Sclerotherapy
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Sclerotherapy vs Laser for Spider Veins
Sclerotherapy is the first choice for spider veins on the legs. A fine needle puts a solution into the vein and it closes, and the injection also reaches the slightly larger feeder veins that keep spider veins coming back. Surface laser is better for very fine veins and for the face. It works through the skin with no needle, which suits people who cannot face injections. Whichever you have, expect more than one session.
At a glance
| The difference | Sclerotherapy | Surface laser |
|---|---|---|
| What it feels like | Stinging, then a brief cramp | Snapping, like a hot elastic band |
| Downtime | None, and walking is encouraged | A day or two of redness |
| Cost | Priced per session, and it is a course | Priced per session, usually more of them |
Surface laser
Light absorbed by the blood A beam passes through the skin. The blood inside the vessel absorbs it and heats up, and that heat damages the vessel wall so it seals.
Side by side
The differences that matter
What actually happens
Sclerotherapy
A fine needle, used several times
A liquid or foam goes into the vein. It irritates the lining so the vein swells shut, and your body absorbs it over weeks.
Surface laser
Light absorbed by the blood
A beam passes through the skin. The blood inside the vessel absorbs it and heats up, and that heat damages the vessel wall so it seals.
How it works, illustrated
Sclerotherapy
Which veins it is for
Sclerotherapy
Spider veins and the feeders behind them
The purple and red lines, plus the slightly larger blue reticular veins under them that supply the pressure.
Surface laser
The very finest vessels
Threadlike red vessels too small to get a needle into, and veins on the face and around the nose.
The feeder vein problem
Sclerotherapy
It can reach them
A needle can be placed into a reticular vein a few millimetres down and close it. That is why results tend to last.
Surface laser
It usually cannot
Surface laser works on what is near the skin. If a feeder vein underneath is still pushing, the fine veins refill.
What it feels like
Sclerotherapy
Stinging, then a brief cramp
Each injection stings for a second. Some solutions cause a short cramping ache in the leg afterwards.
Surface laser
Snapping, like a hot elastic band
Repeated for each pass. Skin is cooled during treatment, and legs hurt more than faces.
How long until you see a change
Sclerotherapy
Weeks to a few months
Treated veins darken, then fade. The final look takes a few months.
Surface laser
Weeks, and often gradual
Some vessels vanish on the day. Others fade over several weeks or need another pass.
How many visits
Sclerotherapy
Usually two to four
Spaced a few weeks apart. Large clusters take more.
Surface laser
Usually more than sclerotherapy
Three to six sessions is common for legs, fewer for the face.
Downtime
Sclerotherapy
None, and walking is encouraged
Compression stockings for a week or two. No gym or long standing for a day or so.
Surface laser
A day or two of redness
Redness, mild swelling and sometimes small scabs along the treated lines.
The main downside
Sclerotherapy
Brown staining and new tiny veins
A brown line can follow the treated vein for months. A fine blush of new tiny vessels can appear nearby. Both usually fade, but not always.
Surface laser
Marks on the skin itself
The energy passes through the skin, so it can leave a lighter or darker patch, a small blister, or a fine scab. These usually settle.
Skin tone
Sclerotherapy
No light involved
The needle does not care what colour your skin is.
Surface laser
Needs care
Melanin in the skin absorbs some of the light. On tanned or deeper skin the settings must be gentler, and the risk of a pale or dark patch is higher.
Cost
Sclerotherapy
Priced per session, and it is a course
Ask for the cost of the whole plan, not one visit.
Surface laser
Priced per session, usually more of them
Often the more expensive route for legs, because it takes more visits.
The at-home or drugstore version
Sclerotherapy
Stockings and vein creams
Compression stockings genuinely help aching legs and slow new veins forming. They do not remove a vein. Creams with horse chestnut or vitamin K may soothe, but nothing you rub on closes a vessel.
Surface laser
Home laser and IPL pens do not do this
Handheld devices sold for veins put a fraction of the energy in, and cannot be aimed at a specific vessel. They mostly heat the skin surface. Burns and pale patches are the usual result.
Who each suits
Sclerotherapy
- Best for — Spider veins on the legs, especially clusters with feeder veins.
- The mindset — You will accept a needle for a better and longer-lasting result.
Surface laser
- Best for — Very fine facial vessels, and legs where the veins are too small to inject.
- The mindset — You cannot do needles, or the veins are on your face.
Why injections are still the first choice for legs
Sclerotherapy
Sclerotherapy also handles a wider size range. Changing the strength of the solution, or using a foam, lets the same technique treat a threadlike vein and a small ropey one. Laser does well on a narrower band of vessel sizes.
Surface laser
A needle reaches the feeder. A surface laser does not. That single fact explains most of the difference in results. Treating only what you can see, without closing the supply, gives a good week and a disappointing month.
Before you book
More photographs
Sclerotherapy
Common questions
Questions Patients Ask
Is sclerotherapy or laser better for spider veins on the legs?
Sclerotherapy is the usual first choice for legs. A needle can reach the larger feeder veins sitting under the visible ones, and closing those is what makes the result last. Surface laser generally cannot reach them.
When is laser the better option for veins?
For facial vessels, for threadlike leg veins too fine to inject, and for people who genuinely cannot tolerate needles. Laser is also often used to finish off what injections leave behind.
How many sessions will I need?
Sclerotherapy is usually two to four sessions, spaced a few weeks apart. Laser on legs commonly takes more. Neither is a single-visit treatment for a whole leg.
Does either one hurt?
Sclerotherapy stings for a second per injection, and some solutions cause a brief cramping ache. Laser feels like a hot elastic band snapping, repeated with each pass. Legs are more uncomfortable than faces with either.
Will the veins come back?
The treated veins do not usually return, but new ones form over time. Family history, standing work and age keep producing them, so most people have a top-up every year or two.
Is spider vein treatment covered by insurance?
Spider vein treatment on the legs is nearly always cosmetic and paid out of pocket. Treatment can be covered when the legs ache, swell or the veins bleed, but that usually means a larger vein problem and a different procedure.