Microsclerotherapy for thread veins
A cosmetic injection treatment for tiny surface thread or spider veins, where a weak solution is injected through a fine needle to make the veins fade.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Microsclerotherapy is a cosmetic injection treatment to fade tiny thread or spider veins, not a medical treatment.
- Several sessions are usually needed, results vary, and new thread veins can still appear in future.
- A good clinician checks for underlying varicose veins first, because untreated deeper veins make thread veins come back.
- It is not usually available on the NHS, and skin staining or new tiny veins (matting) are common, expected effects.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can fade unsightly thread and spider veins to improve the look of the skin
You have significant untreated varicose veins or vein reflux feeding the thread veins — these usually need addressing first.
You can usually walk out and resume normal activities. Compression may be advised for a period.
Honest discussion that this is cosmetic, gradual and usually needs several sessions.
You can usually walk out and resume normal activities. Compression may be advised for a period.
Redness, mild bruising, itching and small bumps at injection sites are normal and settle over a few days.
Treated veins begin to fade. Brown staining may appear and tiny new veins (matting) can show; both often improve...
The fuller effect of a session becomes visible. A further session is usually planned, as a course is normally...
What is microsclerotherapy for thread veins?
Microsclerotherapy is a treatment for thread veins (also called spider veins or telangiectasia) — the tiny red, blue or purple veins that sit just under the surface of the skin, often on the legs. A very fine needle is used to inject a small amount of a weak solution (a sclerosant) into the veins. This irritates the lining so the vein closes and gradually fades from view.
Thread veins are usually harmless and are different from varicose veins, which are larger, bulge under the skin and can cause aching, swelling and other symptoms. Microsclerotherapy is mainly a cosmetic treatment to improve appearance; it is not usually needed for health reasons.
Because thread veins can be fed by larger faulty veins beneath the surface, a responsible clinician will check whether you also have underlying varicose veins. Treating thread veins on the surface while ignoring a faulty deeper vein often leads to disappointing results and the veins coming back.
Microsclerotherapy usually needs several sessions, results vary from person to person, and it does not stop new thread veins forming in future. Laser treatment is an alternative for some veins, particularly very fine ones or those on the face.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Thread veins vs varicose veins
| Feature | Thread (spider) veins | Varicose veins |
|---|---|---|
| Size | Tiny, flat, surface | Larger, bulging |
| Symptoms | Usually none | Aching, swelling possible |
| Main concern | Cosmetic | Can be medical |
| NHS funding | Not usually | If symptomatic |
Thread veins can be fed by hidden faulty veins, so assessment of the deeper veins matters before cosmetic treatment.
Preparing for your injection
- Have your legs assessed first; if you also have bulging varicose veins or symptoms, ask about a duplex ultrasound scan to check the deeper veins.
- Tell the clinician about any previous blood clots, clotting disorders, or allergy to sclerosant solutions.
- List your medicines, including blood thinners, the contraceptive pill and HRT.
- Avoid fake tan and heavy moisturiser on the area before treatment.
- Bring or arrange compression stockings to wear afterwards if advised.
- Plan to avoid sunbeds and strong sun before and after, as this affects staining.
- Have realistic expectations: this is gradual, usually needs several sessions, and is cosmetic.
What happens
Microsclerotherapy is done awake as an outpatient and usually needs no anaesthetic, as the needle is very fine. You lie down and the skin is cleaned. The clinician injects a small amount of solution into each thread vein, often using magnification to see the tiny veins clearly.
You may feel a brief sting or mild burning as each injection is given. Many veins can be treated in one session. Afterwards, compression stockings or pads may be applied and you are usually able to walk out and go straight back to normal activities.
The treated veins are not removed; they close and fade over the following weeks. Because results build up gradually and not every vein responds first time, a course of several sessions a few weeks apart is usual.
Is this injection right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You have significant untreated varicose veins or vein reflux feeding the thread veins — these usually need addressing first.
- You are pregnant or breastfeeding.
- You have a known allergy to the sclerosant solution.
- You have a current blood clot or are unable to mobilise afterwards.
- Your expectations are for complete, permanent clearance, which microsclerotherapy cannot guarantee.
Delay or rearrange if…
- You are pregnant or breastfeeding, as thread veins may also improve after pregnancy.
- You have an active skin infection or sore in the area.
- You have recently had a blood clot or are acutely unwell.
