Vein specialist Dr. Dev Batra explains the differences between laser treatment and sclerotherapy injections for spider veins, and which option is better.
Because Dallas Vein Institute is a full-service vein clinic, we’re often asked why we don’t offer laser treatment. The short answer is that sclerotherapy injections have proven advantages over laser treatment that ultimately benefit our patients. For the long answer, we’ve provided a detailed comparison of the two treatment options.
There are a number of different laser treatment devices that are designed specifically for the removal of spider and reticular veins. These devices utilize light energy that’s finely tuned such that it is selectively absorbed by oxyhemoglobin in the blood and converted into thermal energy. When applied to the the skin, this intense heat causes rapid coagulation of the blood, injury to the vein, and thrombosis (clotting) of the target vessel.¹
Laser treatment is most effective when veins are small, sparse, and shallow. Typically, laser energy will not be effective on veins that are larger than a 30-gauge needle and cannot treat at depths greater than a few millimeters without damaging surrounding tissue.² These limitations are due to the nature of light itself. In general, lasers that penetrate deeper require more energy to eliminate the target vein, but excess energy can also cause non-selective heating of tissue that surrounds the vein.²
Sclerotherapy (also known as ‘chemical ablation’) injections involve the injection of a sclerosant agent directly into the veins. A sclerosant is a chemical that triggers a series of biological reactions from within the veins causing vein irritation, dehydration, and destruction. Sclerotherapy injections begin to work immediately, so our patients tend to be very excited to see their spider veins fade away as soon as they receive an injection.
In contrast to laser treatment, sclerotherapy injections can be used to treat virtually all sizes of spider and reticular veins. Sclerotherapy also has the ability to treat larger veins that lie further underneath the surface of the skin, making it an important accessory treatment to completely eliminate branches of varicose veins.³
In most cases, spider or reticular veins treated by sclerotherapy require one or two treatment sessions for complete resolution. On the other hand, multiple laser treatment sessions are often necessary for the complete elimination of problem veins (sometimes as many as six!), costing patients time and additional medical expenses. However, laser treatment is particularly useful in rare instances of needle phobia and allergy to sclerosants.¹
Where we can, we like to lean on quality clinical evidence to guide our medical practice. In a study published in the Journal of the European Academy of Dermatology and Venereology, 56 patients with spider and reticular veins on both of their legs received laser treatment on one leg and sclerotherapy injections on the other leg.
Legs treated with sclerotherapy saw faster resolution of their veins and subjects reported significantly less pain in the leg treated by sclerotherapy than in the leg that received laser treatment. Besides temporary hyperpigmentation, which occurred more in legs treated by sclerotherapy, mild side effects occurred at similar rates between the two treatments.⁴
To conclude our position on the laser vs. sclerotherapy debate, we’ve summarized the unique advantages of each approach below:
Sclerotherapy injections allow for more comprehensive vein treatment because of their ability to treat larger veins and veins that lie further underneath the surface of the skin.⁴
Sclerotherapy injections provide faster resolution of problem veins, typically with less treatment session that laser.⁴
Sclerotherapy injections usually only requires one or two treatment sessions for complete resolution, while laser typically requires more⁴.
Sclerotherapy injections are less painful than laser treatments.⁴
Sclerotherapy injections can be used following varicose vein treatment to eliminate small vein branches if needed.³
Sclerotherapy is typically cheaper for patients than laser treatment.¹
Laser treatment is useful when sclerotherapy is not an option because of needle phobia or an allergy to sclerosants.¹
Laser treatment provides a lower rate of temporary hyperpigmentation following treatment.⁴
At Dallas Vein Institute, we know that better clinical decisions translate into higher quality patient care. As part of our commitment to providing the best possible vein care, we will always opt for treatments that maximize convenience, comfort, and long-term healing.
About the Author
Dr. Dev Batra, M.D. is a vein specialist and founding partner of Dallas Vein Institute. Holding board certifications in radiology and vascular & interventional radiology, he is well-versed in vein issues and has been voted one of D-Magazine’s best doctors in Dallas for three years running.
This blog post was written with research and editorial assistance from OnChart™.
 Nakano LCU, Cacione DG, Baptista-Silva JCC, Flumignan RLG. Treatment for telangiectasias and reticular veins. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD012723.
 Mccoppin, H., Hovenic, W., & Wheeland, R. (2011). Laser Treatment of Superficial Leg Veins. Dermatol Surg, 37(6), 729–741.
 Morrison, N., Gibson, K., Vasquez, M., Weiss, R., Cher, D., Madsen, M., & Jones, A. (2017). VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 321–330.
 Parlar, B., Blazek, C., Cazzaniga, S., Naldi, L., Kloetgen, H. W., Borradori, L., & Buettiker, U. (2015). Treatment of lower extremity telangiectasias in women by foam sclerotherapy vs. Nd:YAG laser: A prospective, comparative, randomized, open-label trial. Journal of the European Academy of Dermatology and Venereology, 29(3), 549–554.
The Materials available in the Dallas Vein Institute blog are for informational and educational purposes only and are not a substitute for the professional judgment of a health care professional in diagnosing and treating patients.