Spider Vein Treatment

Spider Veins - What Are They?

Spider veins, also known, as telangiectasias are small, dilated blood vessels that appear near the surface of the skin. Spider veins tend to be red or blue in color, and can be painful, itchy, and potentially bleed.

Spider veins are generally caused by an increase in pressure in veins close to the skin from increased pressure in the deeper veins. The deeper veins may include veins in the reticular dermis (reticular) or underlying pathology in the superficial or deep system. In some cases an ultrasound (US) needs to be done to determine if there is an origin.

Spider Vein Treatment with Sclerotherapy
This is what a spider vein looks like under the microscope.

Spider Vein Treatment Options

The treatment of spider veins has greatly improved in the last ten years. Several different treatment types are used to treat spider veins: sclerotherapy, laser, ohmic thermolysis, surgical techniques, and intense pulsed light (IPL). Most patients require a combination of treatments for the best result. Many times your doctor will perform an ultrasound to rule out underlying causes of spider veins.

Your First Appointment: Examination and Ultra sound?
Typically, your first appointment is a consult and it is important not to wear creams or lotions on your legs. At this appointment, you will fill out the required paperwork. The doctor will do an examination of your legs and perform an ultra sound.

An ultra sound (US) is a noninvasive test that uses sound waves to create images. The US provides the doctor with detailed information about your venous system. The US will show blood flow, which will demonstrate where the reflux is occurring. Your doctor can easily determine where your veins are leaking and other serious vein conditions can be ruled out.

At your initial visit, the doctor may perform a few injections to test your response to the chemical solution used. Based on your response, the amount or type of chemical solution may be adjusted. Often times it takes multiple sessions for each leg. Pain is minimal or you may not have any pain during your treatment. Patients often report a slight burning or stinging sensation. The doctor may also test the laser or ohmic thermolysis on a spider vein to see how you react to these devices.

Light Sources
Your doctor may use a vein light of some type that tran-illuminates the skin making the identification of reticular veins easier.

Using Accuvein to treat reticular/spider vein complexes

Vein Specialists may use light sources to:

  • Show veins to patients
  • Locate feeder veins
  • Show foam sclerosant in real time
  • Highlight veins during transdermal laser therapy
  • Map veins for phlebectomy

Sclerotherapy - Most Times Used for Spider Vein Treatment
This technique involves injecting a problem vein with a chemical solution (sclerosant). This is simple to do, performed in a short office visit, painless and requires no anesthetic. The chemical solution causes the blood vessel to close and it will eventually disappear. Sclerotherapy is the gold standard for treating spider veins and is also used to treat certain varicose veins.

How Does Sclerotherapy Work?
A chemical solution is injected, using a needle, into a dilated blood vessel. The chemical solution causes inflammation, which makes the walls of the vein stick together. Because of this, the treated vessel can no longer hold blood and it scars up and is eventually reabsorbed by the body.

There are two types of sclerotherapy used, liquid and foamed. Foam is made by mixing the sclerotherapy solution with air or C02. The type used depends on the size or the vein or your presenting problems. For more information visit our blog.

Using sclerotherapy to treat spider veins

Complications and Risks of Sclerotherapy
Complications and risks of sclerotherapy are rare but may include the following:
• Staining
• Incomplete closure of the vein
• Allergic reaction
• Blood clot
• Scabbing or scarring
• Small skin ulcers
• Formation of new blood vessels
   around treated area

What Can I Expect After My Treatment?
You can return to your normal activities right after your treatment.

Some patients go back to work after being treated. Patients are told that they will look worse before they look better.

With sclerotherapy, there is always bruising and clotting of treated veins.

Some people clear up in 1- 2 treatments and some people require 5-6 treatments.

Post Sclerotherapy Care
• Resume normal activites as soon as you can
• Wear dressings or compression stockings as directed
• Elevate your legs as directed
• Walk every day
• Avoid strenuous activities as advised by your doctor
• Avoid hot tubs and whirlpools as advised by your doctor
• Protect the treated areas from sun exposure by using sun block
• Follow all instructions from your doctor

In our clinic, we use dermaka® which is a cream designed to minimize bruising and inflammation.

Many lasers are used in the treatment of spider veins. Lasers vary in wavelength and ability to effect damage. The most often used wavelengths are the 940 nm and the 1064 nm. Lasers speed up the treatment of spider veins by causing heat damage to the veins. The heat damages the vessel lining causing the veins to become smaller. In most cases, sclerotherapy is also used. The combination of heat and sclerotherapy gives a quicker resolution for a superior cosmetic result.

Laser Treatment for Spider Veins
Laser Treatment for Spider Veins

Treating spider veins with laser

Complications of laser therapy are mostly related to skin damage but if done properly, this is rare. Patients with darker skin types cannot have laser treatment for veins.

