Sclerotherapy vs Ablation
Sclerotherapy is better for spider veins and small varicose veins near the surface. It is an injection, and most people need a short course of them. Ablation is better for the large vein underneath that is feeding those surface veins. A thin tube is threaded inside that vein and closes it, usually in one visit. Vein size is what decides, and plenty of people end up having both.
What actually happens
A liquid or foam goes into the vein. It irritates the lining so the vein swells shut and your body absorbs it over weeks.
It goes in through one small puncture, guided by ultrasound. Heat or medical glue seals the vein along its length. Blood reroutes into deeper veins straight away.
Which veins it is for
The thin purple and red lines, and small ropey veins near the surface.
Usually the saphenous vein running up the inside of the leg. You often cannot see it. It shows up on ultrasound as the source of the pressure.
What it feels like
Each injection stings for a second. Some solutions cause a short cramping ache in the leg.
For heat ablation, numbing fluid is injected along the vein first. That part is the least comfortable bit. Glue needs numbing in one spot only.
How long until you see a change
Treated veins darken, then fade. The final look takes a few months.
Heaviness and swelling usually improve first. Visible bulges shrink over weeks, and some still need treating separately.
How many visits
Spaced a few weeks apart. Large clusters can take more.
A follow-up ultrasound checks the vein stayed closed.
Downtime
Compression stockings for a week or two. No gym or long standing for a day or so.
Most people are back at work the next day. Stockings for about a week. No heavy lifting for a few days.
The main downside
A brown line can follow the treated vein for months. A fine blush of new tiny vessels can appear nearby. Both usually fade, but not always.
The closed vein can feel like a tight string for a few weeks. A small numb patch on the skin is common and usually settles. The rare serious problem is a clot spreading into a deep vein.
Cost and insurance
Ask for the cost of the whole plan, not one visit.
The at-home or drugstore version
Compression stockings genuinely help symptoms and slow things down. They do not remove a vein. Creams with horse chestnut or vitamin K may soothe, but nothing you rub on can close a vein.
A home device cannot reach a vein several centimetres down or run a catheter inside it. Handheld "vein removal" pens work only on the skin surface, and can burn or mark it.
Who each suits
They are usually done together, not instead of each other
Most people with real varicose veins need both: Ablation closes the source. Sclerotherapy tidies up what is left on the surface.
The order matters: If the big vein underneath is still leaking, injected surface veins tend to come back quickly. The pressure that made them is still there.
That is why a scan comes first: An ultrasound of the leg shows whether blood is flowing backwards in the deeper trunk vein. It is the test that decides which treatment you are having.
When sclerotherapy on its own is the right answer
Plenty of spider veins have no faulty vein behind them: If the scan is clear and the veins are cosmetic, injections alone are the sensible choice. Ablation would be treating a problem you do not have.
Foam sits between the two: Whipping the same drug into a foam lets it treat larger veins than a plain liquid can. A ready-made version, Varithena, is used for trunk veins as an alternative to heat.
What neither one does
Neither one stops new veins forming: Both treat the veins you have. Family history, standing work and time keep making new ones, so touch-ups are normal.
Neither one removes a big bulging vein instantly: A vein you can feel standing proud of the skin is often better hooked out through tiny nicks, in a procedure called microphlebectomy.
Before you book
Ask whether you have had a duplex ultrasound, and what it showed.
Ask whether the plan is ablation first and injections after.
Ask how many sclerotherapy sessions are expected, and what the whole course costs.
Ask which parts your insurance is likely to cover and which are cosmetic.