- You have a recent suntan or fake tan on the area, which affects staining.
- Underlying varicose veins have not yet been assessed.
Alternatives to discuss
- No treatment — thread veins are usually harmless and a cosmetic choice.
- Camouflage make-up to cover thread veins.
- Laser or IPL, particularly for very fine or facial veins.
- Treating underlying varicose or feeder veins first if these are present.
- Compression and lifestyle measures if there are also aching or swelling symptoms.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can fade unsightly thread and spider veins to improve the look of the skin
- Uses very fine needles and usually needs no anaesthetic
- Quick to perform with usually no time off
- Can treat many small veins in one session
- Can be combined with treating larger feeder veins for a better result
Risks & complications
- Brown or grey skin staining (pigmentation) along the treated veins, which can last months
- Tiny new red thread veins appearing near the treated area (matting)
- Redness, mild swelling, bruising and itching at injection sites
- Some veins not fully fading, so further sessions are needed
- A small skin sore or ulcer if solution leaks outside the vein, occasionally leaving a small scar
- Inflammation of the vein (thrombophlebitis) causing a tender red line
- Temporary visual disturbance or headache shortly after injection
- Allergic-type reaction to the solution
- Blood clot in a deeper vein
- Persistent skin staining or a permanent small scar
- Serious allergic (anaphylactic) reaction to the sclerosant
- Very rarely, neurological symptoms reported with sclerotherapy, more often discussed in people with a hole in the heart (PFO) or migraine with aura
The commonest disappointments are brown staining and tiny new veins (matting) rather than dangerous problems. Serious reactions are rare. Because thread veins are often fed by hidden faulty veins, the biggest avoidable mistake is treating the surface without checking the deeper veins, which leads to poor results and recurrence. Ask whether you need a scan first.
Published figures to discuss
Thread vein treatment is low-risk overall, and reliable percentages for cosmetic outcomes are limited because results depend heavily on the individual, the technique and the solution used. We therefore describe most risks qualitatively rather than with invented figures. Common cosmetic effects (staining, matting) are expected rather than rare; serious complications are uncommon.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Brown pigmentation or staining | Common to uncommon; usually fades but can persist | Pigmentation is more likely with larger veins, inflammation and trapped blood. | Guide sourcesClinical context |
| Matting of tiny new vessels | Uncommon to common depending on skin type and vein pattern | Matting can need further treatment and is one reason results are not instant. | Guide sourcesClinical context |
| Skin ulceration from extravasation or arterial injection | Rare but important | Severe pain, whitening or blistering during injection should be reported immediately. | Guide sourcesClinical context |
| Incomplete clearance or recurrence of thread veins | Common | Multiple sessions and maintenance may be needed; underlying reflux should be assessed when veins are extensive. | Ambulatory phlebectomy and sclerotherapy for veins and telangiectasias — PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually no real recovery time and most people return to normal activities the same day. The cosmetic result is gradual, though: veins fade over weeks, and brown staining or tiny new veins can appear before things settle.
- Redness, mild swelling and small itchy bumps at injection sites for a few days
- Bruising along treated veins
- Brown or grey staining that fades over weeks to months
- Some tiny new thread veins (matting) that often settle
- Veins fading gradually rather than disappearing at once
Aftercare
- Wear compression stockings for as long as the clinician advises.
- Walk regularly and avoid long periods sitting or standing still soon after.
- Avoid hot baths, saunas, sunbeds and strong sun on the area in the early period.
- Use sun protection on the treated skin, as sun can worsen staining.
- Avoid strenuous leg exercise for a day or two if advised.
- Expect to come back for further sessions to build up the result.
- Contact the clinic about a spreading skin sore, a tender red leg, or calf swelling.
- Underlying varicose veins checked or excluded
- Compression stockings ready if advised
- Sun protection for the treated area
- Loose clothing and comfortable shoes
- Time allowed for a course of several sessions
- Realistic expectations discussed
- Clinic contact number for problems saved
Scars and how they heal
Microsclerotherapy uses very fine needles, so there are no cuts. Brown or grey staining along the treated veins is common and usually fades over months. If solution leaks outside a vein it can rarely cause a small skin sore that may leave a faint permanent scar.
