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Spider veins, telangiectasias, and varicose veins are some of the most common conditions that patients consult with Dr. Michele Green daily in her NYC office. Luckily, thanks to sclerotherapy for spider veins and the V-Beam laser for telangiectasias, these unwanted leg veins can be quickly treated without side effects and recovery time. Varicose veins are more common in women than men, and it is believed to be both genetically and hormonally mediated in women. Varicose veins are due to the weakening or damaged valves in the veins themselves. When blood collects in the veins, the blood expands the size of the veins, making them appear varicose. Both spider veins and varicose veins are generally not linked with serious health conditions, but they can be uncomfortable and unattractive. For these reasons, many patients seek treatment, as they are self-conscious about these spider veins and shy away from wearing shorts or dresses on a hot summer day.

Sclerotherapy remains the gold standard for treating spider veins and varicose veins. Sclerotherapy involves injecting a sclerosing agent directly into spider veins and varicose veins, causing them to collapse, get reabsorbed, and fade away. The combination of sclerotherapy treatment and V-Beam laser treatment is the best non-invasive method to remove these unsightly veins and blood vessels without any discomfort or downtime. Dr. Michele Green is an expert in sclerotherapy and non-invasive cosmetic dermatology and has been treating and removing these unwanted spider veins for over 25 years in her boutique, private, Upper East Side office. Dr. Green is highly experienced in treating these spider veins using both injections and lasers to give you the best cosmetic results.

Thanks to sclerotherapy and the laser treatment of spider veins and varicose veins, there is no need to cover up your leg veins during the hot summer months. Approximately twenty percent of adults suffer from varicose veins. With so many patients having spider veins and varicose veins, it is no wonder that more than 300,000 sclerotherapy treatments are performed in the United States each year. Dr. Michele Green has treated thousands of patients for unwanted veins in her NYC office. She will review with you all of the best treatment options to remove your unsightly leg veins, and have you return to beautiful clear legs.

What are varicose veins and spider veins?

Varicose veins are characterized by swollen, twisted veins that are visible on the surface of the skin. Typically a deep blue or purple in color, these affected veins most commonly appear on the lower extremities, such as the legs. Varicose veins are usually just a cosmetic concern – the discoloration and bulging nature of the veins often appear unsightly – but can also cause pain or discomfort. The symptoms of varicose veins include throbbing, heaviness, aches in the legs, cramping muscles, or swelling. These painful symptoms can be exacerbated if you are in one position for too long, such as standing or sitting for extended periods of time. Heaviness, aching, and swelling in the legs can also occur after walking a great deal.

Spider veins, also known as telangiectasia, are similar to varicose veins but are smaller and less severe in their symptoms. They are dilated or broken blood vessels present on the skin. Typically, spider veins appear blue or red in color and are closer to the surface of the skin. Spider veins are also most commonly found on the legs but may also develop on the face. Both spider veins and varicose veins are very common, affecting nearly 20% of all adults, and both conditions become more prevalent with age. Again, both spider veins and varicose veins are present in both men and women but are more common in women.


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What causes varicose veins?

Blood circulates throughout your body within two types of channels: arteries, which are responsible for transporting blood from your heart to the rest of your body, and veins, which circulate blood from your extremities back to your heart. When it comes to transporting blood to and from the legs, gravity aids in the circulation of blood through your arteries. However, to pump blood back to your heart from your legs, your circulatory system has to work against gravity. For that reason, valves in your veins open as vascular muscles contract to pump blood upwards and then close again to keep the blood from flowing backward. If the valves in your veins become weakened or damaged, it can affect the forward flow of blood. Blood can begin to flow backward and pool in the vein, causing the elastic walls of the vein to swell and twist and leading to the appearance of varicose veins.

What are the risk factors for developing spider veins or varicose veins?

There are many risk factors for developing spider veins and varicose veins, which are caused when the valves in the veins that keep blood from flowing backward are damaged. This leads to blood pooling in the veins and causes them to twist and swell, creating unsightly, dark-colored bulges near the surface of the skin. Damage can occur to the valves in the vein from a variety of biological factors and lifestyle habits, including the natural aging process, hormone fluctuations, genetic predisposition, obesity, or the frequency with which you stay in one position.

