Spider vein treatment – now you see them, now you don't

Superficial leg veins causing red, blue or purple discolorations are sometimes referred to as spider veins, especially when they resemble a spider web pattern. The medical term from them is "telangiectasia." While they are most frequently seen in the thighs, ankles and calves, they can appear anywhere on the body. They can start appearing in your 20s and become more visible as you age.

Although some severe forms of spider veins may be a symptom of vein disease, most cases are small, harmless and painless. Most treatments are done for cosmetic reasons. However, any associated itching or burning should prompt an evaluation by a medical professional.

What causes spider veins?

Veins are responsible for carrying blood back to our heart and contain one-way valves for blood to travel in only one direction. When the valves weaken, some blood flows backwards and accumulates in the veins. The extra blood in veins causes the vein walls to weaken and bulge out over time, making them more visible.

Spider veins have a variety of causes. They have been associated with prolonged sitting and standing which leads to increased venous pressure in the legs. They are also commonly associated with increased age, pregnancy, sun damage, hormonal changes that dilate veins and past injuries to the area. In addition, those with blood relatives who have spider veins have an increased risk for developing the condition.

Venous conditions are very common. It is estimated that 50 to 55 percent of women and 40 to 45 percent of men have spider veins. Around one-half of the population over 50 years of age have this condition.

How do you get rid of spider veins?

If you have symptoms or are concerned about the appearance of spider veins, there are several options available to treat them.

Sclerotherapy

Sclerotherapy, which can be done in an office setting, is the most common treatment for spider veins. The procedure involves injecting a solution directly into the veins, causing them to constrict and close. As blood is rerouted to healthy veins, the spider veins "disappear" as blood no longer flows through them. The collapsed vein is reabsorbed by your body and fades within a few weeks. For larger veins or more resistant cases, several sclerotherapy treatments may be needed. It may also take 3 to 4 months to see full results.

There are several injection solutions to choose from. Hypertonic saline is a salt concentrate solution that is widely used and is very effective. It is the cheapest option and has no risk of allergic reactions. However, the injection of saline solution into veins typically causes an intense burning sensation. To help ease discomfort, the saline solution is often mixed with lidocaine, an anesthetic.

Two other injection solutions are Sotradecol and Asclera. While sclerotherapy with these solutions is more expensive, the injections are generally painless and provide a more comfortable experience. They have been shown to be just as effective as hypertonic saline and are also FDA approved.

Sclerotherapy takes less than an hour to complete, and you will be able to resume normal activities on the same day. Like with any treatment involving injections, there may be some mild bruising or skin discoloration to the injection area that should fade over the course of a few weeks. You may also be instructed to use compression stockings or bandages for around two weeks to maintain compression on the treated veins. Veins that respond to treatment generally do not come back.

Transcutaneous laser ablation

Spider veins may also be treated with a laser. During the procedure, a laser light will be focused directly at the vein. This causes tiny blood clots to form that block off and destroy the spider veins without damaging your skin. No incisions or needles are used for laser therapy. While sclerotherapy is more common, laser treatment may be more suitable for smaller spider veins that are too small to be targeted with injections.

Most patients can return to normal activities the same day. Smaller veins may disappear immediately after treatment, while larger veins turn dark and fade over the next few months. Additional laser treatments may also be needed for larger or unresponsive spider veins.

Self and preventative care

There are many activities you can do to maintain your results from sclerotherapy or laser treatment, as well as prevent new spider veins from appearing.

• Routine exercise – Walking or running increases leg circulation and helps maintain a healthy, constant flow of blood through the valves in your veins.
• Avoid prolonged sitting or standing (2+ hours) – Prolonged sitting or standing allows for blood to pool up in your legs, most of which is held in the veins. Taking a break to walk around even for a few seconds can help decrease venous pressure and prevent valve damage.
• Prop up your feet – During breaks throughout the day, you can elevate your legs above your heart. This uses gravity to pull blood from the leg veins back to the heart and prevents excessive blood from pooling in the legs.
• Use compression stockings – These apply steady pressure in your lower legs, which helps move blood from your legs back to your heart. They can be found in local pharmacies and medical supply stores.

These measures may not be able to completely prevent spider veins from appearing, but they can help lower your risk.

Ready to get rid of your spider veins?

If you are unhappy about the way your spider veins look or if they are causing discomfort, reach out to a plastic surgeon about your treatment options. Board-certified plastic surgeons have made many advances for safer and less invasive treatments for leg veins and are in the best position to perform the procedures safely.