Micro Sclerotherapy

MICRO SCLEROTHERAPY
Spider veins are like varicose veins but smaller. They are also closer to the surface of the skin than varicose veins. Often they are red or purple. They can look like tree branches or spider webs with their short, jagged lines. They can be found on the legs and face and can cover either small or large areas of skin.Spider veins can be caused by hormonal changes, sun damage or local injury. They can also occur as a result of larger underlying varicose veins which are not always visible.
It is suitable for use on thread veins on the legs or body, provided they are beneath the heart. Thread veins on the face are better treated with advanced electrolysis , Intense Pulsed Light (IPL) or laser. As gravity has an effect on the blood in the veins and also as the skin is more sensitive to burns, Microsclerothtrapy is the most preferable treatment for thread veins below the heart.

Injection is a treatment for spider veins which involves injecting a chemical substance called “Fibro-vein” using fine needles. The Fibro-vein  irritates the inner wall of the veins and causes them to become inflamed; the vein walls then stick together and the vein disappears.Is recommend at least 2 treatments for an area of thread veins before any improvement can be seen. It is possible that you may only require one session of treatment; however this is all dependent on the number and severity of veins. It may take a number of repeat treatments before reaching your desired look.

Price for treatment starting from £175 depending on the treated area 
After the procedure, it is recommended to wear compression tights for two week.
Depending on the size of the area and number of veins to be treated, the treatment can take from 20 to 40 minutes. After keeping your legs elevated for 10 minutes, you will be able to go home after your treatment.Is advise that you leave 6 weeks between each treatment session in order for the results of each treatment to be clear.
The injections do tend to sting slightly but they are rarely painful, as only fine needles are used during the treatment. Some people do experience a burning sensation immediately after the treatment, but this usually only lasts a few seconds.
The treated areas may feel slightly sore and itchy for a few days. It is normal for there to be bruising at the injection sites; if you have had multiple injections the bruising can be extensive and may take several weeks to resolve. The veins themselves tend to appear worse and darker after treatment, but this will fade slowly. Although treated veins usually disappear, you may develop new thread veins in the future.
It is not uncommon for the skin over the treated area to develop brown discoloration which can take from 6 weeks to over a year to fade. In rare cases, staining can be permanent.

Contraindications for the treatment:
Unable to walk for any reason, Currently pregnant or breastfeeding, very overweight (obese),Experiencing acute inflammation with/or without blood clot formation (phlebitis/superficial thrombophlebitis) in the vein to be treated. A history of deep vein thrombosis (DVT) or pulmonary embolism (PE).
An infection in the skin on the area to be treated. An infection throughout the body (systemic infection), such as a virus or a cold. Diabetes that is not well controlled. Significant heart disease. Significant peripheral arterial disease. Significant kidney disease. Varicose veins which require surgical/endovenous intervention.
Varicose veins caused by pelvic/abdominal tumours. Currently on medication to thin the blood (e.g. Warfarin).

Contra-Indications
• Allergy to the sclerosant or any other component used.

