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Physician Clinical Exchange > Leg Veins Stab or ZAP?

Interested in doing leg veins. I have not had any formal training in sclerotherapy and I am a bit leary having read a number of papers and the side effects of injecting. Pls correct me if I am wrong, but I believe the foam is the best for bigger veins that don't need excision/ligation, but would you use it for smaller 2-4mm feeder veins? Or use non foamed product. Would you leave them for 2 weeks then zap?? or longer?

My intention is not to treat bigger veins but refer them on to a surgeon etc.

10.9 | Unregistered CommenterDavid

Robert Weiss puts on a comprehensive one day course every couple months where you can learn everything you need to know for vessels up to about 3.5 mm diameter. He advocates combining sclero with 1064 long pulsed Nd:YAG laser. I think it would be worth the time and money to get started on the right course so you are optimizing your treatments and avoiding problems. You can get astonishing results for garden-variety leg spiders and telangiectasia by using the right laser parameters and techniques.

Laser vs. Sclerotherapy by patient choice: Sclerotherapy less painful as voted by my patients that have done both. I don't use my Yag laser anymore.


Sclerotherapy. I am trying to get appx dilutions for STS for foam sclerotherapy. Can anyone post recommended dilutions v's size please


01.22 | Unregistered CommenterDavid

Complicated issue
basically I treat LSV and SSV and very large branch varices with 3% 1:3 with air
Retics 0.3% 1:4 mix with air
teles with 0.12% PLAIN
Be careful - I think there is an increased risk of matting and haemosiderin with retics with foam and many are still using 0.3-0.4% plain for these - stronger soln for below knee
does that help?

01.28 | Unregistered CommenterTopher

Thanks Topher.

I dug around for some papers again and came up with .15% for <1mm, .25% for 1-3mm, .5% for 3-6mm

Any other tips.


01.29 | Unregistered CommenterDavid

I have the European Consensus Statement on foam sclero - as published Feb 08 - if you email me I can send to you. Very very detailed but a little conservative I feel. Are you able to post your email address here??

01.29 | Unregistered CommenterTopher

Hi Topher

Heres my email

If u contact me I have a couple of useful items too.


01.29 | Unregistered CommenterDavid

Would you be able to email me that paper too?
I also prefer to do Nd Yag on leg spider veins ( too time consuming and sometimes more painful if you use injection sclerotherapy)...but for larger reticular veins, definitely foam sclero.

05.3 | Unregistered CommenterRyanT

Hellos David,
If you are still interested in doing leg spider and varicose vein treatment and need help, please don't hesitate to contact me. I am using sclerotherapy, foam sclerotherapy, laser vein treatment on daily basis and I am willing to help. You can reach me by visiting the contact page of Nu Vela Esthetica, a Medical Spa and Vein Clinic located in Porter Ranch CA.

Hi Raffi,

I'm in Southern California (actually in the SFV) and wondering if you'd be willing to to help me, a newly trained physician, learn some procedures.


Would you mind e mailing me that paper as well?? you!!

04.14 | Registered CommenterLAJ

PacificMedDoc "I don't use my Yag laser anymore

Would you still use YAG laser to treat vessels smaller than the injection needle.

04.14 | Registered Commentercharlie

Chris qld,

I use sclero for about 95% or more. A 31 gauge needle will fit in just about any size vein. I rarely use my yag for leg veins any longer. I do use it for facial veins though. The laser does not do as good a job as sclero on leg veins. The increased pressure found in the venous system of the legs is likely the reason.

For sclero you have 3 choices for sclero, polidocanol, sodium tetradecyl sulfate and hypertonic saline. Most phlebologists use STS or PD. PD just received FDA approval. You will find that HS is the most painful and also the most likely to cause ulceration of the skin.

I have done well over 2000 sclero sessions both ultrasound guided and visual sclero. I currently use foam STS and only use liquid in patients with a PFO or history of previous visual changes with foam sclero. Liquid sclero mixes with the blood immediately where the foam does a better job of pushing the blood out of the way and contacts a larger percentage of the vein lumen.

