Spider veins are small dilated veins close to the skin surface, usually a cosmetic issue. Sometimes they signal reflux in larger veins, so a Doppler before treatment is advisable. The main treatment is sclerotherapy, with surface laser for some cases, and no surgery is needed.
Spider veins (thread veins) are fine red, blue or purple lines on the thighs and legs, sometimes forming a web or star pattern. They are one of the most common reasons, especially for women, to visit a vascular specialist.
Spider veins vs varicose veins
Spider veins are very small veins (under about a millimetre) within the skin that don't bulge. Varicose veins are larger, twisted and bulging under the skin. Both are part of the same venous disease at different degrees.
Causes
- Genetics, the strongest factor.
- Hormones: pregnancy, the pill and hormone therapy.
- Prolonged standing.
- Age and excess weight.
- Repeated sun exposure, especially on the face.
Do spider veins need a Doppler?
Often, yes. Sometimes spider veins are just the "tip of the iceberg", fed by reflux in a larger vein beneath. Treating the spider veins alone without that reflux means they come back quickly. A Doppler is advisable especially if there is heaviness, swelling or visible varicose veins.
Treatment options
- Sclerotherapy: the main and most effective treatment for leg spider veins. A solution is injected through a very fine needle, closing the vein so it fades over weeks. More than one session may be needed.
- Surface laser: useful for very fine veins or people not suited to injections.
- Treating the feeding vein: if Doppler shows reflux in a larger vein, it is treated first with endovenous laser or radiofrequency.
What to expect after sclerotherapy
Mild redness or bruising may occur and fades within days; occasionally a light brown staining fades over time. Compression stockings are advised for a short period, and avoiding direct sun and strenuous exercise for a few days.
Do they come back?
Treated veins disappear, but new ones can appear over time because of genetics and hormones; they can be treated with simple follow-up sessions. Read more about varicose veins.
Frequently asked questions
Are spider veins dangerous?
Usually not; they are mainly cosmetic, but they can signal reflux in larger veins that needs a Doppler assessment.
What is the best treatment for leg spider veins?
Sclerotherapy is the main and most effective treatment, with surface laser for some very fine veins.
How many sessions are needed?
It depends on the number and size; many cases need one to three sessions.
Content on this website is for awareness only and does not replace a specialist medical examination.