Sclerotherapy for leg veins.
A solution injected into a spider vein irritates its lining so the walls seal together. The vein stops carrying blood, and your body absorbs it over the following weeks. It has been the standard treatment for small leg veins for decades.
The vein is closed, not removed.
A spider vein is a small vessel that has stretched and is no longer moving blood usefully. The solution injected into it damages the lining deliberately, the walls swell and adhere, and what is left is a thread of scar tissue rather than an open vessel.
That thread is then broken down and cleared by the body over four to eight weeks, which is why nothing looks better immediately and why the leg often looks slightly worse for a fortnight before it looks better.
Blood that was going through that vein reroutes into the healthy deep veins, which were doing the real work already. Closing a spider vein takes nothing away from your circulation.
Surface veins are sometimes a symptom rather than the problem.
This is the part that decides whether the result lasts, and it is the reason the assessment includes questions that seem unrelated to how your legs look.
Signs that need investigating first
- Aching, heaviness or throbbing in the legs, worse by the end of the day
- Ankle swelling that improves overnight
- Cramping at night, or restless legs
- Itching over the veins themselves
- Brown or hardened skin around the ankle
- Any ulcer, or any area of skin that has broken down and healed slowly
- Bulging, ropey veins you can feel standing proud of the skin
- A history of deep vein thrombosis
Why it matters
Those point toward venous insufficiency, where valves deeper in the leg have stopped closing properly and pressure is being pushed out into the surface vessels. Spider veins in that situation are the visible end of a larger problem.
Treating only the surface veins there is treating a symptom. They clear, and then new ones appear, because the pressure that produced them has not changed. The right first step is a duplex ultrasound and a vascular opinion.
If any of the signs on the left apply to you, expect to be referred for assessment before treatment rather than treated on the day.
What it treats, and what it does not.
Commonly treated
- Thread and spider veins on the thighs and calves
- The blue green reticular veins that often feed them
- Small varicose veins where the deeper circulation has been shown to be sound
- Veins behind the knee and around the ankle
- Clusters that have appeared after pregnancy
Not what this does
- It does not treat large bulging varicose veins, which need a vascular opinion.
- It does not correct valve failure deeper in the leg.
- It does not treat venous ulcers or the skin changes around them.
- It does not treat facial thread veins, which are usually a laser question.
- It does not stop new veins forming, since the tendency that produced them remains.
What actually happens.
Assessment
History first, including clotting history, pregnancies, family pattern and the symptom list above. Both legs are examined standing, because veins fill under gravity and looking at them lying down understates them.
Mapping
The feeding vessels get treated before the smaller ones running off them. Working the other way round means the small veins refill from a source that was never closed.
Injection
A very fine needle into each vein in turn, with a small volume in each. It stings briefly as the solution goes in, and the sting fades in seconds. A session covers many veins and takes around half an hour.
Compression
A stocking goes on before you stand up and stays on. Compression holds the treated walls together while they seal and it measurably improves the result. It is not optional advice.
Walking
You walk for fifteen to twenty minutes straight afterwards, and daily after that. Movement keeps the deep veins pumping, which is what lowers the risk of a clot.
Review
Four to eight weeks later, once the treated veins have cleared and it is possible to see what remains. Most legs need two to four sessions, and judging it earlier is judging a leg mid process.
Recovery, described honestly.
The legs look worse before they look better. Knowing that in advance is the difference between a normal recovery and a worried phone call.
- Compression stockings as directed, typically for one to two weeks.
- Walk daily. Avoid standing still for long periods, and avoid heavy lifting for forty eight hours.
- No hot baths, saunas or hot tubs for two weeks. Heat dilates veins and works against the treatment.
- Bruising along the treated veins is expected and takes two to three weeks to fade.
- Brown staining along the line of a treated vein happens in a minority of people. It usually fades over several months, and occasionally longer.
- A fine network of tiny new red vessels can appear near a treated area. It is called matting, it is usually temporary, and it is more likely with larger veins.
- Sun on a healing leg makes staining worse, so cover the area or use sunscreen on it.
- Call about calf pain, swelling of one leg, shortness of breath or chest pain rather than waiting. These are uncommon and they are the ones that matter.
Reasons this is declined or postponed.
- Pregnancy and breastfeeding. Many pregnancy related veins improve on their own in the months after birth, so waiting is the right advice as well as the safe one.
- A history of deep vein thrombosis or pulmonary embolism, or a known clotting disorder, without vascular clearance
- Being unable to walk or mobilise normally afterwards
- Peripheral arterial disease, where compression itself carries risk
- Active infection or inflamed skin over the area
- Known allergy to the sclerosing solution
- Untreated venous insufficiency, which gets assessed first rather than injected over
- A known hole between the chambers of the heart, which changes the risk profile and needs a specialist opinion
When something else is the better answer.
| Option | Where it genuinely wins | Where it does not |
|---|---|---|
| Sclerotherapy | Spider and reticular veins on the legs. The long standing standard, and it reaches veins a laser cannot. | Large varicose veins, valve failure, and legs with untreated insufficiency. |
| Laser for surface veins | Very fine vessels too small to cannulate, and facial thread veins where sclerotherapy is not used. | Leg veins generally, where it is less effective than injection and usually more expensive. |
| Vascular assessment and ablation | Where the underlying valves have failed. Fixes the cause rather than the appearance. | Overkill for cosmetic spider veins in a leg with sound deep circulation. |
| Compression and movement | Symptoms of aching and heaviness, cheaply and immediately. Also slows progression. | Does not clear a vein that is already visible. |
| Doing nothing | Entirely reasonable if the veins are painless and only bother you in a mirror. | They tend to increase slowly with time, pregnancy and standing work. |
Often asked about together.
About this treatment specifically.
Does it hurt?
There is a brief sting as each vein is filled, lasting a few seconds. The needle itself is very fine and most people find the compression stocking afterwards more of an inconvenience than the injections were. No anaesthetic is needed.
Will the veins come back?
A vein that has been properly closed and absorbed does not come back. New veins can appear, because whatever caused the first ones is still there: genetics, standing work, pregnancy, time. That is maintenance rather than failure, and it is a different thing from a vein reopening because the feeding vessel was never treated.
How many sessions will I need?
Usually two to four, spaced four to eight weeks apart, and it depends on how many veins there are rather than on how well you respond. Nobody can give you an accurate number without looking at the leg standing up.
Do I really have to wear the stockings?
Yes. Compression is not comfort advice, it is part of the treatment. It holds the vein walls in contact while they seal, and it reduces both staining and the chance of the vein reopening. Skipping it produces a worse result from the same appointment.
Why has my leg gone brown along the vein?
Iron from broken down blood cells left in the skin. It affects a minority of people, it is more common with larger veins and darker skin, and it usually fades over several months. Keeping sun off the area while it settles genuinely helps.
Can I have it done in summer?
You can, but there are two arguments against. Compression stockings in July are unpleasant, and sun on a healing leg makes brown staining more likely and longer lasting. Autumn and winter suit this treatment better, which is also when it is easiest to book.
Do I need an ultrasound first?
Not everyone does. If your legs are comfortable, there is no swelling, no skin change and no bulging vein, spider veins can usually be treated directly. If any of the symptoms listed further up this page apply, then yes, and having it done first protects you from paying for a result that will not hold.
Call and describe what you notice.
416 475 324871 Albert Street, Oshawa, Ontario L1H 4R1.
Simok Aesthetics is a medical aesthetics clinic at 71 Albert Street in Oshawa, Ontario, offering injectables, skin treatments, PRP, vein treatment and IV nutrition therapy to patients across Durham Region.