What it does
A very fine needle delivers a small volume of sclerosant solution directly into the vein. The solution irritates the lining, the walls of the vessel stick together and seal, and over the following weeks the body breaks the closed vein down and absorbs it. Blood simply reroutes through the healthy veins nearby — the leg has far more venous capacity than it needs, which is why removing a vein costs it nothing.
It remains the standard treatment for spider veins and small varicose veins, and has been for decades, because for surface vessels nothing has reliably beaten it.
Before the first injection
For straightforward cosmetic spider veins, the examination is the assessment. Where the pattern or the symptoms suggest something underneath — clusters around the ankle, aching or heavy legs, veins that have returned after previous treatment, a strong family history — Dr. D’Alessio will map the leg with duplex ultrasound first.
This is not an upsell. Surface veins fed by an untreated refluxing vein will refill, and a course of sclerotherapy over an unaddressed source is money spent on a result that undoes itself. Where the ultrasound is unnecessary, it will not be suggested.
The session
You lie down. The leg is cleaned, and the veins are injected one at a time, working through the mapped cluster. Most sessions take around thirty minutes. There is no anaesthetic, no incision and no stitches. Compression stockings go on at the end, and you stand up, walk, and leave.
Afterwards, realistically
The part people are least prepared for: it looks worse before it looks better. Treated veins commonly darken and appear bruised for two to four weeks. That is the vein closing, not a complication. The colour then fades and the vessel disappears over about four to eight weeks.
Occasionally a small brown mark (haemosiderin staining) persists for some months before clearing. Sun on a healing vein makes that more likely, which is why the advice about sun exposure is worth following.
What you will be told
Whether your veins are a cosmetic problem or a medical one, and what the difference means for your bill. How many sessions is a realistic estimate. And, where an ultrasound shows an underlying vein driving the problem, what treating that involves — before you spend anything on the surface.