Sclerotherapy is done after the larger veins have been treated with laser therapy. Ultrasound-guided sclerotherapy is done when the veins are deeper and cannot be seen on the skin surfaces. Often veins such as tributaries, distal saphenous veins, and larger reticular veins are treated by ultrasound-guided sclerotherapy. If the veins are more superficial, reticular, or spider veins, they can be injected without ultrasound guidance. Most superficial veins will need at least three treatments about a month apart to eliminate the vein. We use Soledechol, which is the only approved agent to treat varicose veins at this point.