Procedure

Sclerotherapy

A solution injected with a fine needle into spider veins on the legs, which irritates the vein lining so the vein closes and is absorbed. It takes several sessions, and a brown line often marks the treated vein for months afterward.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Sclerotherapy. Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

This is a course, not an appointment — most legs need two to four sessions several weeks apart, and each clears some of the veins, not all. A treated vein commonly leaves a brownish streak along its path from iron left when the blood broke down; most fades over six months to a year, some occasionally stays, and on deeper skin tones it is more visible and slower to go.

Are spider veins the real problem: Aching, swelling, ropey bulging veins or a color change at the ankles means a larger vein underneath is probably failing. That needs an ultrasound and a vein specialist, not a cosmetic appointment.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

−
Also calledSpider vein injections, sclerotherapy for telangiectasias
DowntimeNone. You walk out and are asked to keep walking. Compression stockings for days to a couple of weeks
SessionsUsually 2 to 4 per leg, spaced about 4 to 6 weeks apart. Some veins need more than one treatment each
Typical costAbout $300 to $600 per session in the US, often quoted per leg. Varies by city and by how much is treated
Results timelineTreated veins fade over 4 to 8 weeks. Brown staining along the vein can take 6 to 12 months to clear
PainBrief stinging or cramping with each injection, a few seconds each. Some solutions sting more than others
Skin tone safetyThe technique is the same for all skin tones. Brown staining and marks after inflammation are more visible and slower to fade on deeper skin tones

What It Is

−

A very fine needle injects a small amount of solution — a sclerosant — into a spider vein. It irritates the lining so the walls stick together and the vein closes. Over the next few weeks the body breaks the closed vein down and absorbs it. It is the standard treatment for spider veins and the small blue reticular veins feeding them, done in an office in fifteen to forty-five minutes. Dozens of injections in one session is normal. A foamed form guided by ultrasound is used for larger veins — a different treatment, done by a vein specialist after a scan finds which vein is the problem.

How It Works

−

Blood in a spider vein is not doing useful work. It is a small surface channel that has widened and become visible; closing it sends blood back through the many other veins in the leg. Nothing is lost.

The sclerosant damages the cells lining the vein. The walls inflame, swell and stick together, and the vein seals shut. Over weeks it becomes a thread of scar tissue and is absorbed, which is why the vein fades gradually rather than disappearing on the day.

Two common side effects follow. Trapped blood breaks down and leaves iron in the skin — the brown line along the vein. The inflammation can also prompt tiny new vessels, a fine red blush called matting.

The solution treats the vein it reaches, not the tendency to make them. New ones appear over the years, which is why touch-ups are common.

Skin is about two millimetres thick on the face. How deep a treatment reaches decides what it can change, and whether it treats all of the skin or scattered columns of it decides how long you take to heal.

How it works
Compare
Skin basics
EPIDERMISDERMISFAT0.05 mm — pigment0.5 mm — texture + pores1.0 mm — collagen1.5 mm — deep dermisPEELNEEDLINGNON-ABLATIVE LASERABLATIVE LASERREACHES THE DEEP DERMIS

This goes through the full thickness of the skin, past the collagen and down to where hair bulbs, larger vessels and glands sit. At this depth a treatment can reach structures creams never touch, and it is also where scarring becomes a real risk if it is done badly.

A peel or a scrub takes the skin off evenly from the surface down. Everything above the line goes and nothing below it is touched, which is why peels suit surface pigment and rough texture, and why the whole face flakes for a few days after.

Needles make hundreds of separate channels and leave the skin between them untouched. That untouched skin is what heals the rest, so recovery is quick — but a needle only injures the skin to start repair. It removes nothing.

The light passes through the surface and heats a column underneath it. The surface stays whole, so you leave red rather than raw — and it takes a course of sessions rather than one.

The laser removes columns of skin outright: the white gaps here are tissue that is gone, and new skin grows in from the sides. The strongest of the four, and the longest to heal.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

−

No strong evidence for any condition.

