Is Investing Heavily in CLaCS a Calculated Clinical Decision—or a Gamble?

By Dr. Haroun Gajraj | VeinCare Academy | 19th August 2026

Dr. Haroun Gajraj is GMC-registered Vascular Specialist, Founder & Board Member of the British Association of Sclerotherapists (BAS).

CLaCS is an impressive technique. It combines Nd:YAG laser treatment, skin cooling and injection sclerotherapy in a way that is technically sophisticated, visually compelling and increasingly supported by clinical evidence.

But impressive technology is not automatically a sound investment.

A personal perspective

I looked closely at CLaCS in 2020.

At the time, I was already familiar with laser treatment in venous practice and had spent many years treating veins with established techniques, including endovenous laser treatment, ultrasound-guided foam sclerotherapy and Microsclerotherapy.

CLaCS was an attractive proposition. It promised a more advanced way of treating spider veins and reticular veins: laser energy to damage and constrict the vessel, cooling to improve tolerability, and a smaller-volume sclerosant injection to complete treatment.

The appeal was obvious: more sophisticated technology, potentially fewer visible treatment sequelae, and a premium treatment proposition for an aesthetic vein practice.

However, after examining the equipment, training, workflow, capital cost and likely patient throughput, I decided not to introduce CLaCS into my vein practice.

The business case simply did not stack up.

That was not a judgment that CLaCS did not work. It was a judgment that new technology must earn its place in clinical practice.

The evidence for CLaCS has moved on

The position is not exactly the same in 2026 as it was in 2020.

A 2026 systematic review and meta-analysis, available online in the Journal of Vascular Surgery: Venous and Lymphatic Disorders, pooled six studies involving 813 patients or treated limbs. It found that CLaCS was associated with lower rates of telangiectatic matting, microthrombi and bruising than isolated sclerotherapy.pubmed.ncbi.nlm.nih

These are not trivial outcomes.

In cosmetic vein practice, matting, trapped blood, bruising and pigmentation can matter just as much to patients as technical vein closure. Reducing these events may mean fewer unplanned reviews, less post-procedure reassurance, fewer drainage appointments and stronger patient confidence.

Individual randomized studies also support the possibility of a meaningful clinical advantage. In a 392-patient randomized trial, complete lesion elimination after three treatment sessions was reported in 100% of the CLaCS group versus 85.3% of the polidocanol-sclerotherapy group. The CLaCS arm also reported lower pigmentation and complication rates.pubmed.ncbi.nlm.nih

A within-patient randomized trial found less bruising, fewer microthrombi and drainage procedures, lower sclerosant volume, and lower pigmentation intensity with CLaCS than with 0.5% polidocanol foam. However, it did not find a statistically significant difference in pigmentation incidence or vein-diameter

So, should I revise my view?

Not necessarily.

Better evidence does not automatically mean a better investment

The latest evidence supports CLaCS as a credible specialist option. It does not yet prove that it is the best answer for every spider-vein patient, or that it should replace meticulous microsclerotherapy in routine practice.

The important caveats remain:

• Hyperpigmentation has not been shown consistently to be lower with CLaCS across pooled studies.

• Better long-term clearance and recurrence outcomes are not firmly established.

• There is no persuasive formal cost-effectiveness analysis showing that CLaCS delivers a better return than excellent microsclerotherapy.

• The published evidence base, while improving, is still relatively small and has not yet been broadly replicated by numerous independent groups.[1-3]

That matters because CLaCS is not simply another injection technique. It requires capital equipment, laser infrastructure, cooling systems, training, maintenance, protocol development and a sufficient stream of suitable patients.

A clinic can buy a very expensive solution to a problem it may already manage well.

The danger of technology-driven practice

There is a temptation in aesthetic medicine to assume that the most technologically advanced option must be the best commercial and clinical option.

Sometimes it is.

But the right question is NOT: “Is CLaCS better?”

The right question is: “Is CLaCS sufficiently better, for the patients treated in this practice, to justify the cost and complexity of introducing it?”

For some high-volume specialist clinics, particularly those with an existing laser platform, a premium patient base and a clear focus on reducing short-term visible sequelae, the answer may now be yes.

For others, particularly clinics with strong microsclerotherapy outcomes and limited treatment volume, the answer may still be no.

What the evidence supports saying to patients

A clinic using CLaCS can credibly say:

“CLaCS combines laser treatment, cooling and sclerotherapy. Current comparative evidence suggests that it may reduce some short-term treatment effects, including matting, trapped blood and bruising, compared with sclerotherapy alone.”

A clinic should not routinely say:

“CLaCS is proven to be superior to microsclerotherapy for everyone.”

That claim exceeds the evidence. The technique may offer an advantage in selected patients and for selected outcomes, but long-term recurrence, consistently superior clearance, formal cost-effectiveness and broad independent replication are not yet established.[1-3]

A sensible adoption strategy

Rather than treating CLaCS as an all-or-nothing purchase, consider a staged clinical investment.

