How Sclerotherapy Works: Step by Step from Consultation to Results

When a patient comes to me for the first time about spider veins or varicose veins, there is almost always the same question: «So how does this all actually work?». I understand that desire — knowing what to expect in advance is far more reassuring than walking into the unknown. That is why I am writing this article: no unnecessary words, just step by step.

Step 1. Examination and Vein Duplex Ultrasound — There Is No Skipping This

Sclerotherapy never begins with a needle. It begins with a conversation and an examination.

During the initial consultation I gather complaints, assess the character of the vessels, and evaluate the skin. But the most important part is vein duplex ultrasound. This is a mandatory step that allows us to see what is invisible to the naked eye: the condition of the deep and superficial veins, the presence of reflux (reverse blood flow), and valve insufficiency.

Why does this matter so much? Because if you treat only what is visible on the skin without addressing the underlying cause, the result will be temporary. Vein duplex ultrasound helps clarify whether we are dealing with isolated cosmetic spider veins or a manifestation of more serious venous insufficiency. The treatment strategy depends on this.

If vein duplex ultrasound reveals significant reflux in the truncal veins, we address that first — and only then work on the smaller vessels. Otherwise the spider veins will return.

Step 2. Preparing for the Procedure

Sclerotherapy does not require special preparation, but there are a few guidelines to follow:

• For 2–3 days beforehand, avoid heat exposure: bathhouses, saunas, hot baths.
• On the day of the procedure, do not apply creams or oils to your legs — these interfere with the adhesion of compression hosiery.
• Bring compression knee-highs or stockings with you (the compression class will be specified at the consultation).
• Dress comfortably — shorts or loose trousers that are easy to remove.

There is no need to come on an empty stomach. Avoid alcohol for 24 hours beforehand.

Step 3. The Procedure Itself — What Happens in the Office

The patient lies on the treatment table. I clean the skin with an antiseptic. Then come the injections.

The sclerosant (a specialised medication) is injected with a fine needle directly into the lumen of the vessel. The medication causes chemical damage to the inner wall of the vein, after which the vessel collapses and gradually dissolves. This is the essence of the method.

What Does the Patient Feel?

• A mild burning or tingling sensation at the moment of injection — this is normal and passes within a few seconds.
• Occasionally a slight feeling of warmth along the vessel.
• Most patients do not describe pain in the traditional sense — it is more of a mild discomfort.

For very small vessels (spider veins) I use a liquid form of sclerosant. For larger varicose veins I use the foam form (foam sclerotherapy): it makes better contact with the vessel wall and produces a more pronounced effect. Sometimes the procedure is performed under ultrasound guidance — this is called echo-sclerotherapy, and it is used for veins that are not visible from the outside.

How Long Does a Session Take?

One session takes 20 to 40 minutes depending on the scope of work. Several zones can be treated in a single visit. After the procedure the patient remains in the office for another 10–15 minutes while I monitor their response.

Step 4. Compression After the Procedure

Compression hosiery is put on immediately after the injections. This is not merely a recommendation — it is a mandatory part of the treatment.

Compression serves several functions at once:

1. 1It keeps the vessel walls pressed together — this enhances the effect of the sclerosant.
2. 2It reduces the risk of pigmentation and thrombosed nodules.
3. 3It decreases swelling and discomfort after the procedure.

As a rule, during the first days the hosiery is worn continuously (removed only for showering), and thereafter during daytime hours. I specify the exact duration individually: it depends on which vessels were treated and their diameter.

Patients who follow the compression regimen achieve significantly better and faster results. This has been confirmed by practice.

Walking after the procedure is not only permitted — it is encouraged. A 20–30 minute walk immediately after the session improves blood flow and helps the medication distribute evenly within the vessel.

Step 5. How Many Sessions Are Needed?

This depends on several factors: the area affected, the calibre of the vessels, and the individual response of the body.

• For small spider veins, 1–3 sessions are often sufficient.
• For more widespread varicose veins, 4–6 or more visits may be required.
• The interval between sessions is typically 2–4 weeks.

I do not prescribe a fixed number of sessions in advance — I assess the progress after each visit and adjust the plan accordingly. This is a more honest and effective approach.

Step 6. When Results Become Visible and What to Expect

The vessels do not disappear immediately after the procedure — they go through several stages: inflammation, adhesion, and resorption. This process takes time.

• First changes become noticeable after 3–4 weeks.
• The full result is assessed 2–3 months after the last session.
• Some temporary mild pigmentation (brownish marks along the vessel) may appear — in most cases it resolves on its own within several months.

Restrictions after the procedure (for 1–2 weeks):

• Avoid bathhouses, saunas, and hot baths.
• Limit intense physical activity (light walking is encouraged).
• Avoid sun exposure: UV radiation intensifies pigmentation.
• Do not take a hot shower immediately after the procedure.

More details about the sclerotherapy procedure itself can be found in the relevant section of the website.

Book an Appointment in Tashkent

I see patients at M-Clinic (Tashkent). If you would like to find out whether sclerotherapy is right for you, come for a consultation with vein duplex ultrasound: this will provide a clear answer and a specific treatment plan.

If getting to the clinic is difficult, a home visit may be possible — please ask about this when booking.

Appointments can be made by phone: +998 99 883-93-21

When sclerotherapy is not suitable

• pregnancy and breastfeeding;
• acute deep vein thrombosis or thrombophlebitis;
• blood clotting disorders;
• allergy to the sclerosant;
• severe general illness in an acute phase.

After the procedure, if you have severe leg pain, sudden calf swelling, shortness of breath or chest pain, see a doctor immediately or call emergency services — this may be a sign of deep vein thrombosis. Such complications are rare but need urgent care.

Do not delay — the earlier treatment is started, the simpler and faster the result is achieved.

Not sure? Call and I'll tell you how urgent your situation is: +998 99 883-93-21

This article is for informational purposes only and does not replace a consultation with a qualified physician. If you are experiencing symptoms, please see a specialist.