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Sclerotherapy, or injection therapy, is the most common treatment for small diameter veins such as spider veins. During sclerotherapy, a tiny needle is used to inject a mild chemical solution into the vein. This solution damages the inside wall of the vein causing the vein to collapse. The solution, together with the use of compression hose, effectively prevents the vein from working and it stops carrying blood. The body then absorbs the vein over time, eliminating the appearance of the vein.
A single sclerotherapy session involves multiple injections. Patients describe the injections as feeling like a pin prick or mosquito bite. The number of sessions needed will vary from patient to patient, depending on the amount of veins treated. One complication that can occur is hyper pigmentation (brown spots).

In a small percentage of patients, the brown spots or discoloration may persist long term. Another complication that some patients have experienced, which is a concern with any medication, is an allergic reaction to the solution. This is a very rare occurrence.

Ultrasound guided sclerotherapy is used for the treatment of deeper veins that cannot be seen or felt and for larger superficial veins. Using ultrasound, doctors can guide the needle to the exact area to be treated. A mild solution is injected into the veins causing the vein walls to collapse. Compression stockings are then used to make sure that the vein walls stay collapsed. Ultrasound guided sclerotherapy requires expert knowledge that conventional sclerotherapy does not. Once again, as the larger veins are treated, smaller spider and reticular veins will often disappear. The advantages are no scarring and smaller veins disappear, white the downside is the possibility of brownish discolorations, allergic reactions and the rare development of skin ulcers.