• Clients unable to walk for any reason.
• Use of oestrogen or oestrogen-based contraception.
• Significant obesity.
• Acute superficial thrombophlebitis.
• Local or systemic infection.
• Varicosities caused by pelvis or abdominal tumours.
• Uncontrolled systemic diseases such as diabetes.
• Significant valvular incompetence requiring surgical treatment. • Cardiac failure.
• Pulmonary oedema.
Side Effects
Due to the fact that the treatment is minimally invasive there are very few side effects. Some minor itching and burning immediately after the treatment is normal and will fade quickly. In rare cases, allergic reaction or infection at the injection site or a complication associated with poor injection techniques. As long as the sclerosant is injected correctly as the correct concentration the only likely adverse reactions are pigmentation and thrombophlebitis.
Adverse Effects List
• Itching
• Swelling & Lumps
• Bruising
• Pain & Burning
• Paraesthesia & Anaesthesia • Pigmentation of the skin
• Neovascularisation
• Thrombophlebitis
• Allergic Reaction
Itching
Itching will occur around the injected area which is mild and can last for a couple of days after the procedure.
Swelling
Swelling can occur and present as raised, red areas at the site of the injection. Swelling will disappear after a few days. Larger veins that have been injected may become lumpy and hard due to a trapped thrombus and can take several months to dissolve and fade. The chance of this occurring can be decreased with the use of proper compression of the vein and the use of compression stockings post procedure.
Hard lumps may form in the treated veins. These are areas of blood clotting in the treated veins and is nothing to worry about but may be associated with inflammation and discomfort.
Bruising
This may occur around the injection site and can last several days or weeks and can be minimised by avoiding aspirin and Ibuprofen products for ten days before and after each session.
Local Pain or Burning
Localised pain or burning may be experienced temporarily. It is common for there to be some tenderness at the injection site. The injection of the sclerosing agent can also be uncomfortable but is usually tolerated well by clients. The feeling should dissipate within 1-7 days.
Paraesthesia and Anaesthesia
This may occur is an injection affects a cutaneous nerve.
Pigmentation
This can occur from superficial thrombophlebitis. It usually fades over a period of a few months and can disappear completely.
Some clients may hyper-pigmentate and some clients are more prone to this than others. Hyperpigmentation can occur in around 10-30% of all treatments. It is usually not permanent but can last for around 18 months. Pigmentation that is permanent should not occur in more that 1-2% of clients.
Hyperpigmentation can happen regardless of the sclerosant used and is caused by hemosiderin staining of the dermis and can look like bruising over or around the treated vein. The pigment comes from the red blood cells that extravasate into the dermis as a result of the inflammatory response or ruptured vessels. Pigmentation may look like spots of lines.
The level of pigmentation seems to be due to the level of inflammation. Smaller veins require less Sclerosant and cause less pigmentation than larger veins.
Neo-vascularisation
Neo-vascularisation also known as telangiectatic matting is the formation of new tiny blood vessels at the site of the micro-sclerotherapy treatment and can occur in around 10% of clients. These tiny veins can appear days or weeks after a procedure and the reason is unknown. If untreated, the matting will resolve itself in 3-12 months and is very rarely permanent. If the matting does not fade it can be re- injected or treated with laser.
Thrombophlebitis
Any procedure where the skin is compromised carries a risk of infection. The chance of infection that may require antibiotic treatment is thought to be less that 1 in 1,000.
Mild thrombophlebitis is not uncommon after sclerotherapy and can be due to the trapped blood in the vein. It is important to remember that a hard sclerothrombus is formed at the injection site as part of the process, however ‘soft’ thrombi may result after micro-sclerotherapy due to trapped blood in the remainder of the vein. Once sclerosed the flow through the vein stops and any trapped blood will form a soft thrombus. This can be reduced by compression post treatment.
Sensitivity and allergies
It is important to ask your client about any allergies or sensitivities prior to carrying out the procedure. If you are uncertain at all then you can test a small area with the sclerosant before a full procedure.
Allergic reactions are rare and usually mild, presenting as a local or generalised rash, urticaria, nausea or vomiting, asthma or vascular collapse.
Anaphylactic shock which can be fatal is extremely rare but can still remain a possibility. Repeated treatments is thought to increase the risk of allergic reaction and may involve intervals of several years between treatments.
Complications
• Skin Necrosis or Ulceration • Pulmonary Embolism/DVT
Skin Necrosis & Ulceration
This complication should be very rare and is caused by injecting outside of the vein and into the surrounding tissues. If the sclerosant is injected properly into the vein then there is no damage to the surrounding skin. If the sclerosant concentration is too high or injected wrong then the tissue cells die which can lead to an area of necrosis which may surface as a small ulcer. This can take several weeks to heal and may leave a scar.
It is very rare when small amounts of dilute sclerosant is used but has been seen with higher concentrations or 3% are used. Provided the sclerosant is injected correctly at the right concentration then ulceration will not occur.
Necrosis is rare when using concentrations of 0.01-0.2% sclerosant which is recommended for thread veins.
Pulmonary Embolus/Deep Vein Thrombosis (DVT)
A blood clot can form that may migrate to the lings or the deep leg veins where is can become stuck (venous thromboembolism) and can cause symptoms or even death. There is an extremely low incidence rate of this type of complication. However, if the solution passes into the deep veins then there is risk of thrombosis. This could be very minor with no side effects or a major blood clot with a risk of pulmonary embolus (passage of a blood clot to the lungs). This is more common when treating larger veins.
Pain Management
When the treatment is performed correctly then the level of pain experienced should not exceed that of any small injection and therefore no local or topical anesthetic is required. Only when some blood leaks out of a vein and into the tissue that the client may experience some pain, this may only occur on larger veins. If an anesthetic is used then it can make it very difficult to visualise the vein.
Aftercare Advice:
• Compression stockings should be worn 24 hours a day for a minimum of 7 days post treatment.
• Avoid hot baths, whirlpools, saunas, and swimming for 48 hours.
• Avoid direct sunlight for 2 weeks.
• Showers are allowed but these should be cooler than user.
• Treated area can be washed with mild soap and water.
• Driving is fine post procedure and normal everyday duties may be resumed.
• A 15-minute walk is recommended immediately after treatment. If you are sitting or standing
for long periods of time take regular breaks to walk or move your ankles for at least 10 minutes.
• Avoid aspirin and ibuprofen for at least 10 days post treatment.
• A follow up appointment is required 6 weeks post treatment.
In rare cases complications may occur.
Should a vein rupture and start to bleed, apply compression immediately and raise your leg, medical assistance should be sought straight away.
Other side effects that need medical attention include:
• Inflammation within five inches of the groin • Sudden swelling of the leg(s)
• Formation of ulcers at the site of injection