9 Facts to Help Decide If Sclerotherapy Is the Right Treatment for Your Varicose and Spider Veins

If you have spider veins and varicose veins, you are not alone. Up to 80% of adults in the U.S. have one of these conditions. 

Bulging and discolored leg veins can impact your self-esteem. They can also cause discomfort, swelling, and skin bleeding. The good news is that there are many treatments available including sclerotherapy. Modern sclerotherapy has been around for nearly 100 years. The procedure is FDA approved for treating spider veins and small varicose veins. 

Sclerotherapy is only one of several treatment options for spider veins and varicose veins. To help you decide whether the procedure is right for you, here are nine facts about sclerotherapy.

What is sclerotherapy?

During sclerotherapy, a medical procedure that can reduce and even remove spider veins and small varicose veins. During the procedure, a trained healthcare provider injects a substance called a sclerosant into troublesome veins. The sclerosant breaks down the vein’s wall. Then, the vein collapses and scars down so blood can’t flow through it. That makes it harder (or impossible) to see the vein through your skin. It also keeps the vein from bulging through the skin. 

Is sclerotherapy worth it? 

Like any procedure, sclerotherapy has benefits and drawbacks. Consider your goals, overall health, time commitment, and budget. Here are nine things to take into consideration.

1. Sclerotherapy is effective

Sclerotherapy works pretty well. But, like all cosmetic procedures, sclerotherapy isn’t perfect. Your veins may not completely disappear, even if you work with an experienced healthcare provider. But there’s reason to be optimistic. 

Research shows that 75% of people experience benefits with sclerotherapy such as: 

• Improvements in size, visibility and bulging

• Improvements in appearance of reticular veins

• Less pain and itching 

• Fewer episodes of bleeding and irritation

• Faster ulcer healing

• Prevention of returning ulcers.

2. Sclerotherapy is minimally invasive

When a medical procedure is “minimally invasive,” it has a lower risk and quicker recovery time. So they’re safer overall.

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Sclerotherapy can be done at your healthcare provider’s office and usually takes a few hours. 

This may be a benefit if you are looking for an option that quickly delivers strong results. 

Sclerotherapy is also less painful than more invasive options. Even though it does involve needles, your healthcare provider will use numbing medications so you don’t feel pain. They’ll also use ultrasound guidance to more easily see the veins. This cuts down on the number of times they have to inject the medication. 

3. Recovery is quick

It takes a few weeks to see the full effects of sclerotherapy. But on the bright side, most people don’t need to change their routine at all after sclerotherapy. You can also drive yourself home right after the procedure and continue with your regular day afterward. 

4. There’s minimal aftercare

While some procedures come with confusing aftercare (discharge) instructions, sclerotherapy needs minimal aftercare. Try to avoid the sun for about 2 weeks or wear sunscreen over the treated areas. This will help lower the risk of skin discoloration. Your healthcare provider may also ask you to wear compression stockings for a few days or a few weeks.

Depending on how many injections you need, your provider may ask you to avoid intense exercise or heavy lifting for a few days. But otherwise, you should be able to do your usual activities without any extra help. 

5. Sclerotherapy is safe and well tolerated

Sclerotherapy is safe and complications are rare. The most common side effects include skin irritation and pain at the injection site. These symptoms are temporary and usually will go away within a few days. Speak to your healthcare provider beforehand if you are at higher risk for any of these symptoms.

About 15% to 25% of people experience telangiectatic matting. This occurs when many spider veins stick together after sclerotherapy. Although matting can look alarming, studies show it usually goes away after a few months. If it doesn’t go away, talk to your healthcare provider about laser therapy can help eliminate matting. 

Matting is also more likely to occur with certain sclerosants. If you’re concerned about this side effect, talk to your healthcare provider about avoiding sclerosants that are more likely to cause matting. 

About 30% of people experience skin darkening after sclerotherapy. You're at higher risk for this side effect if you have a darker skin phototype. You are also at risk if you are treating larger varicose veins. Skin darkening does go away most of the time, but this can take up to 2 years. Some sclerosants are less likely to cause skin darkening. Talk to your healthcare provider about using a sclerosant that is less likely to cause this side effect.

In a few cases, sclerotherapy can cause more serious side effects, like blood clots and air embolism. An air embolism occurs when air bubbles enter the bloodstream and cause a stroke. Your healthcare provider will go over symptoms of both conditions. If you develop any symptoms, go to an emergency room right away. 

6. It’s not a great option large or small veins

Sclerotherapy is an effective treatment for spider veins and small varicose veins. But it isn’t so great for larger varicose veins. 

You can opt to treat your larger varicose veins with sclerotherapy. But remember that that veins may reopen after a few months. Once the vein reopens, you’ll be able to see the varicose vein again. And you can develop symptoms like pain, itching, and ulcers. You can get sclerotherapy again, but you may also need to consider other options.

Sclerotherapy also doesn’t work great for very small spider veins. This is because it can be hard to get a needle into a tiny vein. 

Sclerotherapy can’t be used to treat spider veins or varicose veins that develop below the ankle. This is because there’s a higher risk of complications. 

7. You may need more than one treatment

Even with an experienced provider, you may need more than one sclerotherapy treatment. If you have a lot of spider and varicose veins, it may not be possible to inject all the veins at once. You may also need more treatments in the future. This doesn’t always mean that the veins reopened or that the sclerotherapy didn’t work. Studies show people can form new spider veins and varicose veins over time. 

8. Not everyone is a good candidate for sclerotherapy

Although sclerotherapy is safe, not everyone is a good candidate for this procedure. You should not get sclerotherapy if you are pregnant or allergic to any components of sclerosants.

You may not be able to receive sclerotherapy if you have any of the following medical conditions:

• A history of blood clots

• Diabetes

• Peripheral artery disease

• Migraine headaches with aura

• Patent foramen ovale

9. Your insurance may not cover sclerotherapy

Some people get sclerotherapy for cosmetic reasons. This means getting rid of your spider veins and varicose veins because of how they look. In this case, insurance won’t cover the procedure. You can expect to pay about $400 per sclerotherapy treatment. But you may need more than one session, and costs vary by area. 

If you have symptoms, like bleeding, ulcers, itching, or pain, insurance will cover sclerotherapy. You may need a letter of medical necessity from your healthcare provider to show your insurance company before the procedure. 

Medicare typically covers sclerotherapy from hip to toes if:

• You have specific symptoms.

• The treatment is considered medically necessary.

• The procedure is FDA approved.

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who believes in achieving optimal health through healthy lifestyles. She’s a diplomate of the American Board of Obesity Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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