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  • 25% of all adults have varicose or spider veins.
  • For over 75 years, sclerotherapy has been the leading procedure to remove them.
  • Sclerotherapy is simple, fast, effective, and comes with limited side-effects or potential risks.
  • Recovery is practically instantaneous.

It’s true, nobody’s ever died as a result of spider or varicose veins, but that’s not to say they haven’t caused people a lot of pain over the years, both emotional, and certainly in the case of varicose veins, physical as well.

Fortunately, not every varicose vein is a constant source of discomfort, but when they are, the result can be pretty unpleasant. Plus, they’re occasionally the first sign of more serious circulatory problems to come, which is to say that if you have any, it’s probably wise to have them examined.

Spider veins, on the other hand, are for the most part just ugly, plain and simple. They may not be a source of physical discomfort, but for anyone who is already self-conscious about the attractiveness of their legs, or their physical appearance in general, developing spider veins isn’t going to do much for their self-esteem.

Sclerotherapy is the “go-to” procedure to remove spider veins. While there are other, newer treatments to address them, sclerotherapy, which was developed over 75 years ago, remains the standard treatment option.

What is the difference between spider veins and varicose veins?

Many people assume that spider veins and varicose veins are just different names for the same condition. And while it’s true that they both have similar causes, symptoms, and share many of the same treatments, there are subtle differences between the two of them.

For starters, spider veins are not typically painful, although some people do occasionally complain of slight itching, burning and stinging sensations stemming from them. Spider veins are blue, red and/or purple, usually under 1mm wide, and tend to resemble a tree branch or spider web, hence their name.

They are asymptomatic and basically harmless, so the only reason why people choose to remove them is cosmetic. Sclerotherapy is almost always the treatment option.

Varicose veins, on the other hand, can cause pain or discomfort in a variety of ways. They can swell, throb, itch, ache, cramp and even instigate restless leg syndrome in some people. Varicose veins are typically raised and appear swollen.

Dr. Brian Heeringa, a board-certified general surgeon and vein specialist with a practice in Northern Michigan, summarizes: “Varicose veins are enlarged, diseased veins that often appear ropy, gnarled and twisty. They cause bulging of the overlying skin and by definition are at least 3mm in diameter. Spider veins, by contrast, are typically 1mm or smaller in size, often appear blue, red or purple, and are on the skin surface.”

Close up of varicose veins (left) and spider veins (right).

What are spider veins and varicose veins caused by?

Both conditions are very common, especially among women, although many men develop them as well. Approximately 25% of all adults have varicose veins. In most cases, they appear on the lower legs and feet, although spider veins occasionally show up on the face as well, often on the nose.

They can develop at any age, although don’t generally form before people reach their thirties. As we age, we become increasingly susceptible to developing varicose and/or spider veins. Of all groups, the condition is most common among women aged 30-50.

Scientists have yet to categorically agree upon what exactly causes these blood vessels to become visible on some people, but the condition often runs in families, indicating that one potential explanation could be hereditary.

Many experts also believe the hormone estrogen could play a role in cases involving women because both puberty and pregnancy, two periods in a woman’s life when hormone production is accelerated, appear to encourage varicose and spider veins to form.

According to Dr. Heeringa, “the most common cause of varicose veins is faulty or non-functioning valves. Our veins have to carry blood, against gravity, back to the heart. The leg veins have one-way valves which prevent the backwards flow of blood, and if those valves don’t function properly blood will pool in those veins, causing them to enlarge. Blood backing up into tiny skin veins in turn leads to spider veins.”

Spider veins appear to stem from a wider variety of causes than their varicose siblings. For example, they can develop from trauma inflicted on an area of the body, and apparently even from wearing ill-fitting undergarments being held up by overly tight rubber bands.

It’s also believed that prolonged exposure to the sun and extremely hot or cold weather causes them to appear on the face (more so with fair-skinned people), while obesity and occupations that involve standing for long periods of time are other suspected culprits. Finally, spider veins can also be a sign of underlying varicose veins that are rooted deep below the skin and otherwise invisible.

Are they dangerous?

As with spider veins, varicose veins sometimes bleed, and while rare, they can bleed to the point where a trip to the hospital might be required. They’re also more prone to clot than spider veins, and if these blood clots dislodge and travel to the lungs, the possibility develops that they could trigger a pulmonary embolism, a life-threatening condition.

Can they be prevented?

There is currently no universally accepted way to prevent spider or varicose veins from forming, although some suggest that maintaining a healthy weight and doing regular exercise, walking in particular, could be helpful.

Others believe wearing high-heeled shoes and boots contributes to the problem and as such should be avoided, but again there is little to no solid scientific evidence supporting this hypothesis.

RELATED: Expert Advice on Varicose Vein Treatment and Prevention

What is sclerotherapy?

Sclerotherapy is a microinjection procedure to treat spider and varicose veins. It’s widely considered to be the “gold standard” of treatment options, most notably for spider veins.

The procedure involves injecting a sclerosing solution into the problem veins with an extremely tiny needle. Once injected, this solution, comprised of either hypertonic saline or sodium tetradecylsulfate, causes an irritation to the inner lining of the vein, corroding it’s walls until it finally collapses, at which point it is absorbed by the body and gradually fades until it clears away completely.

Dr. Heeringa elaborates further on the process: “Sclerotherapy involves injecting a medicine into the diseased veins with a tiny needle. The needles used for sclerotherapy are typically about the same size as a hair follicle, which is why patients frequently describe the sensation as akin to a mosquito bite. Sclerotherapy can be done under visual or ultrasound guidance in the physician’s office.”

