Sclerotherapy for Spider Vein Treatment

What is Slerotherapy treatment? Sclerotherapy is the most effective and common spider vein treatment. It is the process of injecting a special solution directly into the small spider vein. The solution irritates the lining of the vein wall and causes it to stick together and close. The closed spider vein scars and eventually disappears. This spider vein treatment is relatively painless and has few serious side effects.

Candidates for sclerotherapy

legs for sclerotherapySclerotherapy works best on little veins of about 1-3 mm in diameter. But spider vein treatment is not for everyone. Some patients want sclerotherapy to resolve spider veins that may be a result of a vein disease called venous insufficiency. In this case, their veins should not be injected without investigating the underlying reason for their condition. Because not all patients have veins suitable for injection, a consultation is advisable prior to treatment. The purpose is to evaluate whether the spider veins are suitable for sclerotherapy treatment. We do not recommend sclerotherapy spider vein treatment for women who are pregnant. We suggest that you wait until after childbirth. Read our blog article on Pregnancy and Vein Treatment. Patients with experience of blood clots should seek further evaluation before treatment.

Sclerotherapy solutions

The common solutions used for spider vein treatment are sodium tetradecyl sulfate (Sotradecol), polidocanol (Asclera / Aethoxysclerol), and hypertonic saline. The San Francisco Vein Center uses Sotradecol for its effectiveness without producing much pain beyond stinging. Sotradecol is an FDA-approved agent and is in use extensively for spider vein elimination. It generally hurts much less than traditional hypertonic saline injections and has very good results. Read our comparison of sclerotherapy solutions.

The procedure

Sclerotherapy treatment is a minor in-office procedure that causes minimal pain. Spider veins are treated with very tiny needles. During the procedure the patient feels a tiny prick and perhaps some stinging rather than a painful injection. If you have an unusually low threshold for pain or are unusually adverse to needles, then sclerotherapy may not be suitable for you.

Recovery and compression stockings

Compression stockings are essential and required In order to obtain the best possible results. We sell them at a discounted rate in our office and have certified fitters to assure the correct sizing and to show you how to put them on correctly. On the day of sclerotherapy, good compression stockings must be brought to the appointment. We give a prescription for compression stockings at the initial consultation. Compression is absolutely essential to achieving a good cosmetic result after sclerotherapy. If spider veins are also in the thighs or on the backs of the knees, thigh high stockings will provide the best results. If they are only on the calves, then knee-high stockings are sufficient. The patient should wear the stockings for 24 hours straight after the spider vein treatment. Then they are worn every day (all day) for about 3 weeks. Night time use is not necessary.

Side effects

Sclerotherapy often causes bruising for several weeks. Assessing the success of the spider vein treatment is possible only after the bruising disappears and the veins heal and disappear. For this reason, we recommend patients schedule sessions several weeks apart. Because treated legs often look worse before they look better, it is best to have sclerotherapy done well in advance of important events such as sunny vacations, weddings, etc. Patients should expect a worse appearance during healing as it is absolutely normal after treatment.

Other side effects can be redness around the injection sites and itching. These effects commonly last for no longer than a few days. Some patients may experience brown spots or lines. This is less common and typically disappears after a few days. However, they can remain indefinitely.

Number of sessions and success rates

before and after sclerotherapy spider vein treatmentThe average patient will see a difference after the first treatment, but it often takes two or three treatments to see a big difference. It’s best to space the treatments out over weeks or months.

Sclerotherapy is the best, but is not a guaranteed spider vein treatment. Studies show that success rates are typically about 80%. It is important to understand that multiple treatments are often necessary for optimal results but some patients may still not have positive results. If venous insufficiency is the underlying cause of spider veins, then they will often recur. This is why we recommend an evaluation before receiving treatment.


Insurance coverage

sclerotherapy for the removal of spider veinsInsurance companies consider sclerotherapy a cosmetic procedure and typically do not cover it. One exception is when a patient has venous insufficiency. Most patients with venous insufficiency have a vein ablation procedure. After the procedure it is sometimes possible that insurance companies will pay for spider vein treatment as well.


Sclerotherapy is $550 for a 30 minute session. Not all patients are candidates. Sometimes it is necessary to run tests before the procedure. If you are not sure sclerotherapy is the treatment you need, we strongly suggest you schedule a separate consultation prior to scheduling the procedure. Consultations are typically covered by insurance. Deductibles and copayments apply. The cost of a consultation for “self pay” patients is $150.