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. The doctor will do an examination of your legs and may perform an ultra sound if indicated.

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.

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


This technique involves injecting a problem vein with a chemical solution (sclerosant). This is simple to do, performed in a short office visit with minimal discomfort. 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 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.

Complications and Risks of Sclerotherapy
  • Staining
  • Incomplete closure of the vein
  • Allergic reaction
  • Blood clot
  • Scabbing or scarring
  • Small skin ulcers
  • Formation of new blood vessels around treated area (Angiogenesis)

Lasers for Spider Veins

There are different types of lasers available for spider vein treatment. A laser is identified by its wavelength. Some wavelengths target the red pigment in blood and some target water in the blood. Lasers by themselves can be used small veins and in larger veins they are used in conjunction with slcerotherapy. Combining a laser with sclerotherapy helps to speed the resolution in the treated vein.

Ohmic Thermolysis

This device closes off small veins by heat. A small needle is inserted into the vein and the heat from the needle causes damage to the vein wall. Over time the vein will gradually be reabsorbed. This treatment is very effective for small red veins less than 0.3 millimeters in size.

Microsurgical techniques

Many times, very small incisions made under magnification will be used to either divide the spider vein or remove its source. These small micro surgcial techniques are performed with tumescent anesthesia (local) and leave no scars.

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.


All spider veins are a result of increased venous pressure to the veins in the skin. Many different treatments exist for spider veins. However, the most common treatment method is sclerotherapy. It is important that your doctor finds the source of the spider veins and treat this in addition to the visible spider veins.

Spider Veins

This is what a spider vein looks on a histology slide of the skin

Post Treatment Care
  • Resume normal activites as soon as you can
  • Wear dressings or compression stockings as directed
  • Elevate your legs as directed
  • 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