Illustration of a woman's legs on a treatment couch, cotton pads taped along one calf while gloved hands fit a compression stocking on the other.

Sclerotherapy, laser, ablation: which vein treatment does what

Sclerotherapy closes small veins with an injected solution; surface laser suits the very finest facial-style vessels; endovenous ablation (laser or radiofrequency) closes the leaking trunk veins underneath. The order matters: source first, cosmetics last — treating surface veins while a deeper leak feeds them is why they keep coming back.

"I've had multiple sclerotherapy treatments over 17 years — they keep returning, worse and worse." That sentence from our community contains the whole lesson of this guide: the treatments work, but only on what they're aimed at.

The menu, decoded

Sclerotherapy (liquid or foam). A solution injected into the vein irritates its lining so it seals and fades. The workhorse for spider veins and the blue-green reticular veins beneath them; foam versions handle larger branches. Expect a course, not a session — and know the honest cosmetic side-effects: temporary bruising, possible brownish staining along the vein that can take months to fade, and occasionally a blush of fine new vessels (matting).

Surface (transdermal) laser. Light through the skin for the very finest red threads — a complement to sclerotherapy, not a substitute, and the least relevant to medical vein disease.

Endovenous ablation — laser (EVLA) or radiofrequency. The one that treats causes: a catheter inside a leaking trunk vein (e.g. the great saphenous) heats and seals it along its length. Walk-in, walk-out under local anaesthetic; this is what largely replaced vein stripping. If your duplex shows truncal reflux, this — not sclerotherapy — is the foundation.

Not on this page: embolisation, the pelvic equivalent — relevant when the feeding leak sits above the groin.

Why veins come back

Three honest reasons, in order of frequency:

  1. The source was never treated. Surface veins are the output of a leak. If a refluxing trunk vein — or a pelvic source — keeps pressurising the network, closed veins are simply replaced. Rapid recurrence after competent treatment is itself a diagnostic clue pointing upstream.
  2. The disease is progressive. Even after perfect treatment, the tendency that caused the first veins continues. New veins over years is biology; new veins over months is a source.
  3. The plan skipped the map. Any treatment worth having starts with a duplex ultrasound standing up. Cosmetic treatment without a reflux map is decorating over damp.

The right order, as a checklist

  1. Duplex ultrasound (standing) → map every leak, including iliac/pelvic inflow where the pattern suggests it
  2. Treat the source: ablation for truncal reflux; embolisation for a pelvic source; a stent where compression blocks outflow
  3. Then sclerotherapy/laser for what remains — at this point it lasts

If a clinic proposes step 3 without step 1, ask why. And if you've already been round the recurrence loop more than once, the question that changes the game is: "has anyone looked above my legs?"

Sources

  1. Rabe et al. — European guidelines for sclerotherapy in chronic venous disorders (Phlebology, 2014)
  2. Lurie et al. — The 2020 update of the CEAP classification system and reporting standards (J Vasc Surg Venous Lymphat Disord, 2020)

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Leg veins that start in the pelvis: when treatment keeps not working

Recurring varicose veins, vulvar or inner-thigh veins, veins from pregnancy — the signs your leg veins are fed from above, and what to ask for.

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KINUUM does not provide a medical diagnosis. It is a symptom-awareness guide designed to help women identify patterns worth discussing with their doctor. Always seek professional medical advice.