How many sclerotherapy treatments are required to remove a spider vein?

In the majority of instances, approximately 2-5 treatments are required in order to realize the desired outcome. In some minor cases where there are limited spider veins, occasionally only one session is needed.

Dr. Larisse Lee, a board-certified vascular surgeon with a busy practice in Los Angeles, notes that much depends on the extent of the problem, but even if in most cases “multiple sessions may be required, sclerotherapy sessions only take 20 minutes to complete.”

Dr. Heeringa confirms that the amount of time required “varies depending on how many veins the provider will treat in a single session.”

How do you prepare for a sclerotherapy session?

Sclerotherapy is a relatively simple procedure that doesn’t require any significant advance preparation.

“Once the physician has determined that sclerotherapy is needed,” says Dr. Heeringa, “there is no specific preparation required. Patients should shower before their appointment and avoid putting lotion or makeup over the areas to be treated.”

“Wear loose comfortable clothing,” adds Dr. Lee, “and refrain from drinking alcohol the day of your treatment.”

Where is the procedure performed?

Sclerotherapy treatments are typically conducted in the doctor’s office or clinic and don’t generally require anaesthesia. For patients who are scared of needles or particularly sensitive to pain, however, a topical local anaesthetic can be applied on the skin roughly 30 minutes prior to the procedure.

What are the most common side effects of sclerotherapy?

Sclerotherapy is a generally safe procedure with little risk of serious complications occurring.

“Risks such as blood clots, allergic reactions and ulcers are very rare,” confirms Dr. Lee. “Some patients could develop hyperpigmentation of the treatment area — typically a brownish discoloration — which is usually temporary.”

Dr. Heeringa also acknowledges that potential negative side effects from sclerotherapy are limited, but adds that “some bruising and tenderness can occur at the site of the treated veins. Plus, staining of the skin is another rare side effect, but the risk is increased by tanning or sun exposure after the procedure.”

Dr. Heeringa further adds that “sclerotherapy can be done with either liquid or foam medication. And while foam often works better, it has a 1% risk of temporary visual disturbances such as those experienced by patients with ocular migraines.”


RELATED: Hemosiderin Staining Explained

How involved is the sclerotherapy recovery process?

There is minimal formal recovery required after sclerotherapy.

“Patients typically need to wear compression stockings for a few days after the procedure and are encouraged to remain active,” says Dr. Heeringa. “Most patients engage in normal activities immediately after the procedures. Depending on the size and quantity of veins treated, they may be discouraged from flying for the first few days afterward and sunbathing may also be discouraged as it can increase the risk of staining the skin along the course of the injected vein.”

Dr. Lee says she instructs her patients that they can resume light activities immediately after treatment, “but no vigorous exercise for that day. We also encourage patients to walk a lot and wear compression stockings to promote healing.”

Who is a good candidate for a sclerotherapy procedure?

Pretty well anyone who has spider veins is a good candidate for sclerotherapy so long as they aren’t pregnant, have cardiovascular disease, undergone heart bypass surgery, or have a history of blood clots in the area to be treated.

Sclerotherapy can be a great solution to treat varicose veins as well, so long as the veins in question aren’t too large, in which case they are usually best treated through lasers or alternate methods.

The best way to find out if your varicose veins can be treated with sclerotherapy is to contact a nearby board-certified vascular surgeon or vein specialist and arrange for a consultation. Upon examination your doctor will be able to immediately determine if you are a suitable candidate for the treatment.

What results can I expect from a sclerotherapy treatment?

Once spider veins have been resolved, they are gone forever. However, new spider veins may appear in other areas, and if so, additional treatment sessions may be needed.

As Dr. Heeringa explains: “Sclerotherapy has excellent long-term results for the veins that were treated. Unfortunately, the underlying genetic and environmental factors that led to the development of the varicosities in the first place typically exist and therefore the risk for developing new spider veins or varicose veins is ever-present. Early recurrence can also occur if there are varicose veins under the skin that weren’t treated prior to doing sclerotherapy of the surface spider veins.”

Will health insurance cover the cost of sclerotherapy?

Few if any health insurance policy’s in the United States will cover the cost of sclerotherapy for spider veins, as removing them is not considered a medical issue but rather strictly cosmetic.

Varicose veins, however, can be a different story under certain conditions. “Insurance will typically cover sclerotherapy for medical vein disease (varicose veins) if the patient is symptomatic, has documented venous reflux, and has not had resolution of their symptoms after a trial of compression therapy,” confirms Dr. Heeringa.

How much does sclerotherapy cost?

As with most plastic surgery procedures in the United States, the cost can vary greatly depending upon your geographic location, the experience level of your physician, and the length of the sclerotherapy session itself.

According to the American Society of Plastic Surgeons (ASPS), in 2016 the average cost of a sclerotherapy session in the United States was $326.

Dr. Lee says she charges $350 per session at her clinic in Los Angeles while Dr. Heeringa says he has “seen prices ranging from $150 to $800 for a single sclerotherapy session,” adding that “it’s important when scheduling cosmetic sclerotherapy to ask how much time is typically spent on that session, what areas will be treated, and how many sessions are expected to be needed to obtain the desired results.”

In the grand scheme of cosmetic procedures, sclerotherapy is a relative bargain. It’s quick, consistently provides satisfactory results, requires little to no recovery time, and once your spider or varicose veins have been treated, they are permanently gone.

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