Expert Doctor

Complete Guide to Spider Veins

What are Spider Veins? 

Most people are not fans of the condition known as spider veins.  Spider veins are capillary veins that are visible through the skin and appear as tiny webs of colored lines.  Spider veins are not a condition that normally contributes to bad health.  They can cause legs to not be aesthetically appealing so many people seek to have them treated.

Various Types of Veins

To understand spider vein therapy, it’s important to know the different types of veins. There are the larger veins, which are the greater saphenous veins that run through the whole leg, and the lesser saphenous veins which run from the knee down on the posterior lateral leg.

Next are reticular veins, which are intermediate-sized veins. These are larger feeders off the main vein or into the main vein. Spider veins are small cutaneous veins less than 2mm to 3mm in width.

What Causes Varicose Veins? 

Varicose veins are often related to genetics and family history. People who have jobs where they’re standing all day and obese people can get varicose veins. Pregnancy can also cause varicose veins because there’s more pressure in the venous system because of the baby.

Backpressure can cause varicose veins.  If there is increased venous pressure then people who have clots can get them. People with jobs involving a lot of heavy lifting and high impact activities increase their blood pressure and venous backpressure. 

Spider Vein Patterns and Severity 

Spider veins come in different patterns. There is a plain pattern, an arborizing pattern, or a linear pattern that are shown on the skin.  They have different severity levels as well as different treatments.    

For really large veins, the classic treatment is stripping or removing the vein.  There is ligation where the vein is tied off, as well as endovascular ablation where a laser is put into the vein that creates energy that collapses the vein. Vascular surgeons do most treatments but the smaller veins can also be treated by a plastic surgeon.

Treatment Options

Spider veins are much smaller and may or may not occur in the presence of increased venous pressure. There are perforators that come through the fascial system.  They are a little dilated and lead to more backflow into the spider veins.

There are two main forms of treatment.  The gold standard is an injection that involves putting a very small needle into the spider vein and injecting a sclerosant solution. The most common one is hypertonic saline (a very concentrated salt solution), which works very well but comes with a burning sensation.  It’s like an acid that burns the inside of the little spider veins.  The spider vein walls will collapse and stick to each other and then close off. 

The other form is Asclera, also called alcohol foam, which is a polidocanol alcohol.  The Asclera works with the foam filling the veins and nothing can get through it.  Afterwards, the body degrades it as opposed to collapsing it.

Lasers can also be used in treatment.  The laser responds to the hemoglobin, the pigment, and the hemoglobin molecule. The laser beam interacts with the hemoglobin and the red blood cells and, in turn, creates energy.  The energy creates heat and the heat destroys it.

Important Pre-Procedure Information

One of the items to look at is the overall health and medication of the patient. Aspirin can increase the risk of bleeding in a procedure.  Birth control pills can increase the risk of clotting.

It’s important for the doctor to look at the history of the patient to determine if anything can be done preventatively or non-invasively. It is also important to see if the patient has any history of vascular or arterial disease, as well as circulation problems.

Misconceptions of Spider Veins

One of the most common misconceptions is that injection therapy or laser therapy cures spider veins.  They just treat the symptoms.

Many people don’t realize that just like the skin, there are many layers of spider veins. When one layer goes away, the next layer shows itself.  In fact, a series of treatments maybe required in order to cure the condition.

It is also possible to prevent recurrence by wearing compression stockings or elevating their legs after walking or running to take the pressure off.


Taking Arnica Montana helps reduce bleeding and bruising.  Patients can also take Bromelain to help reduce some of the bruising and improve healing after the procedure. Avoid aspirin or NSAIDS such as Motrin or Aleve. Avoid hormones that can cause additional blood clotting.  Patients shouldn’t put any lotion on the legs because it’s very slippery and hard to inject.

Spider Vein Treatment Costs

The average injection treatment takes about three injections at $100 per injection.  For laser treatment, it runs from $300-$500 per treatment.

Side Effects of Treatments

The biggest side effect is bleeding or bruising. With the saline you get pain and the feeling of discomfort. Hyperpigmentation is a possible side effect.  A small ulceration can occur as well as superficial blood clots called phlebitis. 


With a saline injection, it’s important to walk around before heading home to make sure all of the saline is circulating through the veins.

Patients shouldn’t do anything with high impact for three days and they should avoid the sun or wear sunscreen.  A patient could resume normal activities anywhere from 3 days to a week after the procedure.


Spider vein treatment should not be seen as a silver bullet procedure. There is still a chance for veins to reappear even on the treated area, so patients should expect multiple sessions to ensure that the veins aren’t resurfacing. Perhaps the best treatment for spider or varicose veins is prevention. As previously stated, wearing compression stockings and elevating your feet after high impact activities can help prevent veins from resurfacing on your skin.

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Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview by Dr. Karen Vaniver in Pasco, WA