Best Sclerotherapy Solution?

I had Sclerotherapy done 3 years ago in FL and the results were wonderful, very noticeable within weeks, continued to get better throughout the 4 procedures I had.

Six weeks ago, I had it done again in Nashville. After 6 weeks, I can't tell any change, actually I only notice the new veins. I don't know which solution was used in FL, but she called it a soapy solution. The clinic here used saline. In your opinion which works best and is better for you to use?

Doctor Answers 15

Sclerotherapy results are based on the injector, NOT the solution injected.

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No matter what sclerosant is used (hypertonic saline, sodium tetradecyl sulfate, polidocenol, or sodium morrhuate are the most common ones), it needs to get inside the spider vein to do its work! The smaller the spider vein, the harder it is to hit properly. Sclerotherapy, as you have found out, is highly operator-dependent, and less related to the solution used. All of the commercially-available sclerosants work well, but have different side effects, proper concentrations for uniform response, and different adherents among users. But all of them have one common denominator--they have to be skillfully and properly gotten into the vessel for it to "work." You have had poor results, I would submit, not because you have had a "wrong" solution (though to be truthful, it can be a partial factor), but because your injector simply missed the veins too often.

As someone who has performed sclerotherapy for 30 years, and taught laser surgery for over twenty, I can still unequivocally state that skillfully-performed sclerotherapy remains the "gold standard" for treatment of spider veins. Larger varicosities require other treatments, but it's the smaller ones that require the best technique and often are the biggest cosmetic concern. Lasers can work for some of the smallest spider veins, but usually at slightly higher risk of complications (blister, scar, pigmentation change, or inadequate result), and almost always at higher cost (It's the laser!).

Find your old sclerotherapist, or a new one with better skills. BTW, since you asked, I believe polidocanol is the best sclerosant, as it is the most pain-free, has the fewest side effects, and has great results when used in 1% concentrations with proper technique. I have use all of the others, so this is based on significant experience with these.

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

The size of the varicosity determines the sclero solution.

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Sclerotherapy is usually done monthly for 3-6 treatments at a cost of $450 per session.  Usually Asclera is now the most recent solution FDA approved.  Whether by foam or by straight solution, both work very well.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

There is no BEST sclerotherapy medicine...

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It all depends on the type of vein being treated and what each clinic has to offer.

For smaller veins, a salt/sugar solution may be used as well as glycerin.

For larger veins, STS and  Polidocanol can be used but the latter is only available in europe and the usa at this time.

Some physicians will also use iodine for larger veins but that is not normal as it is highly irritating and causes significant pain when injected.

You should see an MD who is Board Certified by the American Board of Phlebology for the best results.


Craig Crippen, MD
Kelowna Physician

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Best technique for sclerotherapy of spider veins

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Important considerations in sclerotherapy include the proper use of sclerosant solutions, but more importantly, the technique used for injection. Larger veins should be addressed prior to smaller end branches. As a fellow of the American College of Phlebology and a double board certified surgeon who is a Diplomate of the American Board of Phlebology and the American Board of Plastic Surgery, it is important for me to evaluate these venous patterns in a logical and comprehensive fashion prior to having treatment. Do not focus on the sclerosant as much as the surgical planning and knowledge of the treating physician.

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Thank you for the question! Currently sclerotherapy is the treatment of choice when treating enlarged and bulging veins. In our practice, I use a sclerosing solution that causes the vein to shrink. Usually it takes only 1 to 2 sessions to achieve fading of the undesirable veins.  

An in-person exam with a board-certified plastic surgeon is the best way to assess your needs and obtain expert medical advice. Best of luck!

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Sclerotherapy solutions and techniques - Buffalo Niagara, NY

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There are many techniques and solutions that are used for sclerotherapy. However, the best at the present time is a foam technique with Asclera. 

Sclerotherapy, sclerotherapy solutions , polidocanol, asclera, Tetra decyl sulfate

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There are many types of sclerotherapy solutions and they fall into different categories.  Detergent solutions include sodium tetradecty, Asclera(polidocanol) and sodium morruhate.  These solutions are called detergents because they can be foamed like a soap.  Tetra decyl is stronger than Asclera but Asclera is the sclerosing agent of choice for many of us doing a lot of sclerotherapy.  Sodium morruhate is rarely used because of allergic side effects.  Saline is called an osmotic solution and was once the mainstay of sclerotherapy, but again, this too is now used much less often.  Asclera can be mixed in different concentrations for use in different size veins and can be used as either foam or liquid. Asclera is my sclerosing solution of choice for many reasons-it is painless to inject, it has very few side effects and it can be used as liquid or foam.

John Landi, MD
Naples General Surgeon

What is the best sclerotherapy solution?

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I have been injecting leg veins for almost 20 years and there certainly is a difference in solutions.  When I first started out the only option was saline solution injections.  These injections were extremely painful and not as effective as current solutions available.  Asclera is the newest and I believe the best sclerosing solution on the market today.  Yes, the experience of the injector is the most important.  Years ago many doctors touted lasers as the best treatments for spider veins.  Lasers only work on the exquisitely small veins that are too small to be injected.  It is best to be injected several times, approximately one month apart, with Asclera.  If there are tiny tribuaries that remain, these can then be "touched up" with the V-Beam Laser.  It is most important to find an experienced Cosmetic Dermatologist for this and every procedure.

Best Sclerotherapy Solution

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It can take up to 8 weeks to appreciate the results from your sclerotherapy treatment. Asclera and Sotradecol are the only 2 FDA approved agents for the treatment of small uncomplicated varicose veins of the legs.  Studies trying to compare the difference between these two agents and hypertonic saline have not shown a significant difference in effectiveness, but hypertonic saline tends to be more painful with injection and has a greater risk for ulcerations.  One must treat the underlying blue veins that feed the superficial spider veins, or treatment of the superficial spider veins will not be proven successful.  Results are dependent on the technique, compression, and sclerosant concentration used for the vein size being treated.

Sabrina Fabi, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 91 reviews

What is the best Sclerotherapy Solution

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More important than the solution is the injector.  Most of the solutions that physicians use for sclerotherapy work and work fairly well. This is a procedure which is highly operator dependent.  Small vessels such spiders can sometimes be difficult to get into and if you are not experienced it can be troublesome.  Having injected veins for over twenty years I have not seen significant differences in the effectiveness of the solutions but their are some regarding their degree of staining induced  and pain.  Recently the FDA approved a new solution polidocanol, trade name Asclera.  It's main advantage over hypertonic saline is that it is not painful.  Although there are some risks of allergic reaction with polidocano, l it seems to be very small and has become a favorite for many sclerotherapist.

Ted Brezel, MD
Long Island Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.