04.15 | Unregistered CommenterLH

"The increased pressure found in the venous system of the legs is likely the reason."

Thanks LH. That makes sense. What about if Q-Switched Yag is used instead of long pulsed. QS Yag ruptures the spider veins while long pulsed coagulates the veins. The latter may be reopened due to high pressure. I think that the reopening of the treated vessels shouldn't happen to the veins that have been structurally destroyed by QS Yag. Any thought about this?

04.15 | Registered Commentercharlie


The Q will only work on very fine veins. Actually, I own 3 Q-switched lasers and feel they do a very poor job on any type of veins. I have tried them on facial telangectasias, venous matting and port-wine stins with minimal to no improvement.

The advantage to the long pulsed yag is that you can put the energy in over a longer period of time which coagulates the vein. It is like running your hand through the flame of a candle. If you run it through fast (like the Q) it does not hurt but if you do it slowly (like the long pulsed yag) it will be painful. What you are trying to do is inflame the lining of the vein and get it to scar itself down.

I really feel that sclero is superior to any cutaneous laser treatments. If you look at the literature you will get about 80% of treated veins with sclero and about 50% with the lasers.

Lornell Hansen II, M.D.
Lazaderm Skincare Centre

04.15 | Unregistered CommenterLH

I am looking into starting sclero in my practice. How does one charge for the procedure? is it based on time, # of vessels, volume of sclerosant used? Obviously this is market sensitive but I am looking for a ballpark.
thanks in advance for responses

04.18 | Unregistered Commentermark

Medspaguy, where is Robert Weiss? Does he have a website? Thanks.

05.1 | Registered CommenterJIM CAIN

Jim: Dr. Weiss has a clinic called the Maryland Laser, Skin and Vein Institute in Hunt Valley, MD (I believe it is near Baltimore). Each physician with the clinic is board certified in dermatology, and actively engages in national and international medical societies. Dr. Robert Weiss is the President Elect of the American Society for Dermatologic Surgery and Associate Professor at Johns Hopkins University School of Medicine. Drs. Margaret and Robert Weiss began practicing dermatology in 1982. Partner Karen Beasley, M.D. joined the practice in 2000. Their practice also includes a team of licensed nurse practitioners and physician assistants to assist in providing the highest quality care.

The web site is I know they conduct workshops from time to time for a variety of procedures including treatment of leg veins.

I have read many comments by you and am impressed by your knowledge. If you don't mind me asking, where are you located and do you offer any training or know any good training institute for sclerotherapy and advance Dermal Filler injections?


I am in Sioux Falls, South Dakota. I can train you for fillers and sclero. You can contact me at my clinic. Tou can contact me through my website.

I always train one on one.

Lornell E. Hansen II, M.D.

06.10 | Unregistered CommenterLH

I have seen a fair amount of white scarring from laser. I have a laser machine but I rarely use it for spider veins. I exclusively offer sclerotherapy, it is less painful than laser, and works better.

03.20 | Unregistered Commenterjimmyb

can anyone recommend the best solution for sclero?

08.24 | Unregistered Commenterscarlet

I have been using (Sclerovein) Polidocanol .025% to 1.% depending on vessel size. Tried "vein juice" in the past (23% saline & lido mix) and seem to have better results with the Sclerovein. I recommend 3 treatments for best results. Be sure to schedule 6 weeks apart. Post procedure, advise patient to apply graduated compression hose overnight. By the way, I observed staining issues if using higher percentage. Be careful.

09.14 | Unregistered Commentertanisha

I practice in the UK and I only use Fibrovein 0.2% with good results after 2-4 sessions.

I also recommend Sclerovein 0.2% which is the only strength I use with thread veins. I get good results usually after only 1 or 2 sessions . What makes the treatment effective is the proper use of compression 72hrs post injection without taking it off then using it at day time for a minimum of 4 to 6 weeks.

05.28 | Unregistered CommenterIan S

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