⚠ Get urgent help if…
- A skin sore or ulcer developing at an injection site
- A tender, red, hot line or area along a vein (possible inflammation or infection)
- Painful, swollen or hot calf — this could be a deep vein clot
- Sudden breathlessness or chest pain — call 999, as this could be a clot on the lung
- Sudden facial droop, weakness, speech or vision problems — call 999
- Widespread rash, swelling of the face or lips, or difficulty breathing after injection (allergic reaction)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result means the thread veins fade and the skin looks clearer, usually after a course of several sessions. Improvement is gradual and varies from person to person; some veins respond better than others.
Microsclerotherapy treats the veins you have now. It does not stop new thread veins forming, so touch-up sessions may be wanted over the years. If thread veins are fed by an untreated faulty deeper vein, results are often poor and the veins return — which is why assessment of the larger veins matters first.
Treated veins that fade usually stay faded, but new thread veins commonly appear over time because the tendency remains, so many people choose occasional top-up sessions. Results last better when any underlying feeder or varicose veins have also been dealt with.
Related tests, treatments or support
Microsclerotherapy is often combined with treating larger reticular 'feeder' veins, and with assessment or treatment of underlying varicose veins, to improve and prolong the cosmetic result. Laser or IPL may be combined or used as an alternative, especially for very fine or facial veins.
Follow-up & long-term care
A review is usually arranged a few weeks after each session to assess fading and plan the next. There is no medical follow-up scan needed for thread veins alone, but report any skin sore, tender red leg or calf swelling promptly.
- Expect a course of sessions, and possible top-ups over the years
- Use sun protection to limit staining
- Have any underlying varicose or feeder veins assessed for lasting results
- Compression stockings if advised to support the legs
Repeat, follow-on and what comes next
- A course of several sessions is normally needed, and not every vein clears.
- Touch-up sessions are commonly wanted over the years as new thread veins appear.
- Lumpy trapped blood can be released with a fine needle if it occurs.
- Persistent staining or matting sometimes needs further treatment or simply time.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Honest discussion that this is cosmetic, gradual and usually needs several sessions.
- Assessment for underlying varicose veins so results last.
- Clear advice on compression, sun protection and what staining or matting to expect.
- A named contact for any skin sore, tender leg or swelling.
- A realistic plan and pricing for further sessions.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The number of sessions in a course
- The size of the area and number of veins treated
- Whether larger feeder or varicose veins need assessment or treatment first
- Whether laser or IPL is used as well as injections
- The clinician's experience and clinic fees
- Compression stockings and follow-up reviews
- Whether the price is per session or per course of treatment
- How many sessions are realistically expected
- Whether assessment for underlying varicose veins is included
- What further sessions cost if veins do not fully fade
- Compression stockings and review appointments
- The cancellation policy and what is included if matting or staining occurs
On the NHS? Treatment of thread veins is considered cosmetic and is not usually funded by the NHS; symptomatic varicose veins, by contrast, can be treated on the NHS when clinical criteria are met.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being assessed for underlying varicose veins before cosmetic treatment.
- Being led to expect complete clearance from a single session.
- No mention of staining and matting as common, expected effects.
- No explanation that this is cosmetic and not NHS-funded.
- No discussion of what further sessions will cost.
Marketing red flags
- "Permanent" or "complete" thread-vein removal claims.
- "One session" promises that ignore the usual need for a course.
- No assessment for underlying varicose veins.
- "Usually not painful, no-risk" language that ignores staining, matting and rare reactions.
- Before-and-after photos with different lighting or no mention of touch-ups.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Could I have underlying varicose veins, and do I need a scan before cosmetic treatment?
- How many sessions are likely, and what improvement is realistic for my veins?
- How likely am I to get staining or new tiny veins (matting)?
- Would laser or treating feeder veins give me a better result?
- What are the warning signs that should make me seek help?
- What happens if I am not happy with the result?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my injection, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this injection not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is thread vein treatment available on the NHS?
How many sessions will I need?
Why have I got brown marks or new tiny veins after treatment?
Does it hurt?
Will the thread veins come back?
Is laser better than injections?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Varicose veins (and thread veins) overview NICE CG168 — Varicose veins: diagnosis and management Circulation Foundation (Vascular Society) — Varicose veins & leg ulcers Ambulatory phlebectomy and sclerotherapy for veins and telangiectasias — PMC NICE IPG440 — Ultrasound-guided foam sclerotherapy (related sclerosant guidance)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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