Liquid Sclerotherapy
Liquid sclerotherapy. The workhorse technique for reticular veins and many capillaries.
Liquid sclerotherapy at Palazzo Manzoni in Brescia, performed by Dr. Andrezza Silvia Guedes. A sclerosing agent in liquid form injected into reticular veins (1 to 3 mm) and many capillaries; the vessel is closed chemically and progressively reabsorbed by the body.
Liquid sclerotherapy at Palazzo Manzoni in Brescia is performed by Dr. Andrezza Silvia Guedes, with diagnostic ecocolordoppler integrated into the plan when reticular or saphenous reflux is suspected. A sclerosing agent in liquid form (typically polidocanol or sodium tetradecyl sulphate, in the appropriate concentration for the vessel size) is injected through a very fine needle directly into the diseased vessel; the agent triggers a controlled inflammatory reaction that closes the vessel along its path. The body then progressively reabsorbs the closed vein over weeks.
The workhorse technique
For reticular veins and many capillaries
Two to three sessions typical
About a month apart
Brief sessions
15 to 30 minutes
Compression after each session
Class II for one to two weeks
What Brought You Here
The visible part is rarely the whole story.
You have a patch of visible capillaries that has expanded year on year. You have a bluish vein on the thigh or behind the knee that feeds them, and the feeder vein has been there longer than the surface pattern. You have, possibly, been told that one transdermal laser session would fix it. The laser fixes the surface. The feeder, untreated, keeps producing new capillaries.
Liquid sclerotherapy is the technique that addresses the feeder. A very fine needle, a precise injection, a controlled inflammatory reaction along the path of the vessel. The visible capillaries above the treated feeder often resolve on their own once the source has been closed.
The remaining surface vessels, where present, are addressed by transdermal laser or by liquid sclerotherapy of the capillary itself, in the same plan. A reticular vein, ossia a bluish or greenish vein of 1 to 3 mm, often sits just beneath a patch of visible capillaries and feeds it, and treating only the surface is one of the most common reasons capillaries recur.
What Liquid Sclerotherapy Actually Does
The chemistry closes the vein; the body reabsorbs it
A sclerosing agent is a drug that, when injected into a vessel, damages the endothelial lining of the wall in a controlled way. The damage triggers a controlled inflammatory reaction, which leads to the progressive obliteration (the closure) of the vessel. The closed vessel is then progressively reabsorbed by the body over the following weeks.
The technique is precise. A very fine needle is introduced into the diseased vessel under direct vision (for surface vessels) or under ecocolordoppler guidance (for slightly deeper or larger vessels). The volume of sclerosing agent injected is carefully matched to the size of the vessel.
Too little, the closure is incomplete; too much, the inflammatory response is unnecessarily aggressive. The trained hand is what makes the technique reliable.
01
Controlled chemistry
The sclerosing agent damages the vessel wall and the body reabsorbs it.
02
Matched to the vessel
The volume and concentration are matched to the size of each vessel.
03
The trained hand
Reliable closure depends on technique, led by Dr. Andrezza Silvia Guedes.
How It Works, Step by Step
How liquid sclerotherapy works, step by step.
Step 01
Examination and ecocolordoppler
A focused phlebological examination, with attention to whether the visible vessels are isolated or fed from deeper structures. Where indicated, the ecocolordoppler is performed in the same visit.
Step 02
The plan
You leave the first visit with the number of sessions estimated, which vessels will be treated by which technique (liquid sclerotherapy, transdermal laser, or both), and the expected response timeline.
Step 03
The session
Ambulatory. The leg is positioned to favour the planned injections and the skin is cleaned. Each injection uses a very fine needle (typically 30G) and a precise small volume of sclerosing agent. Most patients describe each injection as comparable to a venous blood draw. Session time, 15 to 30 minutes depending on the extent of the area.
Step 04
Compression and immediate return
A class II elasto-compressive stocking is applied at the end of the session. Walking begins immediately. Normal activity from the same hour. Sun protection on the treated areas for several weeks.
Who Liquid Sclerotherapy Is For
Is liquid sclerotherapy
right for your vessels?
Liquid sclerotherapy is the workhorse of aesthetic phlebology, but it is a specific answer for a specific kind of vessel. At Palazzo Manzoni, most liquid sclerotherapy candidates share several of the following.
