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I have had four treatments of sclerotherapy and one treatment of laser on my legs. One area on the inside of my knee still has dark red veins visible. Will this improve post-treatment? It has been 6 weeks since my treatments, and my nurse said if this doesn't work they may need to change the serum.
This depends on several factors. Were you diagnosed with venous reflux (via ultrasound)? Also, the number of sessions for sclerotherapy to be successful vary from patient-to-patient. I would encourage you to speak with your physician about your results or lack thereof. You may wish to seek a second opinion if you are still not satisfied after speaking with your physician.
It will likely go on to fade and disappear after that many treatments. I would be patient, as it just may take longer if it was a larger vein. If it doesn't disappear, it may have survived through the treatment and require a higher concentration of the sclerosant solution.
Some patients require 6-8 treatments before spider veins disappear.
You should be using polydocanol 1%. This usually works best.
Yes, four treatments should have made improvement. There may be reflux in larger veins underneath that will only be appreciated with ultrasound. Changing the sclerosant may help.
First, did the nurse check for "feeding' reticular veins below the spider vein complexes? This is done with a vein light (transillumination) in a darkened room. These must be treated or the surface vein treatments won't be as effective. Treatments vary, but one way is to laser the surface veins and then immediately inject the reticular feeders. There are only two FDA approved sclerosants on the market: Asclera and Sotradecol. Both are effective in the right dilutions. If you only have one residual area in the inside of the knee, these can be resistive to treatments. At times, ultrasound examination can show a small perforator vein which should also be injected, and the worst case scenario would show saphenous reflux. A thorough evaluation by a surgeon specializing in vein treatment may be in order.
They could still disappear but it's not unusual to have to try a different concentration or sclerosant if the original one isn't working.
There are many variables in sclerotherapy - the type of sclerosant used, the strength of the sclerosant (it should be diluted to different concentrations based on the size of the vein being treated) and, lastly, every person responds differently - based on the quality of the treatment, and the skin tone, compliance with limited sun exposure after treatment. What does your treating physician say?
It is possible that the particular serum did not work for you specifically and it may be necessary to change it. With some people, their bodies accept treatment with certain serums and not others. Sometimes it takes a little trial and error to find the serum that works for each individual patient. It might take a few more months before the veins completely disappear.
How quickly you notice veins going away post sclerotherapy depends on how much you started with. So the more you have to start, the longer it takes for the practitioner to actually hit all of those veins. Assuming they have hit all of the abnormal veins, I would have expected to see a marked improvement in the way your legs looked after 6 weeks. That being said, there are two possibilities that might explain why they are not gone. First, the practitioner did not treat everything. Two, you have abnormal veins deep in your leg that are feeding into those resistant veins that were never addressed. Did they ultrasound your legs first before any treatment? If not, then find someone who actually does this. Any practitioner who injections you first without ever looking inside your leg first to see what is wrong inside, probably does not really know what they are doing.
If spider veins have been properly injected four times without improvement, it's certainly time for a new approach. A Vein-Lite transillumination device may show an underlying vein below the surface as the culprit. Alternatively, a stronger sclerosant may be indicated, or an ultrasound to look for a deeper "saphenous" vein. Finally, very fine spider veins may respond only to VeinGogh radiofrequency. In any event, surface lasers are rarely used by expert phlebologists for leg veins due to their poor efficacy.
Usually the treatment of spider veins is a process and takes time to see the results. I would recommend that you be certain that you have no underlying reflux which could be contributing to the spider veins not resolving. A venous ultrasound would show this. By laser, I am not sure if this means closure or topical laser treatment. If topical laser, it is not very effective on leg spiders. If you have no underlying reflux, then I agree that the solution may need to be changed or the concentration increased. Also all reticular veins should be treated.