How to Get Rid of a Lot of Little Spider Veins?

Question

How about if I have A LOT OF LITTLE spider veins all over leg / thigh? I mean a LOT. If I go with sclerotherapy, does it mean that each and every little vein would have to be injected? I assume that would be quite painful?

Monika Kiripolsky, MD · Answer

Hi Ally,

	  Getting rid of spider veins (even when you have LOTS of them) is a lot easier than you think. That said, I'd choose a physician who has specific experience/training in sclerotherapy (treatment of leg veins through injections) and who can also evaluate you for deeper (perforator or greater saphenous) vein incompetence.

	  Think of your leg veins as being similar to trees. The spider veins are the leaves of the tree and the underlying  blue network of less prominant - though still subtly visible - veins (reticular veins) are the tree branches. If you simply treat the spider veins (leaves), you are not addressing the root of the problem (the tree branches/reticular veins that are supplying the spider veins). Thus, laser or injection treatment only to the spider veins can result in a temporary improvement in appearance, but, chances are the spider veins will subsequently recur. This is because the blue network of veins supplying the spider veins were not treated.

	  All of this can be done easily in clinic with minimal discomfort and no downtime.

Jason Emer, MD · Answer

For varicose veins, we typically recommend a safe, minimally invasive procedure called Sclerotherapy. A salt solution is injected directly into each vein, causing them to collapse and ultimately disappear. For long-term improvement, we often complement Sclerotherapy with IPL (Intense Pulsed Light) photofacial and the Excel V laser, which treats both superficial and deep vascular conditions on all skin types. I suggest seeing an expert for a formal evaluation to determine if this is the best solution for you. Best, Dr. Emer

Sanusi Umar, MD · Answer

For smaller spider veins less than 3mm,my office at the Dr.U Clinic in Los Angeles recommends using laser. This works by applying a specific energy wavelength (e.g. 1064nm of the Nd:YAG laser) which is absorbed into the tiny blood vessels by hemoglobin. The walls of the veins are then destroyed and carried away by your immune system. The risk with injecting tiny blood vessels is that there is a bigger chance of inaccurate injections where the drug fluid can then damage the surrounding tissue. You may learn more about spider vein removal in the article written by my clinic below.

Harold J. Kaplan, MD · Answer

When we see patients with lots of spider veins in the legs, it's often part of a bigger circulatory problem. When these small veins are very numerous and very close together it can indicate that the main vein structure is not working as well as it should be. Before performing laser treatments in this situation (we treat only spider veins using only lasers at our facility) we recommend visiting a vascular surgeon for an ultrasound to determine how the main vein structure looks. We suggest you do the same.

John Landi, MD · Answer

If you have a lot of spider veins you may have an underlying reason for this. One of the most common causes of both spider veins and varicose veins is malfunctioning of the valves in the saphenous vein system which is essentially the trunk feeding the superficial leg veins. If the valves don't close properly(reflux), then this can lead to back up of blood into the skin to cause both spider and varicose veins. A large number of spider veins would suggest valvular reflux. You should have a venous reflux ultrasound to evaluate the valves which will then help to determine treatment such as sclerotherapy alone or in combination with closure of the leaking valves. Often times many of the spider veins interconnect and, therefore, you may not need as many injections as you may think. Also we now have better sclerotherapy solutions and small needles which make the treatment much more tolerable.

Hratch Karamanoukian, MD, FACS · Answer

Covering spider veins with a cosmetic only covers a problem that is in need of treatment. These telangiectasias, aka spider veins have feeder veins that need to be injected in interupted surgically - in addition to sclerotherapy or laser therapy of the spider veins. Otherwise, over time you will get more spider veins and some will break down, extravasate blood, deposit hemosiderin in your skin and cause permanent bronzing of the skin. It will look bronze brown in color and may never go away. So, get them evaluated and treated early and do not mask them with expensive cosmetics that don't solve the problem.

How to Get Rid of a Lot of Little Spider Veins?

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