Clinical profile
- Reticular veins (1 to 3 mm), bluish or greenish, often feeding overlying capillary patches
- Capillaries large enough to be cleanly injected (typically above 0.5 mm)
- Residual surface vessels after foam sclerotherapy of larger varicose veins
- Capillary patches unresponsive to transdermal laser alone
Where it isn't the right answer
- The smallest capillaries (below 0.5 mm), where transdermal laser is more appropriate
- Larger varicose veins (above 3 mm), where ultrasound-guided foam sclerotherapy is the appropriate first answer
- Patients with known allergy to the sclerosing agent, active deep venous thrombosis, or open inflammatory conditions at the injection site
- Pregnancy and immediate postpartum
Combined with other techniques
Liquid sclerotherapy is often combined with transdermal laser in the same plan (sclerotherapy on the reticular feeders, laser on the surface capillaries). For mixed pictures with varicose tributaries, ultrasound-guided foam sclerotherapy of the larger vessels precedes the liquid sclerotherapy of the smaller ones.
If liquid sclerotherapy fits, your assessment will confirm it. If a different technique fits a particular vessel better, the assessment will identify which one, and the right combination will follow.
Honest Expectations
A clean, well-established technique, honestly described
Liquid sclerotherapy is a clean, well-established technique. Two to three sessions, spaced about a month apart, are typical for a clean result, with the final assessment at the end of the cycle. Small superficial bruising at the injection sites is common in the first week. A small share of patients develop a transient brown pigmentation along the treated path (post-inflammatory hyperpigmentation), which typically fades over months but can be persistent in a minority of cases.
Recurrence is possible if the underlying reticular or saphenous reflux was not mapped and addressed. The "matting" phenomenon, ossia the appearance of fine new capillaries close to a treated patch, occurs in a minority of patients and typically resolves with additional sessions or with transdermal laser.
Day by Day
The first week, the compression, and the cycle that follows
The hour after the session
A class II elasto-compressive stocking is applied at the end of the session. Walking begins immediately, and normal activity resumes from the same hour. The compression optimises the contact of the sclerosing agent with the vessel walls.
The first week
Small superficial bruising at the injection sites is common. The class II stocking is worn for one to two weeks after the session. Sun protection on the treated areas is important from the start.
The following weeks
The treated vessel closes during the session and is then progressively reabsorbed over weeks. The vein does not disappear immediately; the improvement is gradual. A transient brown pigmentation along the treated path may appear and typically fades over months.
About a month later
The next session, if planned, is scheduled about a month after the previous one. Two to three sessions are typical for a clean result.
End of the cycle
The visible result of a cycle is assessed at the end of the planned sessions, not after the first one. Matting, where it occurs, typically resolves with additional sessions or with complementary transdermal laser.
Honest Trade-offs
What liquid sclerotherapy
doesn't do
Every capillary technique has its trade-offs, and honesty about them matters more than marketing.
Liquid sclerotherapy is not the right answer for the very smallest capillaries (below 0.5 mm), where transdermal laser is more appropriate, nor for larger varicose veins (above 3 mm), where ultrasound-guided foam sclerotherapy is the workhorse. It is not used in pregnancy or the immediate postpartum, in patients with a known allergy to the sclerosing agent, or over active deep venous thrombosis or open inflammatory skin lesions.
Like any procedure, it carries known responses. A small share of patients develop a transient post-inflammatory pigmentation; small bruising at the injection sites is common; and the "matting" phenomenon, the appearance of fine new capillaries near a treated patch, occurs in a minority and usually resolves with further sessions. Recurrence is possible when the underlying reticular or saphenous reflux is not mapped and addressed. The reticular feeder closed properly is what stops the visible capillary above it from coming back, and the Palazzo Manzoni team walks you through the specific picture of your vessels before anything is scheduled.
Meet Your Specialist
Dr. Andrezza Silvia Guedes
Aesthetic phlebology and lipedema lead. Liquid sclerotherapy, transdermal laser, cryosclerotherapy, ultrasound-guided sclerotherapy, ecocolordoppler.
Aesthetic phlebology lead
liquid sclerotherapy, transdermal laser and cryosclerotherapy across the full range of capillary indications
Ultrasound-guided sclerotherapy
ecocolordoppler-guided injection of deeper or larger feeders, shared with Prof. Edoardo Cervi where detailed mapping is needed
Lipedema pathway
dedicated diagnosis and conservative management, with carbossiterapia and mesoterapia where indicated
"Liquid sclerotherapy is the technique that has been the workhorse of aesthetic phlebology for decades. The technique is well-known. What makes the difference is the indication: choosing the right vessel for the technique, not the other way around. The reticular feeder closed properly is what stops the visible capillary above it from coming back."