1. Define the target population.
   Focus on patients for whom visible post-treatment sequelae carry particular importance: extensive reticular feeder patterns, previous troublesome matting or microthrombi, high cosmetic expectations, or complex C1 treatment fields.

2. Audit existing microsclerotherapy outcomes first.
   If current pigmentation, matting, satisfaction, retreatment and complaint rates are unknown, it is impossible to calculate whether CLaCS will create meaningful incremental value.

3. Build a CLaCS registry from day one.
   Record treated area, CEAP class, skin type, laser settings, sclerosant type and volume, number of sessions, bruising, microthrombi, pigmentation, matting, patient satisfaction, photographic clearance and retreatment.

4. Avoid replacing a technique that already works well.
   CLaCS should initially complement, not automatically displace, meticulous microsclerotherapy. Microsclerotherapy remains effective, accessible, relatively inexpensive and well established.

5. Do not make a cost-effectiveness claim yet.
   No persuasive formal health-economic evidence currently demonstrates that CLaCS is more cost-effective than optimised microsclerotherapy. Any return-on-investment calculation should use conservative internal assumptions, not marketing claims.

Calculated decision or gamble?

It is a calculated clinical decision when:

• The clinic has sufficient C1 treatment volume.

• The clinical team already has excellent injection expertise.

• The capital spend is affordable without requiring unrealistic patient throughput.

• CLaCS is introduced selectively and outcomes are audited.

• Marketing claims accurately reflect short-term safety advantages rather than universal superiority.

• The clinic has a broader use case for the laser platform beyond CLaCS alone.

It becomes a gamble when:

• The business case depends on guaranteed superior clearance in all cases.

• Purchase decisions rely mainly on testimonials, training-course claims or social-media marketing.

• The clinic has no baseline microsclerotherapy audit.

• CLaCS is sold as a replacement for clinical judgment and good vein assessment.

• The investment assumes that a premium price alone will create sufficient demand.

• The clinic cannot tolerate a long runway before achieving consistent operator outcomes and adequate case volume.

Bottom line

CLaCS is no longer an evidence-free novelty. Current pooled evidence provides a credible basis for saying that it may reduce matting, microthrombi and bruising compared with isolated sclerotherapy.pubmed.ncbi.nlm.nih

But the investment case should be built around selective quality improvement, not a promise of universal superiority.

A clinic that buys heavily into CLaCS without measuring its current outcomes, defining its target population or planning for utilisation is gambling. A clinic that adopts it in stages, audits results, preserves microsclerotherapy expertise and communicates the evidence honestly is making a calculated clinical decision.

Back in 2020, I decided that the business case did not stack up for my practice. Even with stronger evidence today, I would still start with the same principle:

Buy technology because it solves a clearly measured clinical and business problem—not because it is new, impressive or fashionable.

References

1. Simoni GH, Madera D, Papatheodorou N, Neves S, Varella ACP, Alonso JG, Mahfouz N. Cryo-Laser Cryo-Sclerotherapy Versus Isolated Sclerotherapy for Telangiectasias and Reticular Veins: a Systematic Review and Meta-Analysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2026. doi:10.1016/j.jvsv.2026.102582. Available online ahead of final issue assignment.sciencedirect

2. Nasser MM, Ghoneim BM, Eldaly W, Elmahdy H. A comparative study between cryo-laser cryo-sclerotherapy and sclerotherapy in the treatment of telangiectasia and reticular veins: A randomized controlled trial. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2024;12(4):101874. doi:10.1016/j.jvsv.2024.101874. PMID: 38522666. PubMed.pubmed.ncbi.nlm.nih

3. Rodrigues A, Puggina J, da Silva VS, Ribeiro CM, Santiago FR, Neves S, Simoni GH, Portugal MF, Ramacciotti E. Pigmentation after foam or cryo-laser cryo-sclerotherapy for lower limb reticular veins: A within-patient randomized trial. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2025;13(6):102285. doi:10.1016/j.jvsv.2025.102285. PMID: 40653087. PubMed.

This educational article is written and regularly reviewed by Dr Haroun Gajraj, a GMC-registered vein specialist who has treated thousands of patients with vein disease and has trained many doctors and nurses in microsclerotherapy, radiofrequency thermocoagulation, and related cosmetic vein procedures. Dr Gajraj is the founder and board member of the British Association of Sclerotherapists. You can view his current GMC registration and independent patient reviews on iWantGreatCare for further information about his clinical background.

Clinicians remain responsible for assessing each patient, obtaining informed consent, explaining risks and alternatives, and working within the scope of their professional registration and regulatory guidance.

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© VeinCare Academy | Dr. Haroun Gajraj | veincare.academy
This article is intended for qualified healthcare professionals. All clinical decisions should be based on individual patient assessment, primary medical literature and current professional guidelines.