Laser Spider Vein Removal vs. Sclerotherapy:
Which is Better?

by VIP Specialists | April 2020

The Vein Specialists at VIP explain the differences between laser spider vein removal and sclerotherapy injections for spider veins, and provide their thoughts on which option is better.

Laser Spider Vein Removal vs. Sclerotherapy: Which is Better?

In This Article:

● Overview of laser spider vein removal and sclerotherapy injections
● Benefits and drawbacks of laser spider vein removal
● Benefits and drawbacks of sclerotherapy spider vein injections
● Comparison of laser spider vein removal and sclerotherapy vein injections

Laser Spider Vein Removal – Also called laser light therapy. Heat from a laser breaks down the proteins that form the structure of the vein wall. Eventually, the vein is sealed so that it no longer carries blood.

Sclerotherapy Spider Vein Injections – A chemical liquid (sclerotherapy) is injected into the spider vein. The vein collapses and eventually closes. Because it no longer carries blood, it becomes less visible under the skin.

Laser Spider Vein Removal

Laser treatments apply strong bursts of light to destroy small superficial veins without needles or incisions. This light is absorbed by the oxyhemoglobin molecule within red blood cells, generating high levels of heat that induce thermal injury to the vein. Therapeutic lasers can emit light at a specific wavelength and frequency. The target vein structure, vein depth, and patient skin type determine the specifications of the laser. For example, shorter light pulses can selectively heat smaller vessels (<2 mm), while longer light pulses are more effective in heating larger vessels [4].

Benefits of Laser Spider Vein Removal

● Laser/light treatments are recommended for patients who have failed sclerotherapy.
● Laser therapy is most effective for very small spider veins (diameters less than a 27 or 30 gauge needle) that are located superficially near the skin surface.
● Needle-phobic patients and those with allergies to sclerosants may prefer laser over sclerotherapy.
● Laser/light treatment is optimal for spider veins located at or below the ankle region, which is more prone to ulceration with sclerotherapy.

Drawbacks of Laser Spider Vein Removal

● Multiple treatments may be necessary to achieve desired results. Treatments must be separated by 4-6 weeks.
● Larger veins >5 mm in diameter do not respond as well to laser treatment.
● Long lasting skin hypopigmentation can result from laser treatment. Nerve injury and skin burns are possible.
● Patients report more pain when treated with laser compared to when they’re treated with sclerotherapy [6].

Sclerotherapy Spider Vein Injections

Liquid agents are also used for the cosmetic treatment of spider veins. These chemical agents, called sclerosants, are injected into the vein and work by safely dehydrating and closing down the veins.

Benefits of Sclerotherapy Spider Vein Injections

● Sclerotherapy is considered the gold standard for treating the majority of lower extremity spider veins, telangiectasia, and reticular veins [1].
● Deeper and highly branched or twisted spider veins can be effectively treated with sclerotherapy injections.
● Overall spider vein clearance rate and patient satisfaction favor sclerotherapy over laser treatment [2,3].
● Spider and reticular vein recurrence is uncommon after sclerotherapy.

Drawbacks of Sclerotherapy Spider Vein Injections

● Multiple treatment sessions, with a minimum of 6 weeks in between each session, may be necessary before the vein is fully cleared.
● New spider veins may develop over time.
● Spider veins will lighten in appearance and become less noticeable, but they may not disappear completely.
● Hyperpigmentation can occur after sclerotherapy. Other local, adverse reactions at the site of injection can occur but typically resolve over the course of a few months.

Laser Spider Vein Removal vs. Sclerotherapy: Which is Better?

When comparing laser spider vein removal to sclerotherapy injections, we consider the following:

● 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 [7].
● Sclerotherapy injections provide faster resolution of problem veins, typically with less treatment session that laser [7].
● Sclerotherapy injections usually only require one or two treatment sessions for complete resolution, while laser typically requires more [7].
● Sclerotherapy injections are less painful than laser treatments [7].
● Sclerotherapy is typically cheaper for patients than laser treatment [8].
● Laser treatment provides a lower rate of temporary hyperpigmentation following treatment [7].
● Laser treatment is useful when sclerotherapy is not an option because of needle phobia or an allergy to sclerosants [8].

References
[1] Scovell, S. Liquid, foam, and glue sclerotherapy techniques for the treatment of lower extremity veins. UpToDate. Accessed March 2020.
[2] Lupton JR, Alster TS, Romero P. Clinical comparison of sclerotherapy versus long-pulsed Nd:YAG laser treatment for lower extremity telangiectases. Dermatol Surg 2002; 28:694.
[3] Coles CM, Werner RS, Zelickson BD. Comparative pilot study evaluating the treatment of leg veins with a long pulse ND:YAG laser and sclerotherapy. Lasers Surg Med 2002; 30:154.
[4] Scovell, S. Laser and light therapy of lower extremity telangiectasias, reticular veins, and small varicose veins. UpToDate. Accessed March 2020.
[5] Dillavou, E., Kiguchi, M. Comparison of methods for endovenous ablation for chronic venous disease. UptoDate. Accessed March 2020.
[6] Kugler, N. W., & Brown, K. R. (2017). An update on the currently available nonthermal ablative options in the management of superficial venous disease. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(3), 422–429.
[7] 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.
[8] 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.

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