Which is better, foam sclerotherapy or liquid sclerotherapy?

I am so excited to finally rid my hands and arms of bulging veins from thin skin. I understand some risks are involved bubbles from a small amount of sclerosant foam can appear in the heart or brain, a gas embolism or stroke. Which is best, foam sclerotherapy or liquid sclerotherapy?

Answers from doctors (13)


More About Doctor David Green, MD

Published on Jul 23, 2021

If administered properly, Sclerotherapy will result in the eventual disappearance of the treated veins. The chemicals used in both liquid and foam Sclerotherapy are the same - as you referenced, the foam is made by mixing the gas with the liquid. Some vein specialists prefer foam - others do not. The most important consideration is making sure that the physician offering these treatments has a great deal of experience in their treatment and is confident that they can remove your unwanted veins - almost always with just one treatment.

Answered by David Green, MD (View Profile)

If administered properly, Sclerotherapy will result in the eventual disappearance of the treated veins. The chemicals used in both liquid and foam Sclerotherapy are the same - as you referenced, the foam is made by mixing the gas with the liquid. Some vein specialists prefer foam - others do not. The most important consideration is making sure that the physician offering these treatments has a great deal of experience in their treatment and is confident that they can remove your unwanted veins - almost always with just one treatment.

Published on Jul 11, 2012


Center for Vein Care and Surgery

Published on Apr 10, 2013

In my opinion, it depends on the size of the vein being treated and the skill of the injector. Hand veins like to "roll" and have the consistency of rubber bands. In order to use sclerofoam safely and effectively, the solution should not leak outside of the injected vein. A foam solution of 0.5% Asclera (Polidocanol) is commonly used for the hands and I believe gives the best results. It may be necessary to have any residual clots or thrombus drained in one week to relieve the tender lumps left behind. This is easily tolerated by using a small needle and local anesthetic.

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Answered by Center for Vein Care and Surgery

In my opinion, it depends on the size of the vein being treated and the skill of the injector. Hand veins like to "roll" and have the consistency of rubber bands. In order to use sclerofoam safely and effectively, the solution should not leak outside of the injected vein. A foam solution of 0.5% Asclera (Polidocanol) is commonly used for the hands and I believe gives the best results. It may be necessary to have any residual clots or thrombus drained in one week to relieve the tender lumps left behind. This is easily tolerated by using a small needle and local anesthetic.

Published on Jul 11, 2012


Vein Center of Orange County

Published on Feb 19, 2013

Foam allows for the use of lower concentrations and volumes of sclerosant, as well as fewer injections per length of vessel. Given the premise, less medicine is better than more as long as the job gets done. Although certain high-risk patients should not receive foam, millions of foam injections are given every day without incident.

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Answered by Vein Center of Orange County

Foam allows for the use of lower concentrations and volumes of sclerosant, as well as fewer injections per length of vessel. Given the premise, less medicine is better than more as long as the job gets done. Although certain high-risk patients should not receive foam, millions of foam injections are given every day without incident.

Published on Jul 11, 2012


Vein Clinic of North Carolina

Published on Feb 13, 2013

Whether foam or liquid sclerotherapy is best really depends on the size of the vein and the preference of the clinician. However, hand and arm veins should be treated with caution. It is normal to have prominent veins in these areas.

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Answered by Vein Clinic of North Carolina

Whether foam or liquid sclerotherapy is best really depends on the size of the vein and the preference of the clinician. However, hand and arm veins should be treated with caution. It is normal to have prominent veins in these areas.

Published on Jul 11, 2012


Arizona Vein Specialists

Published on Feb 12, 2013

This is a matter of personal preference. I do not treat above the wrist, as arm veins may be needed in the future for IV access for illness or surgery. Large foam volumes also concern me, so I use liquid for hand veins. I have colleagues who use foam.

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Answered by Arizona Vein Specialists

This is a matter of personal preference. I do not treat above the wrist, as arm veins may be needed in the future for IV access for illness or surgery. Large foam volumes also concern me, so I use liquid for hand veins. I have colleagues who use foam.

Published on Jul 11, 2012


Advanced Vein Center

Published on Feb 12, 2013

Treating your hands and arms is purely cosmetic. If this is important to you, they can be sclerosed. But, these veins are usually too large to effectively treat with liquid. I strongly discourage against having arm veins treated and closed because of future lack of IV access, drawing blood, etc.

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Answered by Advanced Vein Center

Treating your hands and arms is purely cosmetic. If this is important to you, they can be sclerosed. But, these veins are usually too large to effectively treat with liquid. I strongly discourage against having arm veins treated and closed because of future lack of IV access, drawing blood, etc.