Pros and Cons

−
Pros
  • It is the standard treatment Good evidence, and it works for most spider veins.
  • No cutting and no downtime Normal life the same day.
  • Many veins at once Dozens of injections in one session.
  • Treated veins are gone for good A closed vein does not reopen.
  • Cheap next to laser Less per session than laser.
Cons
  • It takes several sessions Two to four, and stubborn veins need repeats.
  • Brown staining An expected mark along the vein, months to fade.
  • Matting A fine red blush of new tiny vessels, in a minority of people.
  • It does not stop new veins Touch-ups every year or two are common.
  • Wrong treatment for large veins Ropey varicose veins need a vein specialist.
  • Needles, plural A poor fit if you cannot tolerate injections.

How to Prepare

−
2 weeks before1 to 2 days beforeOn the day
Sun
2 weeks before
Avoid sun and sunbeds on your legs for a couple of weeks before and after. Sun on a freshly treated vein makes staining worse and longer lasting.
Shaving
1 to 2 days before
Shave your legs a day or two before, if you shave.
Clean, dry skin
On the day
No moisturizer, oil or self-tanner. Tape and dressings need clean, dry skin.
What to bring
Buy the compression stockings your provider recommends beforehand. Bring shorts or loose pants and comfortable shoes — you will walk afterward.

What Happens

−
ArrivingThe treatmentLeaving
Arriving
Your legs are examined standing up, when veins fill, and photographs are usually taken. If the pattern suggests a larger vein is involved, you may be sent for an ultrasound first. There is no numbing — the needle is very fine, and cream would not reach the vein. Your provider will ask about these things.
The treatment
You lie down, the skin is cleaned, and the provider works along the leg injecting small amounts into each vein, often using magnifying glasses or a vein light. A session runs about 15 to 45 minutes. Each injection stings for a second or two, sometimes with brief cramping along the vein.
Leaving
Stockings or wraps go on before you stand, and you walk for fifteen or twenty minutes. The treated veins look bruised, red and raised, like fine scratches — your legs often look worse than when you arrived, and that is expected for a couple of weeks.

Recovery

−
Days 1 to 14Weeks 3 to 8Months 2 to 12
Days 1 to 14
Small red welts, itching and mild aching along the treated veins. Bruising darkens and the veins look brown and feel like firm threads — trapped blood breaking down, not a problem. Keep the stockings on as long as you were told, usually days to two weeks.
Weeks 3 to 8
The veins fade and most bruising resolves. Some veins clearly need a second treatment, which is normal.
Months 2 to 12
Brown staining fades slowly, and most clears within six to twelve months. A small amount can persist longer, and sun makes it last longer still.

Aftercare

−
48 hours1 week2 weeks
Exercise
48 hours
Walk straight away. Heavy leg workouts and running after about 48 hours.
Heat
1 week
No hot baths, saunas, hot tubs or steam rooms for about a week. Heat widens veins.
Compression
2 weeks
Wear the stockings exactly as long as you were told, usually a few days to 2 weeks. This affects staining and comfort most.
Walking
20 to 30 minutes daily from the day of treatment.
Sun
Keep treated legs covered or under SPF 30 or higher for several weeks. Sun makes staining darker and slower to fade.
Sitting still
Avoid long flights and drives for a week or two, and move around on any long trip. Say if one is booked soon after treatment.

Risks

−

Most of what happens is expected: stinging during injection, bruising, itching, small raised welts, firm threads under the skin, and brown discoloration along the treated veins. Serious complications are uncommon. Staining and matting bother people most, and both are worth understanding before the first session.

Brown staining along the vein
Very common — iron left in the skin when trapped blood breaks down. Most fades over six to twelve months; it is more visible and slower on deeper skin tones, and sun makes it worse. A little can persist beyond a year.
Matting
A patch of fine new red vessels at a treated area, usually within a few months. It happens to a minority, often fades on its own, and sometimes needs treating in its own right.
A firm, tender lump along a vein
Trapped clotted blood in a closed vein. Not dangerous, and easily released with a needle in the office, which speeds fading and reduces staining — worth an appointment rather than waiting.
A vein that has not responded
After two treatments, this sometimes means a larger vein underneath is refilling it. An ultrasound is next.
Itching or a rash over the treated area
Usually a reaction to the tape, the compression or the solution. Mention it before the next session.

In Deeper Skin Tones

−

The treatment itself does not change with skin tone. The needle, the solution and the technique are the same. What changes is how visible the aftermath is and how long it lasts.

