SCLEROTHERAPY

Pros

• Sclerotherapy treatment is extremely quick.
• There’s no downtime afterwards, save for injection-site bruising.
• Side effects, including bruising and swelling, are usually minor and short-lived.
• It can treat spider veins that are too large to be resolved by a laser.
• It’s safe for all skin types and tones, unlike some lasers that carry risks of pigmentation issues on olive or brown skin.

Cons

• Full results can take up to six months to appear.
• The treatment can feel painful, especially if saline is used. 
• You might need two treatments for optimal results. 
• Hyperpigmentation (or discoloration) can sometimes occur at the injection site, especially in people with dark skin. In some cases, this can be permanent.
• When the treatment is not properly performed, sclerotherapy can actually cause more veins to appear—so choose your provider carefully.
• In extremely rare instances, a potentially fatal blood clot can form postinjection. Talk with your doctor about how to mitigate this risk.

RealSelf Tip: Don’t worry that you could be destroying veins you’ll need later. Veins addressed with sclerotherapy are already damaged—and you have, literally, miles of blood vessels in the body that can take up the slack, says Dr. Ramandeep Sidhu, a vascular surgeon in Issaquah, Washington.

• Average Cost:
• $679

• Range:
• $145 - $1,790

Your cost will depend on the number of veins treated, the number of treatments you need, your provider’s level of experience, and a few other key factors.

See our complete guide to sclerotherapy costs

The sclerotherapy photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Doctors on RealSelf stress the importance of seeing a physician who is certified as a Diplomate of the American Board of Venous and Lymphatic Medicine, so you know you’re being treated by a vein specialist. This could be a dermatologist, phlebologist, or vascular surgeon experienced in and specifically trained to do sclerotherapy.

Beverly Hills, California, dermatologic surgeon Dr. Monika Kiripolsky says, “Your best bet is to find a physician who is not only good at performing sclerotherapy but also able to screen for possible underlying dysfunction” in your larger veins.

To have your leg veins treated, you’ll lie on your back. Your provider will disinfect the area and use one of two liquid sclerotherapy methods (endovascular or percutaneous) or foam sclerotherapy. Your provider will recommend the best method for you.

For endovascular sclerotherapy, your provider inserts a catheter into a blood vessel, then injects the sclerosing agent into the vein to block it. For percutaneous sclerotherapy, your provider directly injects the solution into the blood vessel. After injection, your doctor will apply pressure (often with a compression pad) to keep blood from refilling the vein and to help disperse the solution.

For larger or varicose veins, they might inject a foam sclerosant into the blood vessel to close it. 

As you’re being injected, you might feel some cramping, burning, itching, or stinging in the vein. If you’re feeling a lot of pain, tell your doctor. The solution may have leaked out of the vein and into nearby tissue. 

The number of injections you have will depend on the number and size of the veins you’re having treated. Typically, treatment takes less than an hour, but Dr. Sidhu says it may take as little as 15 minutes to treat one small vein.

RealSelf Tip: Avoid shaving or applying lotion to your legs prior to the treatment. Wait until the area around the injected vein has healed. 

Related: The Most Effective Way (and Best Time) to Treat Spider Veins

There’s no real downtime after sclerotherapy. However, notes New York City board-certified dermatologist Dr. Michele Green, “you should be prepared for bruising that lasts at least one week. I encourage my patients who can discontinue blood thinners to do so beforehand because of this increased bruising.”

Still, you can have the treatment done during a break in your day and go directly back to work—though it’s a good idea to have a ride lined up, just in case you have any lingering discomfort in your legs. It’s also safe to drink alcohol post-procedure.

Most people return to their normal activities right after their treatment, something doctors encourage to improve circulation and reduce the risk of blood clots. San Diego-based dermatologic surgeon Dr. Sabrina Fabi says, “I strongly encourage my sclerotherapy patients to walk and remain active after their sclerotherapy treatment but discourage them from doing heavy squats or exercises that increase intra-abdominal pressure for at least five days.”

The ease of your recovery will depend on the size, number, and location of the veins you had treated. 

You can shower right away, but avoid excessively hot showers or baths for at least one week. You should also avoid flying (which may increase your risk of blood clots) or tanning for one week.

Your doctor will likely also recommend that you wear compression stockings for two to three months, to reduce the risk of swelling (edema) and blood clots in your legs, and avoid strong sun exposure on the treated area for two to four weeks. “Compression stockings also help the veins heal faster and provide needed pressure,” says Dr. Green.

Within a month, you should be able to do most exercises, but your doctor will probably want you to continue to avoid extended sitting or standing.

RealSelf Tip: “Since compression stockings are hot, and you typically do have bruising after the procedure, I encourage my patients to have sclerotherapy during the winter months, when they are not showing off their legs,” says Dr. Green. “This way, they will have clear legs for summer.”

Doctors consider sclerotherapy relatively safe, with complications happening only rarely. You might have some swelling, bruising, red areas, tiny sores, or changes in skin sensation at the injection site, but all of these side effects should go away in a few days. You can treat inflammation with a pain reliever that contains acetaminophen (such as Tylenol), which won’t interfere with how your blood clots. 

About one in three people, especially those with olive or brown skin, develop dark lines or spots of hyperpigmentation near the treatment area. They could take three to six months to go away, but in some people, they can become permanent. To help prevent this, avoid direct sun exposure on the treated area for a month.

