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One week after sclerotherapy, the treated veins usually look worse than they did before. They can be darker, slightly raised, tender to press, and surrounded by bruising. That is the vein closing, and it is normal. Fading starts in the second and third week and continues for six weeks or more.
Here is what each week looks like, what to do and avoid, and the few things that are worth a call.
Day 0: the appointment
Sclerotherapy is a series of small injections into the vein. There is no anesthetic and the needle is fine. A session takes 15 to 45 minutes depending on how many veins are treated. Afterwards you put on compression stockings and go for a walk. University Hospitals’ patient instructions, which match ours, call for a 30 to 60 minute walk shortly after treatment. Walking keeps blood moving through the deep veins while the treated surface veins close.
Days 1 to 3: compression and bruising
Keep the compression stockings on continuously for the first 24 hours, then during the day for seven to fourteen days. This is the part of aftercare that most affects the result, because compression keeps the closed vein flat so it heals as a thin scar rather than a lumpy one.
Bruising appears within a day and peaks around day three. Some people get small firm lumps along the vein where trapped blood has clotted. Both are expected. Skip hot baths, hot tubs and saunas for a few days, because heat dilates the veins you are trying to close.
Week 1: the ugly week
By day seven the bruising is starting to yellow, but the treated veins themselves often look darker or browner than before treatment. This alarms people. What you are seeing is the closed vein with a small amount of trapped blood inside it, which the body breaks down over the following weeks. Tenderness along the vein is also normal at this point.
Keep walking 20 to 30 minutes a day. Avoid aerobic exercise like running or cycling, and avoid weightlifting or squats, for the first seven days. Keep the treated area out of the sun until the skin color is back to normal, because sun on healing skin can leave a brown mark that lasts months.
Weeks 2 to 3: turning the corner
Bruising fades. The lumps soften. If a lump is large or particularly tender, we can release the trapped blood with a small needle at a follow-up visit, which speeds the fading. Daytime compression can stop at the end of week two for most people.
Weeks 4 to 6: results and the next session
This is when the veins visibly fade. Follow-up is scheduled four to six weeks after each session, and most people need two or three sessions for a full result, more if there are many veins. We treat what is left at each visit rather than everything at once, because the response to the first session shows how much solution each vein needs.
When to call
Most of what you see in the first month is expected. Call the office if you notice any of these:
- A hard, red, painful area that is getting bigger rather than settling
- Blistering or an open area over an injection site
- Swelling in the whole calf or leg, not just around the treated veins
- Pain in the calf that is worse when you flex the foot
The first two are skin reactions we can treat. The last two are the signs of a clot in the deep veins, which is rare after sclerotherapy but needs to be ruled out the same day.
How long do the results last?
A vein that has closed does not reopen. Sclerotherapy is permanent for the veins it treats. It does not stop new spider veins forming, and people who are prone to them will develop more over the years, so many patients come back for a maintenance session every year or two. If new veins appear quickly and in the same area, that can mean a deeper vein is feeding them, and we would suggest an ultrasound before treating the surface again.
The honest part
Sclerotherapy works on spider veins and small varicose veins. It is the wrong tool for a large varicose vein fed by a refluxing saphenous vein, which needs the feeding vein closed first with Varithena or laser ablation. If you are having sclerotherapy for cosmetic spider veins, it is paid for directly rather than through insurance. Our sclerotherapy page covers what a session involves and who it suits.
