Polidocanol, marketed as Asclera® in the United States, is an FDA-approved sclerosing agent used for the nonsurgical treatment of spider veins and reticular veins. Its efficacy and safety are supported by extensive clinical research, positioning it as a leading option for patients seeking minimally invasive vein removal. All medical aesthetic procedures at Cosmetic Injectables Center Medspa are performed by certified expert injectors under the full-time, on-site supervision of Dr. Sherly Soleiman, MD, a board-certified physician and national leader in medical aesthetics.

How Polidocanol (Asclera®) Sclerotherapy Works

Polidocanol is a non-ionic surfactant that damages the endothelium (inner lining) of blood vessels upon injection, causing vessel closure and eventual fibrosis. The mechanism is concentration-dependent, with 0.5–1% solutions used for spider veins and up to 3% for larger reticular veins. Histological studies confirm that polidocanol induces endothelial cell death and media damage, resulting in effective vessel obliteration with minimal risk of scarring or pigmentation (FDA Label, 2025; PMC7909103).

FDA Approval and Indications

The U.S. Food & Drug Administration approved Asclera® (polidocanol) for the treatment of uncomplicated spider veins (≤1 mm) and reticular veins (1–3 mm) of the lower extremities. In five randomized controlled trials (n=401), Asclera® demonstrated 80–95% success rates at 12–26 weeks, with low rates of adverse events such as injection-site hematoma (42%) and hyperpigmentation (5–10%). Serious complications were rare (<1%) (FDA Label, 2025).

Clinical Evidence: Efficacy and Safety

Key Findings from Recent Meta-Analyses and Trials

Efficacy: Systematic reviews and meta-analyses (n=1,412) show polidocanol sclerotherapy achieves vein closure rates of 80–95% for spider and reticular veins, with symptom relief (e.g., pain reduction) in over 90% of cases (PMC7909103).
Safety: Adverse events are typically mild and transient, including local pain, pigmentation, and hematoma. Long-term studies report a 1.1% incidence of minor complications, with serious events being rare (PubMed 20590706).
Foam vs. Liquid: Foam formulations of polidocanol are more effective for larger veins, achieving 92–96% closure rates and requiring fewer sessions than liquid sclerotherapy (ScienceDirect; EJVS).

Comparative Effectiveness

Polidocanol has been compared to other sclerosing agents such as sodium tetradecyl sulfate (STS) and hypertonic saline. Studies show polidocanol produces less inflammation, faster healing, and a lower risk of pigmentation or ulceration (PubMed 27738241). Foam sclerotherapy is statistically non-inferior to endovenous laser ablation for small-to-medium veins, with lower costs and fewer side effects (ScienceDirect).

Indications and Patient Selection

Polidocanol sclerotherapy is indicated for:

Spider veins (telangiectasias, ≤1 mm)
Reticular veins (1–3 mm)
Selected cases of venous malformations (VMs) and small varicose veins

Contraindications include known allergy to polidocanol, acute thrombosis, severe arterial disease, and pregnancy. A comprehensive medical assessment is performed for every patient at Cosmetic Injectables Center Medspa to determine candidacy and ensure safety.

Procedure Options for Spider Vein Treatment

1. Polidocanol (Asclera®) Liquid Sclerotherapy

Used for spider and small reticular veins.
Minimal discomfort, low risk of pigmentation.
Typically requires 1–3 sessions.

2. Polidocanol Foam Sclerotherapy

Preferred for larger reticular veins and small varicosities.
Higher efficacy, fewer sessions needed.
May be combined with ultrasound guidance for deeper veins.

3. Alternative Sclerosing Agents

Sodium Tetradecyl Sulfate (STS): Slightly higher risk of inflammation and pigmentation.
Hypertonic Saline: Less commonly used due to pain and risk of ulceration.

4. Non-Sclerotherapy Alternatives

Laser Vein Removal: Effective for facial spider veins and small vessels; may be used as adjunct or alternative (Laser for Veins).
Radiofrequency Ablation: Reserved for larger varicose veins, not typically used for spider veins.
Lifestyle Modification: Weight loss and compression therapy can reduce recurrence and improve outcomes.

