Vein Treatments

Spider and varicose veins are nothing more than enlarged veins, but the reason so many women dislike them, even though they don’t pose any threat to your health, is because they are unsightly.

Spider veins, which are smaller, crop up as flat, red or purple veins, where as the larger varicose veins tend to bulge more—in some patients, they can even take on the appearance of a twisted cord inside the leg that shows through the skin. “In some cases, varicose veins may need to be treated medically because they can cause swelling and pain, a sign that the valves are not allowing blood to flow properly,” says Hunt Valley, MD, dermatologist Karen Beasley, MD.

Both spider and varicose veins are the result of genetics, pregnancy and/or hormonal changes. “Spider veins can be found anywhere on the legs and are typically grouped around the inner and outer thighs, knees and ankles. Varicose veins commonly arise from the great saphenous vein, which runs along the inside portion of the leg and/or from the short sapherious vein, which runs down the back of the calves,” says Dr. Karen Beasley. The veins in the legs have one-way valves, and any extra pressure can prevent blood from flowing properly. While there are no proven ways of preventing spider and varicose veins, wearing compression garments (especially during pregnancy and if you stand on your feet all day) can help assist blood flow and reduce pressure and swelling.

Varicose and spider veins can cause your legs to look older than they really are—even if your legs are toned. In most cases, varicose and spider veins don’t cause any pain; but the look of them alone can be reason enough to do something about them.

“The easiest way to get rid of them is with sclerotherapy, which usually requires two to three sessions before the veins are no longer visible,” says Smithtown, NY, dermatologist Marina Peredo, MD.

During the 30-minute procedure, your doctor will inject the veins with a solution that irritates the lining of the veins, forcing them to collapse. If your vein is smaller than the needle, a laser may be the best option. “When I need to use a laser, which requires a series of treatments, I use a pulsed dye one,” Dr. Marina Peredo says. “The laser breaks down the color in the vein and coagulates the blood vessel.”

Even though sclerotherapy has been used for a number of years, it is the most effective and reliable procedure for diminishing or eliminating spider veins and small varicose veins,” says Hunt Valley, MD, dermatologist Karen Beasley, MD.

Modern medicine utilizes smaller needles during sclerotherapy, so the treatment is less painful than in years past. “Some patients express concern as to whether or not sclerotherapy will affect how their veins and body function, and it won’t,” says New York dermatologist Doris Day, MD. “The veins that are treated are extra veins on the surface with no real purpose,” she adds. It’s the deeper veins with faulty valves that can cause new superficial vessels to appear that need to be examined more closely.

Sclerotherapy can also address prominent veins on the hands. “A decrease in circulation can aggravate the blood vessels, causing them to become more visible as fat is lost with age,” says Nanuet, NY, dermatologist Heidi Waldorf, MD.

The procedure is performed the same as it is for the legs—numbing cream is applied before a solution is injected into the veins  to irritate the walls (you may experience brief, mild stinging) and permanently collapse them. Your hands may be bruised and swollen post-treatment but, after three sessions, will be free of thick veins.

FDA-approved Asclera is a vein-collapsing agent that was originally intended to serve as an anesthetic. “The main advantage of it over traditional sclerosants is that it causes less pain during injection because it was originally created as a local anesthetic,” says Hunt Valley, MD, dermatologist Karen Beasley, MD, adding that it may also cause less hyperpigmentation and necrosis in the skin. 

Asclera is ideal for treating superficial varicose and spider veins. Even patients who have deep veins that need to be treated surgically could possibly benefit from Asclera as an adjunct procedure.

Taking place over several weeks, the reaction caused by Asclera works over time. Basically, the injection causes the vein to gradually collapse. Once this happens, and the vein no longer transports blood, the body naturally dissolves it.

Some varicose veins need to be eradicated with laser, radiofrequency or surgery, especially if they are too large to be treated via injection. “Inserting a laser directly into the varicose vein heats it from the inside out, shutting it down,” Dr. Karen Beasley says.

Vascular lasers send strong bursts of light into the vein, causing it to fade slowly before it eventually disappears after about two sessions (those with darker skin may need more than two sessions).

Intense Pulsed Light (IPL) or Vbeam lasers are favored since they work well at reducing redness and enlarged veins. The laser’s heat seeks out the inflamed blood vessels and destroys them without damaging the skin. In return, the skin is less flush, and texture will be improved, too.

Treatment generally takes about 15 to 20 minutes, during which you’ll likely feel heat or snapping from the laser. Depending on the severity, two to five sessions are usually necessary, and temporary side effects include redness, bruising and discoloration around the treatment site.

As with all laser treatments, those with darker skin may be more prone to pigment changes, so be sure your dermatologist or plastic surgeon has experience treating patients with skin color similar to yours.

Anyone who has spider or varicose veins.

Anyone not suffering from unsightly varicose or spider veins.

Although most patients see a 50 to 90 percent improvement in appearance, stubborn veins may require additional treatments. Expect to feel stinging with the injections, and you may experience temporary redness and bruising at the injection site. Sclerotherapy is downtime-free, but you may be asked to limit your activity after treatment and to wear compression stockings for at least 72 hours afterward to promote blood flow.

You may be red, and some patients may experience a bruised appearance in the treated area for seven to 14 days. After bruising subsides, the veins and blood vessels are less visible, though it may take more than one treatment to see complete clearing.

There’s no downtime associated with sclerotherapy, but multiple treatments are necessary and you may need to wear support hose or a compression wrap for a period of two days to two weeks. Expect to be swollen and sore after treatment, and you may be asked to apply cool compresses.

• The weight gain, hormone fluctuations and poor circulation experienced during pregnancy can lead to varicose veins.
• Visible veins occur with pregnancy because blood volume increases and baby presses on the veins that return blood to the heart, causing veins to stretch and become more visible.