Spider and Varicose Vein Treatment

What are Spider Veins?
Spider veins are dilated small blood vessels that have a red or bluish color. They appear mostly on the legs, occasionally on the face or elsewhere, and may often be unwanted.

What Causes the Blood Vessels to Become Visible?
The cause of spider veins is not known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition can very occasionally occur as part of an internal disease.

Can Spider Veins be Prevented?
Spider veins can’t always be prevented. Wearing support hose may prevent some unwanted blood vessels from developing. Keeping ones weight at a normal level and exercising regularly may also be helpful. Eating a high-fiber diet and wearing low-heeled shoes can also help. Sun protection is important to limit the number of unwanted vessels on the face.

How Are Unwanted Blood Vessels on the Legs Treated?
In the majority of cases a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930’s and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to clot. Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable or invisible. A single blood vessel may have to be injected more than once, some weeks apart, depending on its size. In any one treatment session a number of vessels can be injected. The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. Your dermatologist will decide the solution that is best for your particular case. Occasionally larger varicose veins are underneath the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done with sclerotherapy followed by compression or by a surgical procedure performed by a vascular surgeon. Other physicians believe that spider veins may be treated by sclerotherapy without worrying about the varicose veins unless they become troublesome.

How Successful is Sclerotherapy?
After several treatments, most patients can expect a 50 percent to 90 percent improvement. However fading is gradual. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area.

Can Sclerotherapy Be Used on all Skin Types?
Yes. All skin types and skin colors respond equally well.

Will Insurance Cover the Treatment of Unwanted Blood Vessels?
Insurance coverage varies. If the treatment is solely for cosmetic reasons, it may not be covered. Sometimes a second opinion, laboratory studies or photographs are required by insurance companies before treatment is started.

Are There Side effects to Sclerotherapy?
Even with a highly experienced physician performing the treatment, there are some possible side effects. They include:

  • Stinging or pain at the injection sites, swelling of the ankles or feet or muscle cramps. Muscle cramps almost always occur when injection takes place in the ankle area or near a muscle. These usually go away within 10 to 15 minutes after injection.
  • Red, raised areas at the site of injection. These should disappear within a day or so.
  • Brown lines or spots on the skin at the sites of treated blood vessels. Probably made up of a form of iron in the blood, these darkened areas may result when blood escapes from treated veins. In most cases, they disappear within a year, but in a small percentage of patients they may last longer.
  • Development of groups of fine red blood vessels near sites of injection of larger vessels, especially on the thighs. About a third of patients develop these; most disappear by themselves, some go away with injection or laser therapy, a few may last.
  • Small painful ulcers at treatment sites either immediately or within a few days of injection. These occur when some of the solution escapes into the surrounding skin or if an injection is into or near a small artery. The ulcer may heal slowly over 1 or 2 months. These can be successfully treated, but it is necessary to inform the physician of them immediately.
  • Bruises at the site where the needle went into the skin. These will disappear in a few weeks and are probably related to the thinness of blood vessel walls.
  • Allergic reactions to certain sclerosing solutions
  • Inflammation of treated blood vessels. This is very unusual but when it occurs it is treated with medications such as aspirin, compression, antibiotics or heat.
  • Lumps in injected vessels, particularly larger ones, may develop. This is coagulated blood but is not dangerous. The dermatologist may drain the blood out of these areas a few weeks after injection.

Will Treated Veins Recur?
Larger veins are likely to recur unless support hose are worn. Spider veins may also recur. It may seem that a previously injected vessel has recurred, when, in fact, a new spider vein has appeared in the same area.

Is a History of Blood Clots in the Lungs or Legs a Reason to Avoid Therapy?
Not necessarily, but the procedure must be done with caution to lessen the risk of blood clots.

Are There Other Treatment Methods?
New lasers may hold promise for treating blood vessels, but currently vessels in the legs do not respond uniformly to laser treatment. Surgically tying veins off (ligation) or pulling them out (striping) are other procedures for treating unwanted blood vessels. They are usually reserved for large varicose veins.

How are Spider Veins on the Face Treated?
There are several ways to treat spider veins on the face. Lasers have been used successfully, alone or in combination with electric needle therapy.

What Do I Do After Treatments?
Physicians may differ in their after treatment instructions to patients. Depending on certain factors, such as size of the blood vessels treated, patients may be instructed to put their legs up for an hour or two and then walk. Others are asked to walk immediately. All patients are instructed to walk a good deal in the days following the procedure so that blood will be pushed through other vessels. Some physicians bandage the injected areas and instruct patients to compress the treated ares by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin and reduce the development of dark spots. It may also reduce the number of treatments necessary and the possibility of recurrence. Others put tape dressings on the areas and do not use compression unless the veins are large or have other characteristics. Between treatments, many physicians recommend the use of compression or support hose. This may be particularly recommended for people who spend a lot of time on their feet.


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Palm Beach Dermatology has been serving patients in and around Palm Beach County for over twenty years, we are a full-service dermatology and dermatological surgery practice with special emphasis on the diagnosis and treatment of skin cancer. All physicians in our group are Board Certified by The American Board of Dermatology and are Fellows of the American Academy of Dermatology. We invite you to visit us at Palm Beach Dermatology to find out why you can trust our skin care team.

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