5. Combined Aesthetic Approaches

Sclerotherapy is often integrated with body contouring and medical weight loss programs to address veins exacerbated by prior obesity (EMSCULPT NEO, Ozempic Weight Loss). While direct studies are limited, clinical practice supports a multidisciplinary approach for optimal vascular and cosmetic results.

Comparison Table: Sclerotherapy and Vein Treatment Options

Treatment Option	Indications	Efficacy (Closure Rate)	Sessions Needed	Common Side Effects	FDA Approval	Best For
Polidocanol (Asclera®) Liquid	Spider/reticular veins	80–90%	1–3	Mild pain, pigmentation	Yes	Most spider veins
Polidocanol Foam	Larger reticular/small varicose	92–96%	1–2	Mild pain, rare nerve injury	Yes	Larger veins, fewer sessions
STS (Sotradecol®)	Spider/reticular veins	75–90%	2–4	More inflammation	Yes	Alternative to polidocanol
Hypertonic Saline	Spider veins	60–80%	2–5	Pain, ulceration	No	Rarely used
Laser Vein Removal	Facial/small leg veins	70–90%	1–3	Redness, swelling	Yes	Facial veins, adjunct
Radiofrequency Ablation	Large varicose veins	90–98%	1	Bruising, nerve injury	Yes	Large truncal veins

What to Expect: Procedure, Recovery, and Results

Procedure: Sclerotherapy is performed in-office. A fine needle injects polidocanol directly into the target vein. Sessions last 15–30 minutes.
Recovery: Patients may experience mild bruising or swelling. Compression stockings are recommended for 1–2 weeks.
Results: Most veins fade within 3–6 weeks. Multiple sessions may be required for extensive veins. Individual results may vary.
Safety: All procedures at Cosmetic Injectables Center Medspa are performed by certified injectors under Dr. Soleiman’s direct supervision, with a focus on patient safety, comfort, and natural-looking outcomes.

Evidence-Based References

Internal Links to Related Procedures

Frequently Asked Questions

What is polidocanol (Asclera®) sclerotherapy?

Polidocanol (Asclera®) sclerotherapy is an FDA-approved injectable treatment for spider and reticular veins. It closes unwanted veins by damaging the vessel lining, causing them to fade.

Is polidocanol sclerotherapy safe?

Yes. Clinical trials and long-term studies show a low risk of serious complications. Most side effects are mild and temporary, such as bruising or pigmentation.

How many sessions are needed for spider vein removal?

Most patients require 1–3 sessions, depending on the number and size of veins. Larger or more extensive veins may need additional treatments.

What are the main side effects of polidocanol sclerotherapy?

Common side effects include mild pain, bruising, swelling, and temporary pigmentation. Serious complications are rare when performed by certified injectors.

How does foam sclerotherapy differ from liquid?

Foam sclerotherapy mixes polidocanol with air or gas, creating a foam that covers larger vein surfaces. It is more effective for larger reticular or small varicose veins.

Can sclerotherapy be combined with other treatments?

Yes. Sclerotherapy is often combined with body contouring or weight loss programs to address veins made more visible after fat reduction or lifestyle changes.

Who should not receive polidocanol sclerotherapy?

Contraindications include allergy to polidocanol, acute thrombosis, severe arterial disease, and pregnancy. A thorough medical assessment is required.

How long do results last?

Results are long-lasting, but new veins may develop over time. Maintenance sessions can address new or recurrent veins as needed.

Is there downtime after sclerotherapy?

Minimal downtime is expected. Patients can resume normal activities immediately but should wear compression stockings and avoid strenuous exercise for a few days.

Why choose Cosmetic Injectables Center Medspa for vein treatment?

All procedures are performed by certified experts under the direct supervision of Dr. Sherly Soleiman, MD, ensuring the highest standards of safety, expertise, and natural results.

Polidocanol (Asclera®) Sclerotherapy: Evidence for Spider Vein Treatment in 2025