Brown staining and post-inflammatory hyperpigmentation — the brown marks skin leaves after inflammation — are both more noticeable on deeper skin tones and both take longer to fade. Staining is the most common complaint after this treatment, so that matters. Reasonable adjustments are to treat a small test area first, use the lowest concentration that closes the vein, treat less at a time, release trapped blood promptly, and be strict about sun protection afterward.

Laser for leg veins deserves care here rather than an automatic recommendation. Laser light is absorbed by pigment as well as blood, so light-based devices carry their own risk of dark or pale patches on deeper skin tones. Where laser is used, longer wavelength devices are preferred, and provider experience with deeper skin tones matters more than the choice between the two treatments.

None of this rules the treatment out. It means going slowly, and having the conversation about staining before the first session.

If You Stop

−

Veins that were treated and absorbed are gone permanently. They do not reopen.

What continues is the tendency. Spider veins come from genetics, hormones, pregnancy, age and time on your feet, and injecting the visible ones changes none of that. New ones appear gradually, so cleared legs drift back toward how they looked if nothing further is done. Most people who care about the appearance have a short touch-up every one to two years.

If the larger vein was never treated: New spider veins come back faster and in the same pattern. That is the situation where stopping feels like the treatment failed, when the underlying cause was never addressed. An ultrasound answers the question.

Combining Treatments

−
Same day
Compression stockings
Help symptoms, but do not remove existing veins.
Same day
Walking
Moving during long standing or sitting helps symptoms.
Same day
Laser
Sometimes combined for very fine vessels, or for matting afterward.
Same day
Feeding vein treatment
A larger vein underneath is closed first, or results do not last.
Wait 4–6 weeks
Another session
Four to six weeks between sessions on the same area.
Until healed
Waxing and hair removal
Leave that stretch of leg until bruising and staining settle.
Plan around it
Long-haul flights
Avoid treatment close to one, and say if one is coming up.

Insurance Coverage

−

Ask what a session includes, whether the price covers both legs, and whether a follow-up visit to release trapped blood costs extra.

Insurance almost never covers spider vein treatment, because it is cosmetic. It often does cover larger veins when there are symptoms — aching, swelling, skin changes or ulcers — and an ultrasound has documented the problem. That is a different pathway, worth asking about if your legs hurt as well.

Ask Your Doctor

−
If you are pregnant or breastfeeding
Ask the doctor managing your pregnancy or breastfeeding. Treatment is usually postponed, and pregnancy veins often improve after delivery.
If you have had a blood clot
In a leg or lung, or you have a clotting disorder. This may change whether treatment is appropriate at all.
If your legs ache or swell
Or feel heavy by the end of the day. That points to a larger vein problem underneath — ask for an ultrasound first.
If you have bulging, ropey varicose veins
These need a vein specialist and a different procedure. Injecting surface veins does not address them.
If the skin at your ankles has changed
In color, or hardened, or you have had an ulcer there. That needs vein assessment, not a cosmetic appointment.
If you have migraines with aura
Or have been told you have a hole in the heart. Foam has been linked to visual disturbance and rare serious events. Say so before any is used.
If you take hormones or a blood thinner
Say what you take. It affects bruising and clot risk.
If you cannot walk regularly
Or are immobile. Walking after treatment is part of what keeps it safe.
If you have a deeper skin tone
Ask about staining, about testing a small area first, and about the concentration used.
If you have a long-haul flight booked soon
Timing matters. Raise it before the appointment.

At-Home Versions

−
Compression stockings
Good alternative
Reduce aching, heaviness and swelling and are useful during long days standing, long flights and pregnancy. They do not remove veins that are already visible. Graduated stockings around 15 to 20 mmHg are the usual over-the-counter starting point.
Walking, leg elevation and calf exercises
Okay alternative
The calf muscle pumps blood back up the leg, so movement genuinely helps symptoms and helps prevent worsening. It does not clear existing veins.
Horse chestnut seed extract
Okay alternative
For symptoms. Some evidence for reducing leg aching and swelling in vein disease. No effect on appearance. Worth checking with a doctor before taking it alongside other medicines.
Vein creams, vitamin K and arnica
Bad alternative
Vitamin K creams included. Nothing applied to the skin closes a vein. Arnica may slightly help bruising after treatment, which is not the same thing.
Sun protection on the legs
Good alternative
The one home step that genuinely changes the outcome of treatment, by keeping brown staining from darkening and lasting longer.

