How Effective is Sclerotherapy?

I have had Sclerotherapy injections for several years in an attempt to combat the spider veins which are in greatest concentration around my shin and ankle areas.

My physician has told me that there is a limit as to what can be done to eradicate these veins, as they are so tiny and numerous. Is there any hope for me to ever have lower legs and ankles that don't look red and blotchy?

Doctor Answers 19

Sclerotherapy effectiveness

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In general, some patients and areas need more sclerotherapy sessions than others. Its just an individual dependent issue, like any medication the response is different in some people. The only was to really tell, would be a physical exam, but in general, there should not be any issue that cannot be resolved.

New York General Surgeon

There are several choices with sclerotherapy

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Sclerotherapy involves the injection of a chemical irritant directly into the small spider veins. These spider veins are completely out of the circulation and do nothing other than look bad. There are two main chemicals that can be used to perform sclerotherapy, hypertonic saline and sodium tetradecyl sulfate. Each has its advantages and disadvantages. In my experience some times one chemical seems to work better than the other. If your veins seem resistant to one it is possible that a test area using another one may be beneficial. Injecting the very small veins of the lower legs can be technically challenging and skill levels can vary from one physician to another. If the veins are too small then it is possible that sclerotherapy is not the best choice for you.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Sclerotherapy is my preference

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There has been several scientific studies comparing sclerotherapy to laser for small leg vessels. Sclerotherapy is more effective with fewer treatments. The ankle area is a risky area if the sclerosant is injected outside the vessel becasue necrosis can occur and this area is very slow to heal. Your age, the vessel size, and your medical history are all important in this decision, so please go to someone experienced and comfortable treating this tricky area.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

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Sclerotherapy and small blood vessels of the legs and ankles

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I agree that the small vessels of the legs and ankles can be resistant to treatment with sclerotherapy. Furthermore, when the vessels are so small, even the best practitioner may have difficulty injecting these vessels.

Vascular lasers are options to consider including the ND:YAG 1064, v-beam (pulsed-dye) and IPl/fotofacial.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Yes there is more than hope.

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Sclerotherapy is very effective. It is important to be aware that several treatments may be needed, and over time you will tend to form more spiders.

That said, it is important also to know that sclerotherapy (injections) has limits- spiders that are too small can't be injected because the needle is too big!

For these, you may want to look into laser or other non-injection treatments.



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Sclerotherapy has a very high satisfaction rate as you might judge from its sitting pretty close to the top of the poll on this site.

Your physician is correct as the small vessels can be very difficult to eradicate. The more times sclero is done the harder it is to get rid of the remaining vessels. I thought that was just me until I went to a meeting and that was pretty much the universal feeling of all the participants. The vessels may develop some sort of resistance. Also, logically we try to knock off the larger and more obvious ones first. Finally, there is a matting effect. That means that sometimes when a vessel is successfully destroyed the body grows new ones at its periphery.

It might be time for the 1064 ndYag laser. I feel that injections are the gold standard and that places that only offer laser do so because the physician is not trained to do sclero with injections. Laser is easier, sounds more high tech, and the doctor can charge more. But injections are the gold standards.

The laser is better at "cleaning up" those small, pesky lingering veins and I would recommend it at this point.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist


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Thank you for the question! Currently sclerotherapy is the treatment of choice when treating enlarged and bulging veins. It uses 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!  

Michael M. Omidi, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 122 reviews

Schlerotherapy Injections for Spider Veins

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On average, 87% of patients were satisfied or very satisfied with their Asclera® treatment.  It is one of the more satisfying aesthetic treatments, in that an immediate result can be seen at the time of the injection. 

The minimal amount of bruising that presents heals quickly and is most often completely resolved in 3-4 weeks.

#Ascleralegtreatments   #spiderveintreatments    #Schlerotherapytreatments

Treating Spider Veins with Schlerotherapy

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Asclera ( Pilodoconal ) works by damaging the endothelium of the cells lining the inside of blood vessels. This causes blood platelets and cellular debris to attach to the lining of the vessels; eventually, cellular debris and platelets cause the blood vessel to clot. Over time, the clotted vein will be replaced with tissue.  Studies show that on average, 87% of patients were satisfied or very satisfied with their Asclera® treatment!   We offer 2-3 sessions 4-6 weeks apart for  the best results!

#Ascleraspiderveins    #Schlerotherapytreatments   #spiderveintreatments

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Sclerotherapy is very effective - Buffalo Niagara, NY

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Sclerotherapy can be repeated and there is no limit as to how many sessions of sclerotherapy you can have. 

I have seen patients who have been referred to me with a file that list as many as 64 sessions of sclerotherapy !  Fortunately, this is an uncommon occurrence. That patient had untreated venous insufficiency ! 

Once underlying venous insufficiency is treated using RF technology (VNUS Closure), laser technology (EVLT), mechanochemical technology (ClariVein) or other newer techniques such as the newly FDA approved Varithena procedure, sclerotherapy will be more durable and more effective.

Untreated venous insufficiency can cause early recurrence and high failure rate with cosmetic sclerotherapy.

There are some topical creams that we use for patients with hyperpigmentation from a myriad of causes in the legs: from venous insufficiency, following wounding, following surgery, following sclerotherapy ...

We recommend Sclerovase and Scleroquin plus topical creams.

You can add retinoid RR Complex Retinoid Repair Cream as well. 

Scler-x post inflammatory hyperigmentation relief complex is a great supplement to take as well. See link below. 

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.