David T Jacobs

My preferred method to treat spider veins is injection sclerotherapy. Using a very tiny needle, the veins are injected under magnification. The injected medication irritates the inside of the vein wall and compression is applied. This causes the vein to seal up permanently. It is preferred to use a special light to help visualize the feeding veins underneath the skin surface which cannot be seen with the naked eye. Injecting those veins will result in a more durable treatment.

Other options, such as surface laser, do not address the feeding veins and therefore have a tendency to allow the spider veins to reappear within a relatively short period of time.

Varicose veins will often go away away by themselves after pregnancy (which causes an increase in blood volume and relaxation of the vein walls). I advise pregnant patients to wait until at least 3 months after delivery to make a decision to treat. During pregnancy I advise compression stockings, thigh-high, 20-30 or 30-40 mmHg compressive strength.

Varicose veins may stay the same or enlarge. If they are asymptomatic, that's a good sign. It means it's unlikely that there is significant venous disease which is leading to the visible varicose veins. Without underlying disease, these veins will often be a cosmetic nuisance, and rarely a health issue. Still, it's good to get evaluated by a vein specialist to know if there's a problem with the underlying veins that is contributing to the varicosities you see.

Spider veins are tiny veins that appear just below the skin surface, usually in a fan-like pattern. They develop from increased pressure in the small capillaries that bring oxygen and nutrients to the skin. They can come about due to a problem with the underlying veins that transmits pressure into these surface veins, or from a weakness in the vein wall which causes them to stretch.

The best way to treat these veins (assuming underlying vein issues have been taken care of) is by injection sclerotherapy. This is where a tiny needle is used to inject a medication which irritates the inside of the vein and causes it to close up. This should only be done by a vein specialist, as there are a wide variety of sclerosants that can be used, and picking the right one is important for the best results.

The best way to treat these veins (assuming any underlying vein issues have been taken care of) is by injection sclerotherapy. This is where a tiny needle is used to inject a medication which irritates the inside of the vein and causes it to close up. This should only be done by a vein specialist, as there are a wide variety of sclerosants that can be used, and picking the right one is important for the best results.

Spider veins may sometimes decrease in size (especially in the first few months after pregnancy), but they usually need treatment to go away completely.

Spider veins in of themselves are not dangerous. In rare instances they can slightly protrude above the skin surface and bleed when nicked, such as when shaving. The amount of bleeding however, is small, and inconsequential. But, the presence of widespread spider veins could indicate that there is an issue with pressure in the larger, deeper veins in the legs. If there is increased pressure in those veins, it can be transmitted to the very fine veins on the skin surface and appear as spider veins. It is worthwhile to have these deeper veins examined under ultrasound to be sure that there is no deeper issue before treating the superficial cosmetic spider veins.

Bulging veins on the back of the hands is a common issue. This frequently occurs in the normal course of aging, where the skin loses elasticity and fat below the skin, making the normal veins more visible. Two options for treatment are fillers and sclerotherapy. Fillers are usually performed by a plastic surgeon, who will inject a substance underneath the skin to hide the veins (and other nearby structures such as tendons). Usually this needs to be repeated every few months. Sclerotherapy is performed by vein doctors and involves the injection of a substance into the vein to cause it to collapse. This does not hide the appearance of tendons, but makes the veins much less prominent.

Nasal spider veins can be treated by sclerotherapy or ohmic thermolysis (also known as VeinGogh). Sclerotherapy is the injection of a medication into the vein to cause it to get irritated and close up. Care must be taken when performing sclerotherapy on the face, as many facial veins drain into structures around the brain, and a clot there could be very dangerous. Ohmic Thermolysis (AKA VeinGogh) involves a tiny jolt of energy delivered with a miniscule needle into the vein and surrounding skin. This causes the vein to close. Evaluation by a vein specialist will determine the best course of action for your nasal spider veins.

It's not recommended to take a hot bath or shower after vein treatment, as heat causes veins to dilate, and that may undo the procedure and cause the veins to reopen. Talk to your doctor about their recommendation for when you can resume hot baths. I recommend that my patients shower with lukewarm water for the first several days after vein procedures.

It depends what kind of procedure you had done. Thermal ablation (RF or EVLT) will usually feel sore for several days after the procedure and it can take weeks for the associated bulging veins to shrink down. Microphlebectomy results in bruising but fast decreased bulging as the veins are removed. Sclerotherapy can take several weeks for the clot within the veins to resorb and flatten out the bulging vein. In all cases good compression will help to ensure a nice cosmetic result. Talk to the doctor who performed your procedure to give you guidance on what to expect in your particular case.

Spider veins come about due to stretching of tiny veins that are normally invisible. This can be due to an inherent weakness in the vein wall (usually inherited), or due to pressure from incompetent deeper veins. An ultrasound can rule out the latter.