Age – As we age, the risk of developing varicose veins or spider veins increases. Over time, the valves in the veins can become damaged by the regular wear and tear of spending a lot of time on your feet, or sitting for too long in one position frequently, for example.

Hormone Fluctuations – Women are more likely to develop varicose veins or spider veins than men due in large part to the hormonal changes that occur more naturally in female patients. The hormones found more prevalently in female patients can have an adverse effect on the wall of the veins, causing them to become more relaxed. This in turn can lead to a reversal of the blood flow and pooling of blood in the veins. The risk of hormone fluctuations leading to varicose veins increases for women who are on hormonal birth control or who become pregnant. Pregnancy also causes an increase in blood in the body in order to support the growth of the fetus; however, this can also cause the veins in your body to bulge.

Genetic Predisposition – Researchers have found a there is a greater risk for patients who have family members with varicose veins to develop the condition themselves. Family history can, therefore, play a role as a risk factor in developing varicose veins or spider veins.

Obesity – Studies have also shown that patients who are overweight or obese are more at risk for developing varicose veins or spider veins. Being overweight means that there is more pressure on the veins in the legs, which can lead to damage to the valves in the veins.

Sitting or Standing for a Long Time – Staying in one position, such as sitting in one place or standing in one place, for long periods of time is also a risk factor for developing varicose veins. Frequently standing for long amounts of time can put a lot of pressure on the veins in the legs. Over time, this can wear away at the valves, which keep the blood flowing forward. Furthermore, blood does not circulate well if you are staying in one position. For that reason, sitting in one position for prolonged amounts of time can also be a risk factor for developing varicose or spider veins.


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Can varicose veins be prevented?

While varicose veins cannot be completely prevented, there are changes to your lifestyle that you can make to reduce the risk of developing varicose veins. To do so, it is important to improve the circulation in your body by exercising frequently, consuming a high fiber diet, wearing shoes without a high heel, and ensuring that you are adjusting your position so you are not sitting or standing in one place for too long. It is best to maintain a healthy weight and lose weight if you are overweight.

While the condition cannot be completely prevented, there are very safe and effective treatment options available at expert dermatologist Dr. Green’s office in New York City. Dr. Green combines sclerotherapy and laser therapy to eliminate the unsightly appearance and discomfort of varicose veins.

What is sclerotherapy used for?

Sclerotherapy involves injecting a sclerosing solution, such as Asclera®, directly into targeted veins to treat spider veins. Spider veins are superficial leg veins that commonly appear on the surface of the skin. This is due to the increased pressure in the veins in the legs while standing and walking, although other risk factors. Spider veins can also be attributed to genetics, obesity, trauma, and hormonal changes. The appearance of varicose veins and spider veins can negatively affect one’s self-esteem and quality of life as many try to hide the appearance of these veins with pants or long dresses. When the sclerosing agent is injected, the injected veins scar, rerouting blood circulation to other healthy veins. The collapsed vein is naturally processed by the body and fades away, eliminating the appearance of bulging, twisted veins. Sclerotherapy is an amazing, non-invasive treatment that can eliminate the appearance of varicose veins and spider veins and return your legs to look younger, more even, and clear.

What is sclerotherapy for varicose veins?

When it comes to eliminating the appearance of bulging, twisted varicose veins, sclerotherapy is the gold standard treatment. Varicose veins are a common condition that affects approximately 20% of adults, and in the United States, more than 300,000 sclerotherapy treatments are performed every year. Sclerotherapy treatment is an effective procedure that requires no downtime or recovery time. The process involves the injection of a liquid, called a sclerosis agent, into the varicose veins or spider veins. The liquid causes the veins to collapse and disappear, thereby eliminating the cosmetic and physical symptoms of the condition. FDA-approved sclerosants available in the United States include sodium tetradecyl sulfate (a detergent) and polidocanol (Asclera). In the past, hypertonic saline was used as a sclerosant, but it had the disadvantage of causing increased matting or neo-vascularization, pain, and skin discoloration. In Dr. Green’s New York City office, she uses the FDA-approved sclerosant called Asclera, which is injected into the affected veins using a small needle. The treatment causes minimal discomfort, especially when performed by an expert, board-certified dermatologist, such as Dr. Green.

How does sclerotherapy work?

