Spider Vein Treatment (Sclerotherapy) in Chicagoland

Spider veins, known medically as telangiectasias, are small vessels that have stretched and stopped moving blood efficiently. Tiny one-way valves inside leg veins normally keep blood moving upward toward the heart. When those valves weaken, blood pools and back-pressure widens the vessel until it becomes visible through the skin as a red, blue, or purple line or web. Sclerotherapy treats that vessel from the inside rather than through the skin.

Your provider injects a small amount of Asclera (polidocanol) directly into the vessel using a very fine needle. Polidocanol is a sclerosing agent, which means it deliberately damages the thin inner lining of the vein, called the endothelium. In response, platelets, fibrin, and cellular material gather and block off the vessel, and the closed vein is gradually replaced by fibrous connective tissue. As that happens, the line you could see through the skin loses its color and flattens out.

The vein is not removed, and nothing is taken out of your leg. It is closed and then broken down by your own body over a period of weeks. Blood continues through your other healthy veins, which is why treating surface spider veins does not affect circulation in the leg. Surface vessels like these carry only a small fraction of the blood returning from the leg, and the deep venous system does the real work.

The strength of the solution is matched to the vessel being treated. Asclera is supplied in two concentrations, a lower one for fine spider veins and a higher one for the slightly larger reticular veins that often feed them. Treating the feeder vein as well as the visible one is part of why a course of treatment is planned around your particular pattern of veins rather than a fixed protocol.

Asclera is the brand name for polidocanol, approved by the FDA in 2010 for treating spider veins and reticular veins in the lower extremity. Because it is a drug rather than a device, the correct description is FDA-approved. It has been used in vein practice for decades and has no boxed warning.

People often search for this treatment as an alcohol sclerosing injection, and it is worth explaining where that phrase comes from, because it is partly accurate and partly misleading.

Polidocanol is classified as a non-ionic detergent sclerosant. Its molecule has two ends: a water-attracting portion derived from dodecyl alcohol, also called lauryl alcohol, and a water-repelling polyethylene oxide chain. That detergent structure is what lets it act on the lining of the vein. Separately, the Asclera solution itself contains 5 percent ethanol, which is included to keep the formulation clear and stable rather than to treat the vein.

So there is alcohol in the chemistry and in the solution, which is why the term circulates. What Asclera is not is the same thing as alcohol ablation, a different procedure that uses concentrated ethanol itself as the active agent. If you have read about alcohol sclerosing injections and are wondering whether that is what we offer, the honest answer is that we use polidocanol, and the name describes the ingredients loosely rather than the treatment precisely.

Sclerotherapy at Express Med Spa is a lower-extremity treatment. In practice that means the areas where surface veins tend to become visible and bother people most. Legs are where spider veins concentrate because standing puts the greatest column of pressure on the leg veins, which is also why long hours on your feet, pregnancy, hormonal shifts, and a family history all make them more likely.

The thighs are among the most commonly treated areas, particularly the outer and back of the thigh where clusters of fine veins spread in a web pattern. The calves and the area behind the knee are also frequent, and veins there often follow a branching line rather than a web.

The ankles and feet can be treated as well. Veins in these areas are a common reason people avoid sandals or shorter hemlines, and they respond to the same approach, though the skin is thinner and your provider will take that into account when planning injections.

Treatment is usually planned by region rather than by individual vein. A single vial of Asclera covers a small region, and how many vials your treatment needs depends on how much area is involved. During your consultation your provider will look at the pattern across both legs, identify which visible veins are being fed by larger reticular veins underneath, and map out a plan that treats the feeder vessels rather than only the lines you can see. Treating only the surface vein while leaving its feeder in place is one of the most common reasons spider veins reappear after treatment elsewhere, which is why the mapping step matters as much as the injection itself.

Asclera’s approval is specific about vessel size, and that specificity is useful because it tells you in advance whether this is the right treatment for what you are seeing.

Spider veins are defined as vessels 1 mm or less in diameter, roughly the thickness of a pencil line. Reticular veins, sometimes called feeder veins, run from 1 to 3 mm and often sit slightly deeper, showing as flat blue-green lines. Both are within the approved range, and both are routinely treated here.

Veins larger than 3 mm have not been studied with Asclera. If you have vessels that bulge above the skin, feel rope-like, or come with aching, swelling, heaviness, skin changes around the ankle, or cramping at night, those are signs of a different problem. Those symptoms point toward varicose veins and chronic venous insufficiency, where the underlying issue is valve failure in a larger vein such as the great saphenous. That is treated by a vein specialist, typically with a duplex ultrasound assessment first and then ultrasound-guided procedures such as endovenous ablation or foam sclerotherapy. The right first step is a vascular evaluation rather than a cosmetic injection. We would rather tell you that at consultation than treat something that needs a different level of care, and treating surface veins while an untreated feeder problem remains underneath tends to disappoint anyway.