Patient Stories
The reticular feeder is small.
The difference, after treatment, is not
A reticular vein, ossia a bluish or greenish vein of 1 to 3 mm, often sits just beneath a patch of visible capillaries and feeds it. Treating only the surface, without addressing the feeder, is one of the most common reasons capillaries recur. Liquid sclerotherapy is the technique that closes the feeder cleanly.
In their own words
"The bluish vein on the thigh was feeding the spider veins beneath it. Once that was treated with liquid sclerotherapy, the surface pattern resolved on its own. The legs look like the legs I remember."
"I'd had laser elsewhere and the capillaries kept coming back. Here they found and treated the reticular feeder first. Two sessions of liquid sclerotherapy later, the patch behind my knee is finally settled."
"Each injection was no worse than a blood draw, and the session was over in twenty minutes. A little bruising the first week, the stocking for ten days, and then the vein was simply gone."
Options
If liquid sclerotherapy isn't right, another technique fits your vessels
Some capillaries are too small for a needle. Some skin reacts strongly to the inflammation that closes the vessel. Some vessels are large enough to need foam rather than liquid.
Liquid sclerotherapy not being the right answer for a particular vessel isn't the end of the story. It usually means a different technique, often combined with sclerotherapy in the same plan, fits your specific picture better.
→Transdermal laser for capillaries
For the smallest capillaries (below 1 mm) without any needle puncture.
→Cryosclerotherapy
Liquid sclerotherapy with a cold contact stream, for sensitive skin and larger patches.
→Ultrasound-guided foam sclerotherapy
For larger varicose tributaries that should be closed before the smaller surface vessels.
→Endovenous laser (EVLA)
For a saphenous segment with reflux feeding the reticular and surface vessels from upstream.
Your consultation will clarify which technique, or combination, is right.
Common Questions
Common questions
about liquid sclerotherapy
Is liquid sclerotherapy painful?
Each injection is comparable to a venous blood draw. The session as a whole is described by most patients as uncomfortable rather than painful, and short.
How many sessions will I need?
Typically two to three sessions, spaced about a month apart. The exact number is established after the first consultation.
Will the vein disappear immediately?
No. The treated vessel closes during the session and is then progressively reabsorbed over weeks. The visible result of a cycle is assessed at the end of the planned sessions.
Will I need to wear compression stockings?
Yes. A class II elasto-compressive stocking is worn for one to two weeks after each session, to optimise the contact of the sclerosing agent with the vessel walls.
Will the capillaries come back?
With an ecocolordoppler-based plan that addresses any underlying reticular or saphenous reflux, recurrence rates are low. Treating only the surface vessels without addressing the feeders is the most common reason capillaries "come back."
What is "matting"?
Matting is the appearance of fine new capillaries close to a previously treated patch. It is a known but uncommon response, typically resolving with additional sessions of liquid sclerotherapy or with complementary transdermal laser.
Can I have liquid sclerotherapy in summer?
Possible, with the caveat that sun exposure on the treated areas must be avoided for several weeks to minimise the risk of post-inflammatory pigmentation. Many patients prefer to plan cycles in autumn and winter.
Is liquid sclerotherapy or transdermal laser better?
Complementary, not "better." Liquid sclerotherapy is the workhorse for reticular veins (1 to 3 mm) and many capillaries. Transdermal laser is more appropriate for the smallest capillaries (below 1 mm). Often both are combined in the same plan.
Can I have the treatment if I am pregnant?
Liquid sclerotherapy is typically deferred until after pregnancy and breastfeeding.
Who performs the procedure, and do I need a referral?
Liquid sclerotherapy at Palazzo Manzoni is performed by Dr. Andrezza Silvia Guedes. Istituto Chirurgico Palazzo Manzoni is at Via dei Mille 14 in central Brescia, and no referral is required. A clear, transparent estimate is provided after the consultation.
Take the Next Step
The reticular feeder is small.
The difference, after treatment, is not.
At Palazzo Manzoni in Brescia, your liquid sclerotherapy plan starts with an examination of both what you see and what feeds it.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Be examined by Dr. Guedes
An examination of the surface vessels and, where indicated, an ecocolordoppler of the feeders.
03
Move forward, with a plan
A cycle of liquid sclerotherapy, combined with laser where the surface needs it.
Content reviewed by Prof. Edoardo Cervi, head of Vascular Surgery.