Microsclerotherapy London | Thread Vein Removal

Microsclerotherapy is the gold-standard medical treatment for thread veins and spider veins on the legs and body — the only technique that targets the vessel itself at its origin and achieves lasting clearance through a clinically controlled biological process.

Thread veins — also called spider veins, telangiectasias, or broken veins — are permanently dilated superficial blood vessels visible through the skin as red, purple, or blue lines, webs, or clusters. They develop as the vessel walls lose elasticity, most commonly on the legs, thighs, ankles, and occasionally on the face and trunk. While entirely benign, they are a source of significant cosmetic concern for many patients and, unlike varicose veins, they carry no circulatory consequence that requires urgent medical attention.

Microsclerotherapy involves the injection of a pharmaceutical sclerosant agent — most commonly polidocanol or sodium tetradecyl sulphate (STS) — directly into the affected vessel using an ultra-fine needle. The sclerosant causes controlled irritation of the vessel wall endothelium, leading to fibrous occlusion of the vessel and its gradual reabsorption by the body over the weeks following treatment. The result is progressive fading and, in most cases, complete disappearance of the treated veins.

At PHP Aesthetic-Wellness, microsclerotherapy is performed by Dr Philippe Hamida-Pisal and Dr Jihyun Byun using prescription-grade sclerosant agents under clinical conditions. Every patient undergoes a vascular assessment before treatment to confirm suitability, exclude underlying venous reflux, and establish a realistic expectation of outcomes.

“Microsclerotherapy has been used for over eight decades because it works. When it is performed correctly — with the right sclerosant, at the right concentration, in the right vessel — the results are consistently excellent and the complication rate is very low. Patient selection and technique are everything.” PHP Aesthetic-Wellness, 22 Harley Street

Types of Thread Veins & Vessels We Treat

Not all superficial vascular lesions are the same. Accurate identification of the vessel type guides sclerosant choice, concentration, and technique.

Telangiectasias True thread veins

The finest superficial vessels — under 1mm in diameter — appearing as red or pink linear, branching, or web-like patterns on the thighs, lower legs, and ankles. The classic presentation of thread veins and the most amenable to microsclerotherapy. Multiple sessions are typically required to achieve complete clearance.

Reticular Veins Feeder veins

Slightly larger blue-green vessels (1–3mm) that feed clusters of telangiectasias and may be visible beneath the skin surface. Identifying and treating reticular feeder veins alongside the overlying thread veins significantly improves outcomes and reduces the rate of recurrence. Treatment is incorporated into the same protocol where present.

Spider Naevi

A central arteriole with radiating vessels, most commonly seen on the face, upper chest, and arms. Often associated with hormonal change, pregnancy, or liver disease. Facial spider naevi are treated with a different technique to leg thread veins; the assessment will confirm the most appropriate approach.

Varicose Veins Referral required

Larger, bulging, tortuous veins caused by venous reflux at the saphenofemoral or saphenopopliteal junction. Varicose veins are a vascular medical condition, not a cosmetic one, and require specialist vascular surgical assessment before any treatment. We identify varicose veins at assessment and refer appropriately. Treating thread veins in the presence of untreated varicose veins produces poor and short-lived results.

The Microsclerotherapy Procedure

Each session follows a structured clinical sequence designed to maximise efficacy, minimise discomfort, and ensure patient safety throughout.

1

Vascular Assessment

The legs are examined standing and lying, with clinical mapping of all visible thread veins, reticular feeders, and any varicose veins. A brief clinical history covering contraindications, previous treatments, and current medications is taken. Patients deemed unsuitable for microsclerotherapy are referred to an appropriate vascular specialist.

2

Sclerosant Selection

The sclerosant agent and concentration are selected according to the vessel type, diameter, and location. Polidocanol is most commonly used for fine telangiectasias; STS at higher concentrations for reticular feeders. The selected agent is prepared to the precise clinical specification for the treatment area.

3

Injection

Using an ultra-fine 30-gauge needle, the sclerosant is injected directly into the target vessel under direct visual or transillumination guidance. Multiple vessels are treated per session, typically working from the largest feeders down to the finest thread veins. A mild stinging sensation is normal during injection and resolves within seconds.

4

Compression & Recovery

Compression stockings or bandaging are applied immediately following treatment and worn for a period determined by the extent of treatment. Patients walk for a short period in clinic before leaving. Compression supports the vessel occlusion process and significantly reduces the risk of post-treatment complications including matting and pigmentation.

5

Progressive Clearance

Treated vessels begin to fade over the two to six weeks following each session as the sclerosed vein is gradually reabsorbed. The full result of each session is assessed at six to eight weeks, at which point further sessions are planned if additional clearance is required. Most patients require two to four sessions for complete clearance.

