Mapperley Park Clinic

Threadveins

Treatment for Leg Thread veins

What are thread veins?
Thread veins, broken veins or telangiectasia are the small red or blue veins which can appear anywhere on the body but are most common on the face and legs. Facial vessels are always treated by laser. For more information on the facial laser treatments see the page entitled 'Facial Veins and Blemishes'.

Thread veins can appear as single veins, widely dispersed or as a collection of broken veins close together. They can also appear as a collection of vessels arising from a single point; these are known as Spider Naevi.

There are currently two main methods available to treat thread veins: sclerotherapy (the injection of a sclerosing agent into the vessels) and laser treatment. We can treat using sclerotherapy, any of our four lasers and light systems, or a combination treatment.

Why do thread veins develop?
Thread veins are caused by a variety of factors including exposure to ultra violet light, wind and extremes of temperature. Steroid creams and the hormonal changes that occur during pregnancy can also induce thread veins.

Some individuals are genetically more prone to develop thread veins than others and some people are more at risk because of old injuries or because they have occupations where they stand for long periods and develop leg veins. It is possible that hormone treatments, such as the contraceptive pill and HRT can increase the likelihood of forming thread veins.

Can all thread veins be removed?
By combining laser and sclerotherapy treatments, we are able to maximise our ability to clear thread veins. However, some very large veins or varicose veins may need to be dealt with prior to treatment on the thread veins. You will be advised in advance during consultation if a consultation with the vascular surgeon is recommended.

Will I have to have laser treatment?
Sclerotherapy is only used on leg veins and is not suitable for all people; selection is usually dictated by the size and distribution of the veins. The initial assessment allows the assessor to inspect the treatment site and select the appropriate treatment.

Which laser would be used?
We use a diode laser, to remove blood vessels up to a diameter of about 2mm or a long pulsed Nd:YAG for larger vessels. Very fine "blushes" of vessels can sometimes be treated with a pulsed dye laser.

How does the laser work?
All lasers work by producing light of a very specific wavelength. If the wavelength of the laser is matched to a target colour (such as the red of blood in the blood vessel), the energy of the laser is absorbed specifically by the target but not by the surrounding tissues.

The diode and the Nd:YAG lasers deliver a series of focused energy pulses generating heat for very short periods of time; this energy closes down the thread veins, without perforating them; it is rather like spot welding.

The pulsed dye laser delivers a larger spot of energy that heats target vessels in the area to destruction, causing bruises to appear. This effect makes the laser most suitable for red flares of vessels and those conditions that do not respond to treatment with the diode.

In either case, the damaged veins are gradually dissolved and removed by the body's immune system over several weeks after treatment.

What is laser treatment like?
The laser is fired in short bursts at the thread veins. This feels like a hot pin-prick on the skin, and some patients may find this uncomfortable; paracetamol taken 1 hour before treatment may help. During and after treatment the skin is cooled to reduce discomfort.

What can I expect after laser treatment?
This depends on the laser. With the diode and Nd:YAG lasers, the treated veins will be immediately less visible than before treatment. There may some skin reaction in the form of a light crusting that can develop after a day or two and rarely slight blistering can occur. With the pulsed dye laser, bruising is present which may take up to two weeks to fade away completely.

How many treatments will I need and how often?
The number of treatments needed will depend on the site and the extent of the affected area and will be estimated at your consultation. It is unusual for less than 2 treatments to be required. Treatments are usually planned at four week intervals.

What are the possible complications of laser therapy?
In general, laser therapy is safe and effective. Complications do sometimes occur but the risk of scarring is very low. We have been using a range of 5 different vascular laser/IPL combinations for more than 10 years and have had only five cases of pin-point scarring, due to clients picking off crusted areas.

Other side-effects may include: blistering and fine 'crusting', particularly on very fine vessels. The area around the ankle is more likely to have complications than other areas, as the skin is thin and fine.

It is very important that you give details of any medication you are taking, and any medical problems you have, which may be relevant to the treatment. We do not carry out treatment in patients who are tanned or recently exposed to UV.

What is sclerotherapy?
Sclerotherapy is the injection of a sclerosing liquid, through an extremely fine needle, causing microscopic damage to the cells lining the vein. The internal walls of the vein become 'sticky' and close up. This prevents further flow of blood through the vessels. The body's own immune system then clears away the dead vessels.

What does it feel like?
The sclerosing agent is used in tiny amounts and causes a brief stinging sensation as the agent enters the vessels.

What happens after sclerotherapy?
For a day or two after treatment the injection sites look rather like insect bites, but these subside quickly. Small bruises will be visible at the injection sites but will fade within a week or two. For one or two weeks the veins will probably appear more prominent than before treatment but will then usually begin to fade and continue to do so for up to eight weeks or longer. From 4 to 6 weeks later, remaining veins can be re-injected to reduce them further.

What are the possible complications of sclerotherapy?
Complications of sclerotherapy are rare but can occur. Following treatment some patients develop brown discolouration of the skin, which is due to the deposition of an iron-containing pigment (haemosiderin) in the skin. This pigment may take time to fade away or, in very rare cases, can be permanent, although we have never experienced this. In some cases it is possible to reduce the staining with a different sort of laser treatment.

Other much rarer complications include a reaction to the agent, causing inflammation at the injection sites. If these are not treated correctly, small superficial ulcers can form. In our experience, this is extremely rare.

For these reasons, pregnant or breast feeding women will be asked to postpone treatment and patients taking certain medications (such as anticoagulants) will be advised against sclerotherapy. All clients are given a medical evaluation and post treatment advice to minimise any risk of complications.

What can I do after treatment?
If the treated area is a little sore or dry then the application of aloe vera gel may help. After both laser therapy and sclerotherapy it is quite safe to perform normal daily activities and gentle exercise is encouraged, with the exception of swimming which should be avoided until the skin is completely healed. You will be required to wear a pair of surgical stockings or tights for seven days following your treatment. These are available for purchase at the clinic.

Work-outs and weights should be avoided as the increased blood pressure will put extra pressure on the treated veins and can render the treatment ineffective.