Ohmic Thermolysis
Spider Vein Treatment Options
This relatively new treatment is done by directly placing a small needle in the spider vein and focusing heat energy (radio frequency). This device is safe for all skin types. It works better than all other methods of treatment for small reddish veins that are difficult to inject.
Ohmic Thermolysis
Complications are almost non-existent, but visible tracts may be present as the vein undergoes resolution and this is temporary. This resolves in 2-6 weeks for most patients.

Treating spider veins using ohmic thermolysis

Dr. Mark Schwartz shares before & after photos of red veins on the nose after using VeinGogh. Two treatments were used spaced 4 weeks apart using ice packs prior to application of VeinGogh.

Other modalities that can be used include Dornier 940 laser, which we use on larger blue veins on the nose, and intense pulsed light, which can be used for small red veins.

The disadvantage of IPL and laser is the need to avoid sun exposure.

With the multiple modalities that are available, it is still surprising that some practitioners use hypertonic saline or other sclerotherapy solutions.

Heat based modalities give you a much safer and quicker resolution of this problem.

Ohmic Thermolysis - before and after

Red Veins on Nose Copyright © 2013 Courtesy - The North Shore Vein Center

Spider Veins - Ohmic Thermolysis Treatment


While sclerotherapy is still considered the “gold-standard” for treating spider veins, it may not be right for all patients. New advances in technology allow for alternative methods of treatment to be available to physicians. Ohmic Thermolysis is a minimally invasive treatment for spider veins that uses heat to collapse the vessel wall while leaving the outer layers unaffected. The VeinGogh Ohmic Thermolysis System combined with Bristle technology represent an optimal alternative method for the treatment of spider veins, increasing comfort for patients, and greater control for physicians.

Spider Veins - What Are They?

Spider veins, also known, as telangiectasias are small, dilated blood vessels that appear near the surface of the skin. Spider veins tend to be red or blue in color, and can be painful, itchy, and potentially bleed.

Spider veins are generally caused by an increase in pressure in veins close to the skin from increased pressure in the deeper veins. (other causes include hormone changes, overexposure to sun, and other injuries). Their presence may suggest a greater venous insufficiency as the underlying cause. This insufficiency will need to be addressed by a physician prior to treatment of the spider veins and you may need an ultrasound.

Traditional Treatment - Sclerotherapy

Treatment of spider veins traditionally involves the use of sclerotherapy. Sclerotherapy involves the injection of a liquid or foam solution into the spider vein, causing the targeted vein to clot, scar, and eventually shrink away. Multiple treatments can be necessary, and patients should expect bruising, discoloration, and clotting in the treated veins.
Sclerotherapy may have complications, although they are minimal. You need to discuss this treatment with your doctor. Other techniques have been developed that can be used alone or in combination with sclerotherapy. One of the other treatments that can be used is called ohmic thermolysis.

Ohmic Thermolysis

Ohmic thermolysis is a relatively new treatment for spider veins. In this treatment, a small needle is inserted into the vein. The heat that is produced causes the vessel to fuse together without damaging the surrounding skin. Relatively few complications exist with this procedure, and while tracts may be visible initially, they typically disappear within 2-6 weeks. Ohmic thermolysis is especially useful for spider veins that are difficult for sclerotherapy.
Vein Experts and Bush Venous Lectures are proud to be partnered with VeinGogh to support the use of the VeinGogh ohmic thermolysis system. With the new Bristle technology developed by Dr. Ronald Bush, and available exclusively through VeinGogh, physicians will be able to clear vessels greater and cause less trauma to surrounding tissue. This results in greater comfort and safety for the patient, while allowing the physician greater control of the procedure.

On May 11, 2012, Refine USA received clearance for its VeinGogh medical device for lower limb spider veins and telangiectasia from the FDA. Ohmic Thermolysis is not laser or light-based, it is the process of using electrical resistivity to deliver a micro-burst of high frequency energy into the vessel via the new patent pending BristleTM attachment. The energy is instantly converted to heat which coagulates the blood and collapses the vessel wall, resulting in a very minimal effect on the outer layers of the skin. The device was already listed for epilation in 2009 but has gained an additional intended use upon its 510(k) clearance last week.

VeinGogh- 'Bristle' Needle – 5/19/12

• Hypo- or hyper-pigmentation
• Slight bleeding
• Burns/blistering
• Pain
• Scarring

Intense Pulsed Light (IPL)
This method of treatment is used for smaller veins in fair skin types. Effective for some patients, the technique requires experience by the provider and there is more discomfort than other treatments. IPL in the treatment of spider veins has been replaced in most part by newer technologies.

Combination Therapy
Often times it is necessary to treat spider veins with different modalities.

Combination Therapy

Surgical Chemical Ablative Technique (SCAT)

This technique is especially useful for larger spider veins. Approximately 5-10 minutes after sclerotherapy is done the area under the treated veins is numbed with a dilute concentration of xylocaine. The veins are divided at regular intervals using a micro-puncture technique. This technique allows for rapid resolution of spider varicosities with minimal staining.

Ron Bush, MD, FACS
Peggy Bush, APN, CNS, MSN