Sclerotherapy is a safe and effective treatment that involves directly injecting a sclerosant, or liquid medicine, into damaged leg veins. This liquid forces the veins to scar and shrink, and, as a result, to be reabsorbed into the body as local tissue. When this occurs, it forces the blood to be rerouted through other veins in order to return to the heart. As the damaged veins are reabsorbed into the body and the blood is rerouted, the appearance of twisted veins on the surface of the skin disappears. Further, the procedure can relieve much of the physical feelings of discomfort that varicose veins can produce. The treatment alleviates the swelling, aching, and burning that can be associated with varicose veins.

Spider veins are smaller than varicose veins and the affected veins can be treated with a sclerosing agent, which destroys these small veins painlessly, with minimal recovery time. Some physicians utilize foam sclerotherapy to treat larger varicose veins. When you have your initial consultation appointment with Dr. Green, she will be able to examine the treatment area to determine which method of sclerotherapy is right for your specific needs.

Who is a candidate for sclerotherapy?

A good candidate for sclerotherapy is someone in good health who wants to eliminate varicose or spider veins either for cosmetic reasons or medical ones. If you are concerned that you might have underlying venous disease, it is best to consult with a vascular surgeon or other qualified healthcare professional. It is important to determine if there is underlying arterial or venous insufficiency. Venous insufficiency predisposes one to increased blood clots, leg swelling, and skin ulcerations. Many patients benefit from sclerotherapy who are suffering from aching, swollen, burning, or night cramps.

If you are pregnant, you may not be a candidate for sclerotherapy. If you are taking oral contraceptives you may not be a good candidate. A history of blood clots would also be a contraindication for sclerotherapy treatment. If you are actively smoking, you are not a good candidate since this can also cause an increased risk of blood clots.

How to prepare for your sclerotherapy treatment

It is best to avoid blood thinners, such as aspirin, Aleve, Motrin (ibuprofen), and other anti-inflammatory medications, vitamins, and herbal supplements for at least one week before your sclerotherapy treatment. Some patients require pre-treatment with an oral antibiotic, and this should be discussed during your consultation with Dr. Green. It is best not to apply any lotions or creams to the treatment area immediately before your sclerotherapy injections. Avoid waxing or shaving the treated areas within 24 hours before your procedure.

Spider vein and varicose vein treatment with sclerotherapy

If you are a good candidate for sclerotherapy, a topical numbing cream will be applied before the procedure to the injection site, to minimize any localized discomfort from the injection of the treated veins. The treatment areas are cleaned and multiple injections with a very fine needle are performed directly into the veins. The sclerosant is injected into the spider veins or varicose veins, causing them to scar and collapse internally. The treatment itself can take 30 minutes or more, depending on the extent of the veins needing treatment.

After your sclerotherapy, the treated areas are wrapped with a long-stretch bandage to add extra pressure, or compression stockings are recommended after treatment for both spider veins and reticular veins. You can return to most normal activities directly after your sclerotherapy treatment. Dr. Green will schedule a follow-up visit for you approximately one month after your procedure to check your progress and your next treatment session.


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Post-Sclerotherapy Treatment

What to do after sclerotherapy

You can resume most normal daily activities following sclerotherapy treatment, including working and light exercising. Physical activity is beneficial after sclerotherapy as it prevents blood clots from forming in the treated area. The most important post-sclerotherapy treatment instruction is to wear mild compression stockings for at least seven days. Dr. Green recommends that the compression stockings be worn as much as possible in between the scheduled sclerotherapy treatments. Compression stockings aid in the recovery process after sclerotherapy as they improve blood circulation and prevent pain and swelling in the legs and ankles. The compression also helps reduce bruising and blood clotting.

Avoid the activities listed here for 48 hours after the sclerotherapy treatment:

  • Airplane travel
  • Hot baths
  • Whirlpools
  • Saunas
  • Direct exposure to sunlight or sunbathing on the treated areas
  • Heavy exercise

How long to wear compression stockings after sclerotherapy

Compression stockings should be worn for at least seven days after the sclerotherapy treatment. Dr. Green recommends that the compression stockings be worn as much as possible in between the scheduled sclerotherapy treatments. They can be worn during the daytime while you are active and can be taken off during the nighttime while you are sleeping. Wearing compression stockings after sclerotherapy treatment reduces the risk of developing side effects, so they are an important part of post-sclerotherapy care.

