What type of spider vein treatment do I need? (Photos)

I started out with a few spider veins, but now I'm noticing even more and what looks like the development of varicose veins. One area of my leg aches off and on. I had that area injected about 4 years ago but it didn't work. What can I do? By the way, I am a teacher, so I'm on my feet most of the day.

Doctor Answers 9

Hidef sclerotherapy for veins in the legs

I would suggest Hidef sclerotherapy to address the smaller veins and the root larger veins. The combination can be performed with laser to reduce smaller veins. 


Dr. Karamanoukian

Los Angeles

Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Sclerotherapy May Be The Answer

Sclerotherapy would be a good option to remove the surface spider veins. It sounds like you may want to have a venous ultrasound done, as you may have deeper vein problems. Treating the cause of the spider veins will help to prevent more from forming.

Eric Seiger, DO
Fenton Dermatologist
5.0 out of 5 stars 26 reviews

Spider Vein Treatment

Based on your photos, sclerotherapy would be a good start.  However, the fact that you have aching and had a prior treatment that did not work suggests you may have bigger issues under the surface.  

I recommend finding an experienced vein surgeon and getting a duplex ultrasound study of the veins.  If you have larger veins not working properly, these can create pressure causing the pain as well as more spider veins to form.

Best luck to you,

Dr. Powell

Scott Powell, MD
Denton General Surgeon

Treatment for leg veins

Based on your picture and the symptoms you are having as well as the fact that you are developing varicose veins, I suggest you have a venous ultrasound of your legs.  I would not be surprised if you have saphenous vein reflux disease which is contributing to the surface veins and symptoms.  You may require an endovenous ablation of a refluxing saphenous vein before sclerotherapy to treat the underlying disease as well as the cosmetic aspects.  Sclerotherapy does not work well if there are large feeder veins underneath that are not addressed first.

Lisa Perez, MD
Atlanta Physician
5.0 out of 5 stars 2 reviews

Spider vein treatment.

The posted pictures look like mostly spider veins with some small areas of matting. If the veins are worsening then a venous ultrasound may be indicated. I would recommend sclerotherapy as the initial procedure. Spider vein formation is a forever problem and you will require periodic treatment of these veins.  Wearing knee length support hose will also help.

John Landi, MD
Naples General Surgeon
5.0 out of 5 stars 5 reviews

Spider Veins that seem prominent

These appear to be larger spider veins that may indicate an underlying venous problem called venous insufficiency. With what your legs look like right now (with minimal spider veins), an ultrasound mapping of your veins in the legs would be a start. A screening, if you will. If a vein is found to be refluxing (not working properly), a trial of compression stockings would be the first step. You may find that wearing compression stockings will help with your symptoms. Spider vein treatments may not have worked 4 years ago because an underlying cause was not properly diagnosed. Otherwise, spider vein treatment includes sclerotherapy, or surface laser with 532nm (KTP) or 1064nm (Nd:Yag) lasers.

Manu B. Aggarwal, MD
Lima Phlebologist

Do I Have Cosmetic or Medical Vein Disease or Both?!

Most people have both medical and cosmetic vein disease.

Your symptoms, pictures and occupation all point toward medical vein disease.

Top 3 causes of vein disease:



Occupations (ex. teachers, nurses, servers, hair dressers)

The reason many people say their spider veins never went away or came back is because many practitioners treat only visible, surface veins. You MUST deal with underlying, often hidden, medical vein disease before you have any chance of getting a great cosmetic result with spider vein treatment.

Spider veins are like "weeds", they have "roots". If you don't treat the roots, the weeds always grow back. Same with spider vein treatment. Find an experienced vein care physician who treats BOTH medical and cosmetic vein problems.

Warning: many vein care physicians only treat medical vein disease. Relatively few treat both medical and cosmetic vein disease. Do your homework online, search reviews, call the office and ask.

Christopher Pittman, MD
Tampa Phlebologist

Worsening veins , treatable

I would definitely recommend an ultrasound to determine reflux or reversal of flow pattern . This can be done by a vein specialist. The treatment options will improve and stop the progression of your spider / varicose veins. 

Ivan Brooks, MD
Beverly Hills Physician
5.0 out of 5 stars 10 reviews

One step before treatment

now that you have had a recurrence.  And it looks like there are more than just spider veins.  I think you would be best served by visiting a vein speciality and getting a venous reflux ultrasound to look for an underlying cause and look for better options for a long term solution.  

Jordan Knepper, MD
Ann Arbor Vascular Surgeon

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.