A note on sessions and clearance: The number of sessions required depends on the surface area and density of thread veins, the presence of feeder vessels, and how the individual’s vasculature responds to the sclerosant. Most patients see significant improvement after two sessions; complete clearance of an extensive area typically requires three to four. We assess progress at each visit and adjust the protocol accordingly. New thread veins may develop in untreated areas over time, as the underlying tendency to vessel fragility is not eliminated by treatment.

Suitability & Contraindications

Microsclerotherapy is suitable for most healthy adults with thread veins on the legs or body. A number of medical conditions and circumstances require discussion before treatment can proceed.

✓ Generally suitable

Healthy adults with telangiectasias or reticular veins

Post-menopausal women off HRT for 4–6 weeks

Men and women over 18 in good general health

Previous sclerotherapy with no adverse reaction

Active individuals able to walk post-procedure

All skin tones — no phototype restriction

⚠ Requires discussion or deferral

Pregnancy and breastfeeding

Untreated varicose veins or venous reflux

Active DVT or history of clotting disorders

Severe arterial disease or peripheral vascular disease

Known allergy to sclerosant agents

Current anticoagulant therapy

Immobility or inability to wear compression

Diabetes with peripheral neuropathy

Aftercare

Correct aftercare in the days following microsclerotherapy is as important as the procedure itself. Following these instructions reduces the risk of complications and supports the best possible outcome.

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Wear your compression stockings as directed — typically for 48–72 hours continuously following treatment, then during daytime hours for a further week. Compression is the single most important aftercare measure.

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Walk regularly in the days following treatment. Walking promotes circulation and aids the clearance of treated vessels. Avoid prolonged sitting or standing in the same position.

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Avoid sun exposure to treated areas for at least four weeks following each session. UV exposure in the post-treatment period significantly increases the risk of post-inflammatory hyperpigmentation and brown staining at the injection sites.

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Avoid heat — hot baths, saunas, steam rooms, and sunbeds — for 48–72 hours following treatment. Heat causes vessel dilation and can compromise the sclerosant effect.

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Avoid strenuous exercise for 48 hours. Light walking is encouraged; high-impact activity, heavy weights, and gym sessions should be deferred.

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Expect some redness and bruising at injection sites in the first few days. A temporary brownish discolouration (haemosiderin staining) may appear as vessels clear and typically resolves over weeks to months. These are normal parts of the treatment process.

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Contact us immediately if you develop significant swelling, warmth, or tenderness in the calf — symptoms that could indicate a deep vein thrombosis, which is a very rare but serious complication of sclerotherapy.

What to Expect & Common Questions

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When will I see results?

Treated vessels begin to fade from two weeks following each session. The full result of a session is typically apparent at six to eight weeks, at which point further treatment is assessed. Some fine vessels clear after a single session; larger areas with feeder veins require two to four sessions for complete clearance.

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Is it painful?

The injections are performed with an ultra-fine 30-gauge needle and produce a mild stinging sensation that typically lasts only seconds. Most patients find the procedure very well tolerated. A topical anaesthetic cream can be applied beforehand on request if you are particularly needle-sensitive.

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Will thread veins return?

Treated vessels are permanently destroyed and do not return. However, the underlying tendency to develop thread veins is not eliminated by treatment — new vessels may form in untreated areas over time, particularly with prolonged standing, hormonal changes, or increasing age. Maintenance sessions address new veins as they appear.

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Are there any side effects?

Temporary redness, bruising, and mild swelling at injection sites are normal and expected. Haemosiderin staining (brownish discolouration) occurs in a minority of patients and usually resolves within weeks to months. Matting — a flushed red network of very fine vessels — is uncommon and typically resolves spontaneously. Serious complications are rare when the procedure is performed by a trained clinician.

Related Concerns

Thread vein treatment is often sought alongside or following other leg and body concerns at PHP Aesthetic-Wellness:

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Facial Thread Veins

Thread veins and redness on the face are a distinct concern requiring a different approach — addressed through our redness and rosacea programme using LED therapy and targeted vascular management.

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Leg Heaviness & Swelling

Symptoms of venous insufficiency — heaviness, aching, and swelling in the legs — accompanying thread veins should be assessed for underlying reflux before microsclerotherapy proceeds. We conduct this assessment at the initial appointment.

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Skin Quality & Hydration

Dry, crepey skin on the legs frequently accompanies thread veins. Body mesotherapy and skin booster treatments address skin quality in the treated areas, completing the aesthetic result alongside vein clearance.

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Microsclerotherapy & Thread Veins