What happens if you don’t wear compression stockings after sclerotherapy?

Compression stockings are an important part of the recovery process following sclerotherapy. After the treatment, Dr. Green typically prescribes the use of compression stockings be worn for the two weeks following the procedure. Compression stockings are beneficial in several ways: by keeping compression on your lower extremities, the stockings help to minimize bruising and swelling, improve circulation, and reduce the risk of developing blood clots. As such, the risk of developing side effects – both mild and more severe – is decreased if you wear your compression stockings for the full two weeks following the sclerotherapy treatment.

What to avoid after sclerotherapy

After a sclerotherapy treatment, you will be instructed to wear compression stockings for one week. These stockings help to “compress” the treated vessels, and make the treatment results more effective. It is important to avoid the following for the next 48 hours

  • Airplane travel
  • Hot baths
  • Whirlpools
  • Saunas
  • Direct exposure to sunlight or sunbathing to the treated areas
  • Avoid heavy exercise

How long after sclerotherapy do veins disappear?

Typically, the treated veins take at least four to six weeks after injections to resolve. Larger veins that are treated may take longer to disappear after sclerotherapy, such as up to six months. After your sclerotherapy treatment, Dr. Green will schedule a follow-up appointment with you to check your progress and determine whether an additional treatment session is needed to achieve the best results.

What are the side effects of sclerotherapy?

There are mild localized side effects and more serious potential allergic reactions associated with sclerotherapy.

Localized side effects include:

  • Pruritus
  • Red areas or raised bumps at the injection site that should disappear within a few days
  • Allergic reaction in the treatment area
  • Bruising near the injected vein can last for days or weeks
  • Larger veins can develop hard lumps which may take months to dissipate
  • Discoloration or hyperpigmentation can develop as a result of the injections
  • Neo-vascularization can occur with the development of new minute blood vessels, which are called telangiectatic matting

More serious side effects, which require immediate medical intervention include:

  • Development of small ulcers at the injection site
  • A sudden swollen leg
  • Signs of inflammation or infection
  • Deep vein thrombosis (DVT) and pulmonary embolism
  • Risk of blood clots
  • Necrosis due to inadvertent injection of a sclerosant into an artery.

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What is the process of Sclerotherapy Treatment for Spider Veins?

The good news is that both spider veins and varicose veins can be treated effectively. If you have painful and unsightly spider or varicose veins, sclerotherapy may be the solution for you. Dr. Green uses the FDA -approved sclerosant Asclera® (polidocanol), which irritates the lining of the blood vessel, causing it to seal up and become invisible. After the vein collapses, the body slowly absorbs the remaining tissue over time until the skin becomes smooth and blemish-free. Sclerotherapy has even been used to treat patients with venous malformations.

Patients can expect a sclerotherapy session to last anywhere between fifteen and forty-five minutes in length, depending on the number of veins needing injection. Asclera® is injected directly into each vein, with a fine needle, and multiple injections are carried out in a single treatment session. It should be noted that most patients will require more than one treatment session, and these are typically spaced one month apart to allow the sclerotherapy treatment to heal and the spider veins to disappear. The average number of sclerotherapy sessions is four treatments, although that number can vary based on the number of spider veins present.


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VBeam laser treatment for spider veins

VBeam laser treatment is the gold standard to treat small red veins or capillaries on the skin, including the face, chest, back, arms, and legs. The VBeam is a pulsed dye, non-ablative laser, which is designed to remove vascular lesions, rosacea, redness, and pigmentation. Dr. Green utilizes the new VBeam Perfecta, which is the gold standard laser therapy to treat the redness. The laser delivers a burst of energy that is intense enough to treat the targeted blood vessels, but gentle enough to preserve the surrounding tissue and ensure patient comfort. The laser pulse is very effective in helping to eliminate the affected veins. VBeam laser treatment can be used on its own to treat spider veins and also be combined with sclerotherapy treatment in order to maximize the results of the treatment.

Which is better for spider veins: sclerotherapy or laser treatment?

