Spider veins or telangiectasia are small to very small veins which are visible on the surface of the skin. Sometimes they can cause discomfort. They are quite common and are not generally harmful, but when they are extensive they can be a source of concern for patients because of their bothersome appearance which can draw other people's attention to them.
There is almost universal agreement amongst experts in this field that Microsclerotherapy is the "Gold standard" in the treatment of telangiectasia or spider veins. Vascular or surface lasers have a very limited role in the treatment of spider veins.
There are four different types of Telangiectasia.
Spider veins arise due to reverse pressure from larger veins downstream called reticular veins which lie slightly deeper under the surface of the skin. Reticular veins tend to have a blue/greenish appearance. They are also called "feeder veins" as they tend to feed into the spider veins. Successful treatment of spider veins most often depends on effective occlusion of these reticular veins with sclerotherapy. Poor results and complications such as matting are usually the result of a failure in identifying and treating the relevant reticular vein network which can often be hidden beneath the skin and not immediately obvious. Their depth, their diameter and their underlying course is highly variable which explains why surface lasers have a limited ability to adequately treat spider veins. Meticulous microsclerotherapy is the most effective method of treatment for moderate to severe telangiectasia and perhaps 3 to 4 sessions of treatment over a few months may be necessary in severe cases.
Spider veins are not infrequently (~25%) associated with underlying problems in the invisible veins deeper under the skin. So this is why at The Leg Vein Doctor we always perform a duplex ultrasound scan on your legs to properly image these veins and check their flow direction with Doppler. Failure to detect underlying incompetence of superficial veins or saphenous veins leads to much greater complication rates in the treatment of surface veins and most trained sclerotherapists will not proceed with surface vein treatment until underlying venous incompetence has been completely treated.
Surface lasers do have a role in the treatment of Benign Essential Telangiectasia which is a relatively uncommon condition and difficult to treat. Microsclerotherapy is not recommended for this condition and we refer patients on for vascular laser or Intense Pulse Light therapy to other specialists who have expertise in these treatments.