Published on Jul 11, 2012


Intermountain Vein Center

Published on Feb 12, 2013

Foam is usually recommended for larger veins, but it will depend on the doctor. Usually doctors treat veins in the legs, so there might be more of a risk with injections in the arms. Talk to your doctor about the risks.

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Answered by Intermountain Vein Center

Foam is usually recommended for larger veins, but it will depend on the doctor. Usually doctors treat veins in the legs, so there might be more of a risk with injections in the arms. Talk to your doctor about the risks.

Published on Jul 11, 2012


Cosmetic Vein Centers of Texas

Published on Feb 12, 2013

I've never treated bulging arm and hand veins with any type of sclerotherapy.

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Answered by Cosmetic Vein Centers of Texas

I've never treated bulging arm and hand veins with any type of sclerotherapy.

Published on Jul 11, 2012


Bella MD Laser Vein and Aesthetic Center

Published on Feb 11, 2013

Foam only when necessary for larger veins that liquid will not work in.

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Answered by Bella MD Laser Vein and Aesthetic Center

Foam only when necessary for larger veins that liquid will not work in.

Published on Jul 11, 2012


General Vascular Surgery Group

Published on Feb 11, 2013

Depends on the veins. I must comment though that I generally recommend against treating hand and arm veins, as these may be needed for IVs if you ever become ill for another reason.

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Answered by General Vascular Surgery Group

Depends on the veins. I must comment though that I generally recommend against treating hand and arm veins, as these may be needed for IVs if you ever become ill for another reason.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Feb 11, 2013

Large hand veins can be removed using microphlebectomy (tiny punctures through which the vein is removed). If the arm veins are very large, they can be also be removed using microphlebectomy or if smaller, injected with a sclerosing agent (sclerotherapy). Foam sclerotherapy works better due to the "mousse-like" texture which adheres to the vein wall better and concentrates the solution there for longer. I tape cotton balls over the area, which also slows the blood flow and allows the solution to work for longer. I also instruct my patients to stay upright for the rest of the day, avoid lifting or using the abdominal muscles, drink plenty of fluids and walk frequently. If patients are screened appropriately and follow the post-treatment instructions, the risks you mentioned are rare. However, we must inform our patients of all possible complications.

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Answered by Vein Specialties of St. Louis

Large hand veins can be removed using microphlebectomy (tiny punctures through which the vein is removed). If the arm veins are very large, they can be also be removed using microphlebectomy or if smaller, injected with a sclerosing agent (sclerotherapy). Foam sclerotherapy works better due to the "mousse-like" texture which adheres to the vein wall better and concentrates the solution there for longer. I tape cotton balls over the area, which also slows the blood flow and allows the solution to work for longer. I also instruct my patients to stay upright for the rest of the day, avoid lifting or using the abdominal muscles, drink plenty of fluids and walk frequently. If patients are screened appropriately and follow the post-treatment instructions, the risks you mentioned are rare. However, we must inform our patients of all possible complications.

Published on Jul 11, 2012


Vein Specialists

Published on Feb 11, 2013

Liquid sclerotherapy is the safest. Foam sclerosant can be made with air or CO2. CO2 is safer than air, and the position of the extremity relative to the heart during the injections is also a consideration (extremity above heart is best). If you want be even more compulsive, consider an echocardiogram before your foam sclerotherapy session to make sure you do not have a "hole" in your heart (patent foramen ovale), which can allow bubbles to move from the venous circulation into the arterial circulation and possibly to the brain. My practice is to limit the use of off-label preparations such as foam in sclerotherapy. You need to weigh the risks and benefits.

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Answered by Vein Specialists

Liquid sclerotherapy is the safest. Foam sclerosant can be made with air or CO2. CO2 is safer than air, and the position of the extremity relative to the heart during the injections is also a consideration (extremity above heart is best). If you want be even more compulsive, consider an echocardiogram before your foam sclerotherapy session to make sure you do not have a "hole" in your heart (patent foramen ovale), which can allow bubbles to move from the venous circulation into the arterial circulation and possibly to the brain. My practice is to limit the use of off-label preparations such as foam in sclerotherapy. You need to weigh the risks and benefits.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Feb 11, 2013

Both work well and are used in different areas. Liquid is usually used for smaller veins and foam for larger veins. Although foam can cause complications as you mentioned, these are very rare. You should have your treatment done by someone experienced in using both.

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Answered by Vanish Vein and Laser Center

Both work well and are used in different areas. Liquid is usually used for smaller veins and foam for larger veins. Although foam can cause complications as you mentioned, these are very rare. You should have your treatment done by someone experienced in using both.

Published on Jul 11, 2012


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