When patients ask which is better, sclerotherapy or laser treatments, the answer is: it depends. Each treatment is very safe and effective for treating spider veins and can either be used individually or combined for an even more thorough treatment process. Neither treatment requires any downtime following the procedure and the risk of side effects for both are minimal. The two treatments have slightly different functions when it comes to addressing the cosmetic concerns of spider veins. If a vein is large enough to have a needle injected, sclerotherapy is the treatment of choice for spider veins. However, small veins or matted veins respond much better to laser therapy with the VBeam laser. When addressing varicose veins, which are typically larger and more swollen than spider veins, sclerotherapy is the treatment of choice. As such, neither treatment is inherently “better” than the other, rather the circumstances and specific needs of the patient dictate which treatment is best. When you have your initial consultation with Dr. Green, the two of you will discuss your physical and aesthetic goals and she will examine the affected area to determine the treatment plan that works best for you.

How much does sclerotherapy cost?

When patients ask, how much is sclerotherapy for spider veins or varicose veins, the answer is: it depends. The cost of the procedure is dependent on a wide variety of factors including your geographic location, the size and scope of the treatment area, the specific combination of treatments, and the type of institution at which you are receiving treatment. The scope and severity of varicose veins determine how many injections are necessary to treat the condition. Spider veins, for example, are a less severe variation of varicose veins and may require fewer injections than a more severe case. In addition, a board-certified dermatologist, who is highly experienced in treating leg veins may be more expensive than a general practitioner. The combination of treatments that you are receiving will also have an effect on the overall cost of the procedure – if you are receiving laser treatments in addition to sclerotherapy, for example. When you come in for your initial consultation, Dr. Green’s office will be able to give you a clearer estimate of the cost of the treatment based on your unique treatment plan.

Is sclerotherapy covered by insurance?

No. Sclerotherapy is a cosmetic procedure and, as a result, most insurances do not consider it a medically necessary procedure. It is always best to consult your individual insurance company to verify your benefits and eligibility. Before you begin the sclerotherapy treatment process, Dr. Green recommends calling your insurance company in order to know for sure whether or not the procedure will be covered.

Does sclerotherapy hurt?

Sclerotherapy involves the injection of liquid sclerosant, Asclera, into the affected veins with a fine needle. There is no downtime necessary following the treatment and you can return directly to your regularly scheduled activities. In terms of discomfort during the procedure itself, sclerotherapy with Asclera is slightly uncomfortable, but not painful. You may feel mild discomfort during injections of smaller veins and cramping may occur for one to two minutes after the injection in larger veins. In the past, dermatologists used hypertonic saline which was much more uncomfortable. To minimize any discomfort, Dr. Green will prescribe a topical numbing cream that you can apply to your legs one hour before the treatment session.

Is sclerotherapy safe?

Sclerotherapy is a safe and effective treatment that has been in medical practice for nearly one hundred years. The procedure is minimally invasive and requires no recovery time, meaning you can return to your regularly scheduled activities immediately after the procedure. The risk of developing major side effects is low and common side effects are minor, such as bruising at the injection site, red bumps around the treatment area, and itching. You may not be a good candidate for sclerotherapy treatment if you are pregnant or have a history of allergic reactions. Patients who have previously experienced allergic reactions to other treatments may be at a higher risk of allergic reactions for sclerotherapy as well.

How long does sclerotherapy last?

The amount of time within which results of sclerotherapy begin to show themselves vary depending on the size and scope of the treatment area. If you are only receiving treatment for spider veins, which are smaller and less expansive than varicose veins, you may see results from the procedure within three to six weeks. Larger varicose veins may take between three and four months for results to become apparent and multiple treatments. The results of sclerotherapy can last for several years. However, if you are prone to having spider veins, new ones can appear sooner and there is no guaranteed way to prevent their formation.


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Is sclerotherapy permanent for spider veins?

Sclerotherapy will treat unwanted varicose and spider veins and remove them. However, due to age, genetics, or hormones, new leg veins can appear which will require treatment. If the formation of new varicose veins or spider veins does occur on your legs, you can receive the sclerotherapy treatment again. This risk of developing new spider veins following sclerotherapy treatment can be reduced if you exercise regularly, eat a well-balanced diet, elevate your legs regularly, and ensure that you are changing your position frequently.

How many sclerotherapy treatments will I need?