How It Compares

−
Laser for leg veins
Worse
Useful for very fine vessels too small to inject, for matting, and for people who cannot tolerate needles. Generally more painful per pulse, usually more sessions for the same veins, more expensive, and carries its own pigment risk, which matters more on deeper skin tones.
Foam sclerotherapy, ultrasound-guided
Different job
For larger veins rather than spider veins. Done by a vein specialist after a scan. It is the same idea in a form that can treat a vein you cannot see.
Endovenous ablation with heat or glue
Different job
The standard treatment when a larger vein underneath is not working. Often covered by insurance when there are symptoms. If this is the actual problem, treating it first is what makes spider vein treatment last.
Vein stripping surgery
Different job
Largely replaced by the less invasive options above for most people. Still used in particular situations, decided by a vein specialist.
Compression stockings
Different job
For symptoms — aching, heaviness and swelling — and none for appearance. They do not remove veins. Worth wearing regardless of what else you do.
Doing nothing
Different job
Spider veins on their own are a cosmetic issue and carry no health risk. Leaving them alone is a legitimate choice, and the honest comparison for anyone weighing several hundred dollars a session.

Finding a Provider

+

The skill here is diagnosis as much as injection. A good provider examines your legs standing, asks whether they ache or swell, and orders an ultrasound when the pattern suggests a larger vein is feeding the surface ones. Someone who never asks is treating the visible part of a problem that may not be visible.

Injections are given by physicians, physician assistants and nurse practitioners, and rules vary by state. Vein specialists, dermatologists and vascular surgeons all do this work.

Ask which solution and concentration they use, how many sessions they expect, whether an ultrasound is warranted, how long you will be in compression, and what they do about staining and matting. Ask to see their own patients' photographs months out, not weeks — staining is what the later ones show.

Red flags: a promise of clear legs after one session, no examination while standing, no mention of staining or compression, and no ultrasound despite bulging veins or aching legs.

Myths

+
  • "Crossing your legs causes spider veins." It does not. The drivers are genetics, hormones, pregnancy, age, weight and long hours standing.
  • "Treating them makes more come back, worse." Treated veins are gone. New veins later reflect the same tendency, not a reaction to treatment. Matting is real at a treated site, and it usually fades.
  • "Creams and supplements can get rid of them." Nothing applied to the skin closes a vein. Some supplements have moderate evidence for aching and heaviness, but none changes what the legs look like.
  • "One session clears your legs." It clears some veins. Two to four sessions is the usual course, with touch-ups over the years.
  • "Spider veins mean something dangerous is going on." Usually they are cosmetic. Aching, swelling, bulging ropey veins or color change at the ankle are what point to a vein problem worth an ultrasound.
  • "Laser is the modern version and injections are outdated." Injection is still first choice for most spider veins and clears them in fewer sessions. Laser suits very fine vessels and people who cannot have injections.

Questions Patients Ask

+

How many sessions will I need?

Usually two to four per leg, four to six weeks apart, and stubborn veins sometimes need injecting more than once. Extensive veins need more. Expect a course, plus touch-ups every year or two as new veins appear.

Why is there a brown line where my vein was?

Blood trapped in the closed vein breaks down and leaves iron in the skin. Most fades over six to twelve months, and sun makes it darker and slower to clear. It is more visible and slower to fade on deeper skin tones. If a firm tender lump forms, having it released in the office speeds the fading.

What is matting?

A patch of very fine new red vessels where a vein was treated, usually within a few months. It happens to a minority, often fades on its own over months, and occasionally needs further injections or laser.

Will it work on my bulging varicose veins?

No. Ropey bulging veins need a vein specialist, an ultrasound to find the source, and usually a procedure that closes the larger vein with heat, glue or ultrasound-guided foam. Treating the spider veins on top is why some people see them return quickly.

Does it hurt?

Each injection stings for a second or two, sometimes with brief cramping along the vein. Dozens in a session make it repetitive rather than severe. Afterward, aching and itching for a few days.

Will my legs look worse before they look better?

Usually yes, for the first week or two. Bruising, raised red lines and brownish streaks are the normal middle stage. Judge the result months after the course finishes.

References

+