Which veins are suitable for microsclerotherapy?
Firstly, microsclerotherapy should only be considered for thread veins (or spider veins) below the level of the heart.
Microsclerotherapy should not be used on bigger veins such as reticular veins, where other techniques such as liquid sclerotherapy, foam sclerotherapy or phlebectomy should be considered.
Microsclerotherapy should not be used on thread veins above the heart and particularly not in the face. Above the heart, “thread veins” cannot be simple veins as blood would drain away from them back to the heart. Therefore the physiology of these veins is different from that of thread veins below the heart, where gravity fills the thread veins up with blood. In addition, injection into thread veins on the face, particularly around the nose and cheeks, can lead to the sclerotherapy injection draining through the portal veins and into veins around the brain called the “cavernous sinus”. Although rare, if the sclerotherapy solution caused a thrombosis of this structure (called a “cavernous sinus thrombosis”) then the patient would become very unwell and have symptoms not dissimilar to a stroke. As the skin on the face is always exposed to the sun, it is very resilient to heat and radiation and so these veins are best treated by laser, intense pulsed light (IPL) or electrolysis type techniques.
This is the reverse of the thread veins (or spider veins) in the legs. In these thread veins, gravity plays a large part as they are below the level of the heart. Before any assessment of suitability can be made, an ultrasound must be performed to check that there are not underlying varicose veins that are hidden below the skin, filling up and “feeding” these leg thread veins (or spider veins). Treatment of the leg thread veins without first checking for underlying hidden varicose veins feeding into them, can result in failure of the treatment which wastes time and money, but also can result in a worsening of thread veins by red stains. Research from 2001 suggests that up to 89% of people with leg thread veins (or leg spider veins) do have underlying hidden varicose veins feeding into the thread veins (or spider veins) meaning that the majority of people will get suboptimal results from leg thread vein treatments if they do not have a varicose veins scan performed before the treatment and any underlying varicose veins treated before the thread vein treatment.
As the skin of the legs is rarely exposed compared to that of the face, it is very sensitive to radiation and heat. As such, thread veins of the legs are optimally treated by microsclerotherapy but laser and intense pulsed light (IPL) are not optimal as they run the risk of burning this skin which is more sensitive to radiation.