Sclerotherapy for facial telangiectasia and reticular veins: Evidence, techniques, anatomical and safety considerations

Facial telangiectasias and reticular veins are common aesthetic concerns for which vascular lasers and light-based therapies are widely used, while the role of sclerotherapy remains less clearly defined. This narrative review evaluates the current evidence regarding the technique, efficacy, and safety of facial sclerotherapy. A literature search identified direct facial studies supplemented by relevant evidence from lower-extremity sclerotherapy and case reports of serious complications. Available studies suggest that liquid sclerotherapy can achieve substantial and durable clearance of selected facial vessels, particularly discrete blue reticular veins. However, the evidence is predominantly derived from small, heterogeneous, and often historical observational studies, and no standardized facial protocol has been established regarding sclerosant, concentration, injection volume, or technique. Facial vascular anatomy represents the principal safety consideration, as inadvertent arterial injection may result in skin necrosis or, rarely, ophthalmic arterial occlusion and permanent visual loss. The relative roles of liquid and foam remain insufficiently defined, while vascular lasers remain more appropriate for most fine telangiectasias and anatomically high-risk vessels. Facial sclerotherapy should therefore be considered a selective treatment requiring careful anatomical assessment, meticulous technique, and individualized risk-benefit evaluation.