Spider veins, also known as telangiectasias, are tiny veins that are typically blue, red, or purple in color most often seen on the surface of the skin of the face and legs. While many people seek treatment of spider veins because of cosmetic concerns, spider veins can also cause symptoms of burning, itching, stinging, pain, and heaviness. Like all chronic vein disorders, spider veins are due to leaky one way check valves located within the veins. There are also a number of things that may predispose a person to the development of spider veins: heredity, hormone therapy (birth control pills and hormone replacement therapy), pregnancy, obesity, chronic vein disorders, a history of blood clots, injury to the skin, and occupations that require long periods of standing.

While at times spider veins truly are just a cosmetic concern, in other cases spider veins and the blue-green feeder veins (called reticular veins) are just the “tip of the iceberg” and indicate the possibility of larger unhealthy veins located beneath the skin not visible to the naked eye. If the larger unhealthy veins are not identified and treated prior to spider vein treatments, the targeted spider vein therapies may be ineffective or produce suboptimal results. In addition, larger unhealthy veins left untreated may ultimately lead to the development of varicose veins and leg symptoms of aching, heaviness, and swelling.

The gold standard of spider vein treatment is injection of medications (sclerotherapy) into both the green feeder reticular veins and spider veins. Sclerotherapy may be done alone or in conjunction with other treatments including a surface laser treatment over the top of the spider veins, ohmic thermolysis, or ambulatory microphlebectomy of the larger reticular veins. All of these procedures are minimally invasive, done in the office setting, and require no down time at all.

Treatment of spider veins is most often a staged process and it can take anywhere from 2-4 months to obtain the maximum benefit of spider vein treatments. We typically expect to improve the appearance of spider veins by about 80%. To maximize the treatments, compression stocking use is recommended for 2-3 week after spider vein treatments.

Sclerotherapy

Treatment of spider veins traditionally involves the use of sclerotherapy. Sclerotherapy is the injection of a liquid or foam solution into the spider vein, causing the targeted vein to clot, scar, and eventually shrink away. Multiple treatments may be necessary, and you will likely experience temporary bruising, discoloration, and clotting in the treated veins.

Surface Laser

Laser energy is directed over the skin of the spider veins. The energy from the laser interacts with the hemoglobin in the blood in the vein that causes an irritation to the inner lining of the vein causing it to close off. The vein stops carrying blood and therefore disappears with time. This is typically done in conjunction with sclerotherapy.

Surface laser should be avoided on individuals with dark skin types or tanned skin. Prolonged sun exposure or tanning beds should be avoided for 2-3 weeks before and after the treatment. Initial bruising and redness should be expected.

Vein Gogh (Ohmic Thermolysis)

Ohmic thermolysis is a relatively new treatment for spider veins. In this treatment, a small needle is inserted into the vein. The heat that is produced causes the vessel to fuse together without damaging the surrounding skin. Ohmic thermolysis may be done in conjunction with sclerotherapy or as a standalone treatment for spider veins that are difficult for sclerotherapy. The Wisconsin Vein Center uses the VeinGogh ohmic thermolysis system with the Bristleâ technology. Ohmic thermolysis can be performed on darker skin tones and tanned skin. Tracts from the small needle may be visible initially, but they typically disappear within 2-6 weeks. Use of fake tanners should be avoided for 2-3 weeks prior to a treatment.

Ambulatory Microphlebectomy

When there are large clusters of dark spider veins, or telangectasias, microphlebectomy of the large reticular veins that feed the spider veins may be recommended. This essentially begins to “dry up” the spider veins it was feeding. This is usually followed up with sclerotherapy, surface laser, or ohmic thermolysis about one month later to treat any residual spider veins. Mild bruising and inflammation can be expected after phlebectomy of large reticular veins.