence of thread veins.
What is Microsclerotherapy and how does it work?
Microsclerotherapy remains the most reliable and effective treatment for leg thread veins. The treatment involves the injection, under magnification, of concentrated salt solution (or other sclerosing agents). A series of microinjections are given using very fine needles. The salt damages the vessel lining causing it to gradually close off. The damaged blood vessels are slowly removed by the body’s healing process. The full effect of the injection takes 6-8 weeks to show.
What is the procedure?
Microsclerotherapy is an outpatient procedure given with the patient lying down. All the veins that need treating are marked out and baseline photographs are taken. Minute amounts of concentrated salt water are injected using very fine needles. The operator wears magnifying glasses (loupes) to ensure accurate placement. No special bandages or stockings are required. Occasionally, small pieces of foam are taped over some of the injected sites to encourage early closure.
Is Microsclerotherapy painful?
Most patients report acceptable levels of pain or discomfort. To minimise pain, the concentrated salt solution is mixed with a local anaesthetic before injection. Patients are advised to take a couple of Paracetamol tablets 1 hour prior to treatment.
What to expect after Microsclerotherapy?
Soon after completion of the injections, the treated sites look like insect bites. This settles down quickly. For a few days, the injected vessels may appear prominent but after that they start to change from red/purple to brown before fading. This process usually takes 6-8 weeks. Patients can drive immediately and go about their usual daily activities following this treatment but are advised to avoid very hot baths/ saunas and exercise for 72 hours after the treatment. Patients undergoing extended sessions should avoid long haul travel for few weeks.
How many sessions of treatment are required?
During a session of treatment, all veins that are suitable for injection are marked out and treated. Most patients get worthwhile improvement after one session. However, repeat treatments, given at 6-10 weekly intervals, usually result in further reduction in the number and prominence of the veins. The total number of sessions required to complete a course of treatment depends on the extent and density of the thread veins. An average of three sessions is usually required with some 60-80% improvement. Complete disappearance is exceptional. Rarely, the treatment has little or no effect.
Do patients require special investigations prior to Microsclerotherapy?
Most patients do not require any special investigations prior to having their first session of treatment. Occasionally, after clinical examination a Doctor may order a Doppler or Ultrasound scan to exclude underlying “invisible” larger feeding veins. If varicose veins are also present it is advisable that these should be treated first.
What are the risks/ side effects of Microsclerotherapy?
Microsclerotherapy is safe and most patients experience no complications.
Mild swelling around the ankles/ knees during the first 24-48 hours is occasionally reported by patients undergoing extensive treatment.
Very rarely a small area of skin may react to the injection with blistering and scab formation. This usually recovers over time although a small indented pink or white scar might persist.
Temporary pigmentation (brown staining of the overlying skin) occasionally follows the injection of large diameter thread veins. It may take several weeks to fade but is unlikely to be as unsightly as the original vein.
Telangiectatic matting is a paradoxical reaction to the injection treatment caused by the formation of extremely tiny blood vessels giving the appearance of a bluish or red bruise. This usually disappears without requiring further treatment within 6–12 months. Occasionally, laser therapy is required to deal with residual veins that are too small to inject.
The amount of concentrated salt water used for the injections is tiny and gets progressively diluted as it reaches the deep venous system. Nevertheless, extra care is taken when extended treatment is given to patients who are on the contraceptive pill or have a history of deep vein thrombosis.
Microsclerotherapy cure versus control
Unfortunately, some people are predisposed to produce thread veins and may continue to do so even after successful treatment. Treatment does not prevent new thread veins emerging over a period of time.Does microsclerotherapy impair the circulation to the skin?
Thread veins that are removed by micro injections are redundant and their removal does not impair the circulation of the skin in anyway.
Would laser treatment be beneficial?
While laser therapy is the treatment of choice for facial thread veins, it does not work very well on average leg thread veins. This is because leg thread veins are usually of a larger diameter and at a relatively deeper location. There is more risk of pigmentation (or permanent areas of whiteness) after laser particularly in dark skinned individuals. Also, with laser therapy, the patient has to avoid sun exposure before and several weeks after each treatment session. There are certain types of leg thread veins that appear like a permanent rash, particularly around the ankles, that respond only to laser (arborising telangiectasia). Laser may also be considered in individuals with needle phobia or when the thread veins are so small that micro injections cannot be given even under magnification.
Images below show a patient with arborising telangiectasia treated with the pulse dye laser.
Is a formal consultation necessary?
Some individuals may be satisfied with the information presented and feel ready to proceed with the first session of treatment. However, a consultation with a specialist to assess the degree and extent of the thread veins, their suitability for micro injections and possible need for investigations such as Doppler or Ultrasound scan may be required. Other aspects of treatment, viewing a range of before and after results as well as examples of potential side effects, approximate cost/ number of sessions required etc is desirable. Sometimes it is possible to combine the consultation with the first session of micro injections.
The opinions and images presented are those of Mr Awf Quaba and are based on his own experience and on an article written for a text book on venous diseases and review of the medical literature.