The question whether sclerotherapy or laser works best for spider veins inevitably comes up in consultations frequently. And rightly so. A comprehensive vein treatment center wouldn’t be complete if it only offered a single option to patients. Our patients are unique, and treatment should be to.
Comparing sclerotherapy vs. laser treatment is like comparing a sports car to an SUV. Neither one is necessarily better, but your decision to drive one over the other might be influenced by what you were wanting to do. You wouldn’t drive a Maserati through the snowy mountains if you could drive a 4×4 SUV instead. The choice to use sclerotherapy or laser is the same concept. Treatment is influenced by multiple factors, including what you are treating, the location, and how large the veins are.
Prior to any initial treatment all of our patients undergo an ultrasound evaluation to rule out any underlying refluxing. Refluxing is the backwards blood flow from veins that occurs when the valves are no longer functioning properly. Underlying refluxing veins, if left untreated, will cause spider vein treatment to fail every time. This is why having a full evaluation is crucial prior to receiving treatment. A visual examination only shows us what is happening at the surface.
You can compare your leg veins to the iceberg analogy: you only see about 10% on the surface. The other 90% of the veins are underneath your skin. We would be remiss as healthcare professionals if we did not address the complete picture.
Treatment with Sclerotherapy: Sclerotherapy is a procedure that uses a medication, called a sclerosant, to produce vein closure. This sclerosant is injected into the dysfunctional veins, usually starting with the largest veins first and working our way towards the smallest veins. Small amounts of sclerosant are injected into each vein until the entire course of the vessel has been treated. Over the next couple weeks (or months for larger veins) the veins will slowly be broken down and dissolved by your body.
Treatment with Laser: Laser technology utilizes energy that when activated is absorbed by the blood vessel. This causes the vein to close down through heat. The entire course of the vein is treated, starting with the largest vein first. As with sclerotherapy the now closed down vein is gradually broken down by the body over the course of several weeks.
The take home point is that either treatment can be a great option, when used appropriately. Ruling out underlying venous reflux is the first step for any patient seeking treatment for veins. Even small spider veins that appear to be cosmetic should still be evaluated to ensure there isn’t underlying refluxing. Great results are not achieved by accident. They are achieved by the right treatment.