The number of sclerotherapy sessions depends on the number of veins and the extent of the treatment area of your spider veins and your general medical conditions. While the number of treatments will vary from person to person, typically four treatment sessions are needed to completely eliminate the appearance of the varicose veins. Treatment sessions should be scheduled approximately one month apart and it is best to have your leg veins injected during the winter months since the main side effect is temporary bruising. By having sclerotherapy of varicose veins performed over the winter, the bruising from the injections will not interfere with your plans, and your legs will be clear by summer.

What is foam sclerotherapy?

Foam sclerotherapy refers to ultrasound-guided sclerotherapy with foam, a treatment option for varicose veins. It is often performed in conjunction with an endovenous ablation procedure. When the foam sclerosant is injected into the targeted vein using a fine needle, it has the ability to stay inside the lining of the blood vessel longer than a liquid sclerosant. This is effective in treating small to medium-sized varicose veins. The treated veins close permanently and the damaged vein is absorbed, processed, and excreted from the body. The blood is then redirected to the surrounding healthy veins to maintain proper circulation. The ultrasound is performed prior to the foam sclerotherapy treatment to locate the target vein, and it is also performed after the treatment to ensure the injected vein has fully sealed shut. Patients are instructed to wear compression stockings after the procedure to encourage healthy circulation. Foam sclerotherapy and endovenous ablation are typically performed at an outpatient vascular clinic. For more information, visit

Can I inject spider veins at home?

No! Do not attempt to inject spider veins at home. First, the sclerosing agent that is FDA-approved to treat spider veins is only available for purchase by physicians, and sclerotherapy must be performed by an experienced physician like Dr. Green. You cannot remove spider veins with any over-the-counter or prescribed creams, gels, or pills. Attempting to inject spider veins at home will greatly increase the risk of developing serious side effects.

Regularly wearing compression stockings can help prevent more spider veins from forming because they promote healthy blood flow throughout the legs. Exercise and weight management can also prevent the formation of new spider veins. Being active and using the muscles helps the legs push blood up through the veins and avoid pooling. Maintaining a healthy weight relieves your legs from the extra downward pressure that makes it more difficult for blood to travel upward in your veins.

What other treatment options are available for varicose veins?

In some cases, Dr. Green may determine that sclerotherapy is not the right option for your particular case of varicose veins. If that is true, there are several other options to consider when determining which treatment process will work best for you. If you have a relatively mild case, compression stockings alone can help to improve blood circulation and reduce the amount of blood pooling in the veins. Compression stockings can be a good place to start with the treatment of varicose veins; they cannot reverse existing varicose veins, but they will help prevent new ones from forming and existing ones from getting worse. Laser treatment is another treatment option for varicose veins and can vary from endogenous laser ablation, or radiofrequency ablation. Laser treatment can also be combined with sclerotherapy to enhance the treatment results. In severe cases, such as cases involving leg ulcers or severe pain, patients can turn to surgery including conventional vascular surgery.

How do I get started with treating my spider veins today?

The appearance of spider veins and varicose veins can be disheartening for patients, especially during the hot summer months when you want to show off your favorite dress or bikini without worrying about your legs. Dealing with spider veins and varicose veins is frustrating, especially if you have tried over-the-counter creams and lotions that claim to help them disappear to no avail. Thankfully, non-invasive cosmetic treatments like sclerotherapy and VBeam Perfecta are available to make those stubborn veins disappear once and for all. Whether your spider veins have developed due to age or genetics, or if your job requires you to sit or stand for an extended period of time, Dr. Green is here to restore your confidence in your legs and help you want to wear your favorite summer dress again.

Dr. Michele Green is a board-certified dermatologist based in Upper East Side, NYC, and an expert in a wide variety of cosmetic injections, including sclerotherapy and laser treatments to treat spider veins. With over 25 years of experience in dermatology with treatments such as Botox, chemical peels, Juvederm injections, microneedling, skin tightening, and CoolSculpting, Dr. Green will listen carefully to your concerns and create a customized plan to achieve your aesthetic goals. When seeking treatment, it is important to consult with a dermatologist who is experienced and highly trained in treating leg veins in order to minimize any unwanted side effects. To book a consultation to find out if you are a good candidate for sclerotherapy, please call our NYC office today at 212 535 3088 or contact us online to arrange an appointment.


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