What is the Difference Between Sclerotherapy and Thermocoagulation?

Is Sclerotherapy or Thermocoagulation better at removing spider veins? Which has better results long terms?

Doctor Answers 5

Several Differences

Sclerotherapy is the injection of a solution into a vein to cause the vein to dissolve.  The solution essentially pushes the blood out of the veins and the vein walls become irritated, stick together and then dissolve over time.  There are many kinks of sclerotherapy solutions and many different kinds of concentrations that can be used.  Commonly today, however, foam solutions tend to be used.

Theromcoagulation is a process whereby heat is applied to a vein to cause it to coagulate and ultimately dissolve.  This process can be done with some variation by many modalities including IPL, , laser, VeinGogh, VeinWave and microneedle radio frequency.

Both sclerotherapy and thermocoagulation play a role in vein treatment and depending on the types of veins to be treated  and the locations of the veins your treating physician can aid you in making the proper decision.

Naples General Surgeon
5.0 out of 5 stars 5 reviews

Treatment of Spider Veins with Sclerotherapy, Lasers and Thermocoagulation

Treatment of Spider Veins with Sclerotherapy, Lasers and Thermocoagulation are all reasonable methods for treatment of Spider or very small diameter superficial veins. There are different injectable agents for Sclerotherapy , different types of lasers based on their  characteristic wave lengths and power settings selected, and different types of Thermocoagulation devises. Finally and what I believe is the most important is the skill and experience of the doctor providing this treatment. My person experience is that lasers and Sclerotherapy are least likely to cause scars or hyperpigmentation (post inflammatory hyperpigmentation or dyscrhromias) afterwareds whereas thermocoagulation is more likely to have these problems..I  prefer Sclerotherapy for the legs, and laser for above the waist as lasers don't work as well in the lower extremities.

Larry Nichter, MD, MS, FACS

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Sclerotherapy or thermocoagulation

The technologies for thermocoagulation that are available on the market are well described below. 

Sclerotherapy with foam is the preferred technique for spider veins, reticular veins and some varicose veins. 

Watch the clip below from The Doctors TV Show. 

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Sclerotherapy versus Laser / Thermocoagulation therapy for Spider Veins

Both sclerotherapy and thermocoagulation are effective treatment for treating spider veins and both have good long-term results. Having said that, there are major differences between the two treatments and which one that you should have done is determined by many different factors after discussion with your vein doctor.  Some of the main differnces in the treatment are listed below:

1) Sclerotherapy involved injection of a chemical into the veins, therefore also requires a needle be inserted into the veins.

2)There is more bruising with sclerotherapy

3)Thermocoagulation uses heat energy to remove the veins, and the heat is trasmitted through the skin and into the veins by a thermal probe (either laser, radiofrequency, or electrical heat energy is used)

4)Thermocoaulation has a small risk of heat burns on the skin that can sometime lead to scarring of the skin

5)Sclerotherapy can usually treat a larger number of veins in a shorter prior of time since the medicication moves to many of the abormal spider veins with a single injection.  Surface thermocoagulation involves a "spot" technique that treats a small focal area at each "zap" and therefore often takes the doctor a longer period of time to treat a small area.  This may translate into sclerotherapy being more inexpensive for the patient since the treatments don't take as long.

6)Sclerotherapy has a small risk of drug reactions or drug allergic reactions, whereas since thermocoagulation does not involve medications, this risk does not exist for thermocoagulation

7)Thermocoagulation is only effective for very small spider vein

8)Sclerotherapy can be used for many different vein sizes, even larger varicose veins as well as small spider veins

9)Sclerotherapy is rarely used on the face or nose, whereas thermocoagulation is commonly used on the face and nose


Since there are so many individual factors that play into whether sclerotherapy or thermocoagulation / laser is the better treatment for you, it is best that you meet one-on-one with a vein specialist to discuss your options and determine which one he recommends for your specific situation.


I hope that you found this information helpful.

Joel Gotvald, MD, FACS
Austin Vascular Surgeon
5.0 out of 5 stars 2 reviews

Spider vein treatments in Los Angeles

We treat all types of veins in our practice.  Sclerotherapy uses a medicine to collapse the veins, whereas thermocoagulation uses a form of heat, whether laser or electrical or RF. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

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.