Vein Doctors

Spider veins (telangiectases) are dilated blood vessels visible as blue or red streaks, webs, or clumps located in the skin itself. They are different than varicose veins which are bulging lumps underneath the skin.

What Do Spider Veins Look Like?

Spiders occur anywhere but are most frequent on the thigh and calf of the lower extremities. They are permanent once they appear and tend to increase in number over time, but do not grow at a predictable rate. Spider veins drain into collecting veins at the base of the skin called reticular veins which are larger and usually of a greenish or bluish tint; reticular veins may be visible or non-visible to the naked eye. Identification and treatment of the reticular veins is an important part of success in controlling spider veins.


These veins are a frequent cause of cosmetic discomfort in Hawaii where the weather is warm and the legs are exposed. They usually are not a cause of symptoms beyond the cosmetic concern but in some instances, they may cause

  • Itching
  • Burning
  • Heaviness
  • Or fatigue in the legs

Some individuals worry that spider veins are the beginning of more advanced venous disease, however, spider veins are considered a cosmetic problem and are not covered by insurance policies, including Medicare.

What Causes Spider Veins?

The exact cause of spider veins is unknown. They are so common that nearly everyone knows someone in the family who has them. They are more prevalent in women but happen in men as well. They can appear locally after trauma or after superficial surgery, even after vein surgery.

We do not know how to prevent them from forming. The advice to avoid crossing the legs or wearing constricting clothing or garters to prevent them has no established basis. The hope that support stockings and dietary supplements are of help is unsubstantiated. Spider veins may be associated with larger diseased veins underneath. This possibility warrants the use of ultrasound to check for the underlying venous disease because treatment should be directed first at the deeper veins.

Treatment Of Spider Veins

It is very important that the person who decides to have spider veins treated understands the benefits and the limitations of the treatment. This is to

prevent disappointment when the healing process seems prolonged or the results are less than ideal. The basic understanding, we suggest that the two-stage treatment will clear about 2/3 of the visible veins in the average case. This means that half will be better than this, and half will not be that good. Recurrent treatments often are safe and are effective in clearing up residual veins. There are some individuals who continue to form veins and need to have interval treatments to maintain a satisfactory appearance in their legs.

The injections should not be expected to achieve immediate disappearance of the spiders on the day of treatment. This is because the method is based upon a controlled injury to the vein wall that causes the inner lining of the vein to dissolve. This is followed by an automatic healing process that causes the vein to ‘dry’ up, and time is required for healing to occur. The vein ultimately becomes scar tissue and is an invisible part of the normal tissue under the skin. In some cases, this happens within a few weeks; in others, 3-18 months may be required before the result is achieved. Unfortunately, it is not possible to predict which persons will get an immediate or a delayed response.

What To Expect After Treatment?

After treatment, bluish bruising of the tissue occurs and requires 2-3 weeks to clear up. In the process of healing the blood cells in the tissue can leave traces of a brownish iron pigment called hemosiderin in the skin. This appears as a brownish streak that is usually more acceptable than the bluish vein color but is not the desired cosmetic result. This brownish staining automatically clears over a variable period but it can take months to do so, and in occasional instances requires a year or two. It is very unusual for these spots to persist permanently, but it is possible.

Spider veins resemble cavities in the teeth because they tend to recur after intervals of time. It is important for those who decide to treat their spider veins to realize the chronic recurrent nature of this problem to avoid excessive disappointment if it happens to them. For these people there can be reassurance in the knowledge that recurrent treatments have been found to give good long-term control of the cosmetic problem in many instances.

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