Historical methods for causing venous endothelial damage include a slender rod of iron, reportedly used by Hippocrates himself; absolute alcohol, introduced by Monteggio and Lerpy D’Etoilles in the 1840s; and ferric chloride, introduced by Charles Gabriel Pravaz in 1851. The idea of injecting irritant substances into the vein for purpose of obliteration appears frequently in the French literature of last century. The injections were made with strong caustic and toxic substances. In 1956, Peter Fluckiger was the first to notice that the foam could be directed into regions other than the site of injection by manual manipulation. This concept is now widely practiced with ultrasound-guided foam sclerotherapy. Sclerotherapy refers to the introduction of a foreign substance (sclerosing solution) into the lumen of a vessel producing endothelial damage, which leads to thrombosis and subsequent fibrosis. The extent of damage to the blood vessel wall determines the effectiveness of the solution. Sclerotherapy has been extensively used by dermatosurgeons in the management of superficial varicose veins and other venous abnormalities. Sclerotherapy is a simple and effective procedure for the treatment of varicose veins. With experience, larger veins can also be treated effectively with sclerotherapy. It can prevent the complications of varicose veins if done in the initial stages. Sclerotherapy being an outpatient procedure, when done with adequate precautions is associated with very minimal morbidity, mortality and loss of work time compared to surgery. Sclerotherapy has emerged as a simple, safe and effective treatment modality for management of venous abnormalities, both therapeutically and esthetically. The advent of foam sclerotherapy has carried the field further forwards. New advances in laser ablation have opened new avenues for management of these common therapeutic and esthetic problems.