Facial vessels are not treated with Asclera. The approval covers the lower extremity only, so the small broken capillaries and telangiectasia that appear on the nose, cheeks, and around the nostrils are handled with a different tool. At Express Med Spa those are treated with IPL Photofacial, which uses light rather than an injection and is well suited to facial redness and visible vessels.

Your visit starts with an examination. Your provider looks at the veins with you standing, since surface veins fill and become easier to trace in that position, and marks the vessels that will be treated. This is also when you will discuss your history, including any previous blood clots, current medications, and whether you are pregnant or breastfeeding.

We map your veins with AccuVein. Express Med Spa uses an AccuVein near-infrared vein visualization device, a handheld scanner that projects a real-time image of the veins directly onto the surface of your skin in bright green light. Nothing touches you and nothing is injected for the scan. It matters here because the reticular feeder veins that supply a cluster of spider veins often sit just deep enough to be invisible to the naked eye. Seeing them mapped on the skin lets your provider treat the vessel that is actually feeding the problem rather than only the lines showing at the surface.

For the treatment itself you lie down. Your provider cleans the skin and places a series of small injections along the marked veins using a very fine needle, delivering a small volume at each point. Most people describe a brief stinging or cramping sensation that passes within seconds. No anesthetic is needed and you stay awake and comfortable throughout.

Compression goes on before you get up. Your stockings are applied while you are still lying down so the treated vessels stay compressed as you stand. Please bring your compression stockings to your appointment. If you do not have a pair, they are available for purchase at the clinic.

After treatment you walk for 15 to 20 minutes. That is protocol, not a suggestion: movement keeps blood moving through the deeper veins, and the walk doubles as an observation window while the team watches for any allergic reaction. Plan on 30 to 45 minutes of treatment time plus the walk, then drive yourself home and return to normal activity the same day.

Sclerotherapy is not an instant result, and knowing the sequence in advance makes the early weeks much easier to interpret.

The first days. The treated area often looks worse before it looks better. Bruising at the injection sites is the most common effect, along with redness, mild irritation, and sometimes small raised areas that settle quickly. You will be wearing compression during this period, for 2 to 3 days after spider vein treatment and 5 to 7 days after reticular veins, following the schedule your provider sets.

Weeks 3 to 6. This is when the visible change usually happens. The treated vessels lose their color and gradually disappear from view as the body breaks them down. Brown or tan discoloration can linger along the line of a treated vein. This is post-sclerotherapy hyperpigmentation, caused by iron pigment left behind as trapped blood breaks down. It usually fades, but it can take several months, and in some cases it persists. Keeping the area out of the sun helps.

A note on matting. Some people develop a fine blush of very small new red vessels near a treated area, known as telangiectatic matting. It is not a sign that something went wrong, it often settles on its own over several months, and it can be treated if it does not.

Additional sessions. Most people need more than one, scheduled 1 to 2 weeks apart. Veins that did not respond fully the first time are retreated, and complete clearance is not guaranteed. A vessel can persist or reopen and need another pass.

Longer term. A vein that has been successfully treated and reabsorbed does not generally come back, because it is no longer there. What can happen is that new spider veins form over time, since the factors behind them, including genetics, pregnancy, hormones, and long hours standing, do not go away. Many people plan an occasional maintenance session for that reason.

There is more than one way to approach visible veins, and the right choice depends mostly on where the vein is.

Sclerotherapy for legs. On the lower extremity, an injection puts the sclerosing agent inside the vessel, treating both the visible vein and the reticular vein feeding it. This is why it has remained the standard approach for leg spider veins, and why Asclera carries a specific FDA approval for exactly this use.

Light-based treatment for the face. Facial vessels are a different situation. Asclera is approved only for the lower extremity, so we do not inject facial veins. For broken capillaries, persistent redness, and telangiectasia on the nose and cheeks, we use IPL Photofacial, which delivers light energy through the skin to the vessel. If your main concern is facial redness rather than leg veins, that is the page to read.

Compression alone. Compression stockings are genuinely useful. They ease aching, heaviness, and swelling, they support the legs during long hours of standing, and they are part of aftercare here. What they do not do is clear veins that are already visible. Compression manages symptoms and may slow new veins from forming, but a vein you can already see will not be removed by wearing stockings.

If you are not sure which category you fall into, a consultation is the practical way to sort it out. Our nurse-practitioner-led team will look at the veins, tell you honestly whether they are within the range this treatment covers, and refer you on if what you need is a vascular workup rather than a cosmetic treatment.