Another side effect experienced by about one-third of patients is matting, the development of new small vessels in the treated area. Matting typically develops four to six weeks after a sclerotherapy procedure and usually resolves spontaneously in 3 to 12 months. 

Rarely, a blood clot can develop in the treated vein and travel to a deeper one, creating a condition called deep vein thrombosis. In extremely rare cases, the clot can move into the lungs, a serious medical situation called pulmonary embolism. An allergic reaction to the sclerosing solution is also an uncommon but serious risk. If you have dizziness, chest pain, or trouble breathing, call for emergency medical care right away.

Nashville vascular surgeon Dr. Tif Siragusa says that the veins themselves usually start to fade in two to three weeks, with final results visible in two to six months. 

Your doctor will probably schedule a follow-up visit a month after your first treatment to check your progress and see if you’ll need another treatment. You’ll have to wait six weeks from your initial treatment before having another sclerotherapy session.

According to Dr. Sidhu, veins that are effectively treated with sclerotherapy should be gone permanently, but new spider veins could crop up at any time, due to genetics and lifestyle, even in the same area. “Patients who spend all day standing are more predisposed to leg veins,” adds Dr. Green. You might need more sclerotherapy treatments in the future.

Wearing compression stockings can help prevent or delay the formation of new spider veins by keeping blood from pooling in your legs.

Sclerotherapy can’t treat large varicose veins—for those, you’ll likely need surgical removal. Larger, bulging varicose veins are usually treated with techniques like ambulatory phlebectomy, which removes the veins through small incisions. 

If you feel aching, pain, or heaviness from swollen veins, sclerotherapy may not be the best option for you. These symptoms come from blood pooling in your legs, which may indicate damage or weakening of the valves in your veins that normally keep blood moving. 

According to Dr. Sidhu, “it’s very important to rule out underlying valvular pathology before proceeding with sclerotherapy. If valve issues aren’t addressed first, the recurrence rate will be very high.” Your doctor may start with an ultrasound, to determine which veins are involved and make a plan to treat them.

	Sclerotherapy nonsurgical	Neo Laser nonsurgical	Vbeam nonsurgical	IPL nonsurgical	Excel V nonsurgical	VenaSeal nonsurgical	EVLT surgical
Worth It Rating	87%	82%	50%	81%	57%	89%	82%
Average Cost	$679	Not yet available	$470	$791	$508	Not yet available	Not yet available
Downtime	No downtime	No downtime	Little to no downtime	One week of social downtime	No downtime	No downtime
Anesthesia	No anesthesia	No anesthesia	No anesthesia	No anesthesia	Topical anesthesia	Topical or no anesthesia	Topical anesthesia

Sclerotherapy is “the go-to treatment for veins in the legs,” according to Dr. Jason Emer, a dermatologic surgeon in West Hollywood, California.

For veins on the face, where the skin is thin, most doctors on RealSelf say lasers are safer and more predictable. Sclerosing agents—including hypertonic saline, polidocanol (Asclera), and sodium tetradecyl sulfate (Sotradecol)—have improved tremendously over the years, but not every vein can be treated with sclerotherapy.

• Laser therapy (like with the Neo laser) is a popular alternative or follow-up to sclerotherapy. Dr. Green calls the Vbeam laser “the gold standard for treating facial veins, telangiectasia, facial redness, and rosacea.” She also uses the Vbeam to address matting on the legs, or clusters of spider veins that can form as a result of sclerotherapy. However, Dr. Sidhu cautions that “lasers treat only very small spider veins, not big veins,” the way sclerotherapy can. In those cases, the only other option is a surgical procedure called a phlebectomy.
• IPL (intense pulsed light) works well for treating spider veins and broken capillaries on the face.
• Veinwave is another treatment for small spider veins. The doctor inserts a fine needle next to the spider vein, and the Veinwave device heats the area enough to destroy the vein. Usually, Veinwave is used for spider veins too small to be treated with sclerotherapy. The affected area is often small enough that you shouldn’t need numbing medication.
• Excel V uses short and long pulse laser light energy to treat vascular conditions, like spider veins. While most other lasers require multiple treatments, Excel V results can be seen almost immediately, with zero downtime.
• VenaSeal is an in-office treatment to seal veins. A catheter is placed in the infected vein, sealing it with a medical glue. There is little to no downtime, and most people maintain their results years later.
• EVLT closes off varicose veins by using short bursts of energy, causing it to collapse. EVLT only shuts down specific veins, rather than correcting overall venous insufficiency, so talk to your doctor if you’re genetically predisposed to spider veins.

Bradbury A., Bate G., Pang K., Darvall K., and Adam D., Ultrasound-guided foam sclerotherapy is a safe and clinically effective treatment for superficial venous reflux (2010)

Coleridge-Smith P., Foam and liquid sclerotherapy for varicose veins (2009)

Cutera Inc., Treatment of Lower Extremity Spider Veins With Excel V (2015)

Mass Device, Medtronic touts five-year VenaSeal study data (2019)

Subbarao N.T., Aradhya S.S., and Veerabhadrappa N.H., Sclerotherapy in the management of varicose veins and its dermatological complications (2013)

Ukritmanoroat T., Comparison of efficacy and safety between foam sclerotherapy and conventional sclerotherapy: a controlled clinical trial (2011)

University of Wisconsin School of Medicine and Public Health, Department of Surgery, Updates in Varicose Vein Treatment (2018)