April 22

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What Spider Vein Treatment Hurts More? Sclerotherapy or Laser?

By Dr. Jose Almeida

April 22, 2020


Sclerotherapy and laser therapy are both effective to remove unwanted spider veins, but does one hurt more than the other and what are the differences? After evaluating many different patient experiences and testimonials of both sclerotherapy and laser therapy, laser therapy is much more painful than sclerotherapy.

"Both laser therapy and sclerotherapy are available options for spider vein treatment, but based on methods of treatment, laser therapy is a more painful treatment." - Dr. Almeida 

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How Is Sclerotherapy Different From Laser Therapy?

Sclerotherapy uses a chemical that is inserted directly into the veins, starting with the largest vein in the spider vein. This chemical damages the lining of the vein and with damage to the vein, the vein begins to scar down, preventing any blood flow through the vein. Once the vein is no longer functional and fully scarred, the body removes the vein, thereby removing the visible spider veins. Laser therapy uses a laser device that is inserted into the larger portions of the spider vein. The laser emits heat that damages the vein, causing it to scar and prevent blood flow. As with sclerotherapy, once the vein is no longer functional, the body removes the vein.

spider veins before and after treatment

Spider Veins Before and After Treatment Example

Is Sclerotherapy for Spider Veins Painful?

As described above, sclerotherapy uses a chemical while the laser uses heat. Most patients do not feel the chemical irritating the vein, but the heat generated by the laser causes a burning sensation that most find unpleasant and painful.

The pain from the laser procedure usually limits the number of veins that may be treated in a single session, which means more treatment sessions, pain, and a longer duration before spider veins disappear, than with the use of sclerotherapy. Despite the burning sensation felt during treatment, since the laser is inserted within the vein and the heat is being applied to the vein, there is no burning of the skin surface.

Even though there is pain with the laser therapy, there is an option to treat the pain while having a treatment session. Topical numbing creams or gels may be applied directly to the skin over the treatment areas about 30 minutes prior to treatment, which may lessen the burning sensation that is felt during the procedure. This is not performed customarily, but is available upon request.

Video: About Sclerotherapy

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What to Expect at Home After Spider Vein Treatment

After both treatments, there may be some slight discomfort, irritation, bruising, or swelling over the areas that have been treated. Over the counter pain relievers are options to treat any post treatment discomfort and use of compression stockings for 1-2 weeks can help to reduce pain and also aid in healing the treated areas. In order to prevent any increasing pain after the procedure, it is best to stay out of the sun, or if needing to go out into the sun, protect the skin with broad spectrum SPF and cover treated areas with clothing. 

Both laser therapy and sclerotherapy are available options for spider vein treatment, but based on methods of treatment, laser therapy is a more painful treatment. When looking for a solution for your spider veins, take into consideration procedural pain when making a choice and speak with a board certified vascular surgeon to learn further details about both procedures and which procedure is right for you.  

Dr. Jose Almeida

About the author

Dr. Jose Almeida, MD, FACS, RPVI, RVT is a veteran academic vascular surgeon who practices Endovascular Venous Surgery in Miami, FL. He is also a Diplomate of the American Board of Surgery in both Vascular Surgery and General Surgery.

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