Best Treatment for Threadlike Spider Veins?

I'm thinking of having my spider veins treated, but am unsure of the best procedure. I don't have any varicose veins, just small threadlike spider veins. Most are red, but some are purple or even bluish- but still very thin. I have heard that sclerotherapy is the gold standard, and that a combo treatment is ideal, but obviously more costly. I'd like to look good for summer, but still plan to have more kids, and thus will probably get more spider veins anyway. Would laser work for the short-term, or is it a waste of money without doing the sclerotherapy first?

Doctor Answers (6)

Sclerotherapy IS STILL the GOLD standard for leg spider veins

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I have been performing sclerotherapy for 20 years and it is still considered the gold standard my those of us who frequently treat them. We have vascular lasers and IPL devices and none can come close to the results of good, old-fashioned sclerotherapy. Emphasis is on GOOD. Technique is all important and you must go to someone very experienced with an eye for detail and patience!


Laguna Niguel Dermatologic Surgeon
5.0 out of 5 stars 163 reviews

Dynamic Foam Sclerotherapy for spider veins

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Not all sclerotherapy treatments are alike in terms of risks and benefits.  I advise patients to go to a surgeon who is board certified in phlebology (vein surgery).  They have a physician locator.  My preference for spider and reticular veins is a treatment known as Dynamic Foam Sclerotherapy.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 46 reviews

Spider veins treatments

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For larger spider veins, sclerotherapy is still the best option.  For smaller spider veins, laser can be effective. Often times the combination of the two procedures is best for patients.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 14 reviews

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Vein treatments

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The spider veins are considered to be cosmetic by patients, but not to phlebologists like myself (i.e. vein specialists). If your goal is temporary relief, then by no means, waste your money without getting a comprehensive evaluation to determine why you have these.

If you had significant leg swelling during your pregnancies, then you may have venous reflux disease causing these spider veins. If you get treated for the spider veins without having the reflus disease treated, then they are more likely to recur.

The old dogma was to wait until your last pregnancy and get it treated after you had your last baby. Now, research suggests that it is best to get the reflux disease treated even if you are still planning on getting pregnant.

In any case, if you have venous reflux disease, you can have an office based procedure such as VNUS CLosure or EVLT (laser version of VNUS Closure) and THEN get treated for the spider veins using sclerotherapy and/or skin laser therapy.

Hratch Karamanoukian, MD, FACS
Buffalo General Surgeon
4.5 out of 5 stars 5 reviews

Vein treatment

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To determine which treatment would be best for you, you really would need to be evaluated in person. While it is true that sclerotherapy is the gold standard for leg/spider veins, laser treatment still can be very effective. The effectiveness of sclerotherapy is also dependent on the skill and experience of the injector. Furthermore, if your spider veins are extremely small, they may not be very amenable to injection in which case you would be better off getting laser treatments.

Hope that helps.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.