Visible Leg Veins: Beyond Vanity

‘Tis the season to take care of those pesky leg veins. If you’re like me, you may opt to improve the appearance of leg veins in the colder months to prepare for summer.


Veins may be classified according to their size and appearance.

Telangiectasias–spider veins–a mild variation of varicose veins, are tiny, thin veins visible just under the surface of the skin. They vary in color from green-blue to purple.

Varicose veins are twisting, enlarged veins. Any superficial vein may varicose, but they’re most common in the legs due to increased pressure in the veins of your lower body upon standing and walking.

Reticular veins are smaller than varicose veins and larger than spider veins at approximately 2mm in diameter. They are also blue or violet but do not protrude above the skin like varicosities. They’re referred to as feeder veins because they sometimes will feed into spider veins.

Primary Risk Factors

  • Age–Increasing wear and tear on the valves in your veins can result in reflux, by which some blood headed toward the heart backflows into your veins, where it pools.
  • Sex–Incidence greater in women than men due to hormonal changes (puberty, pregnancy, postpartum, menopause) and hormonal treatments (birth control pills, replacement therapy).
  • Pregnancy–secondary to increased blood volume and hormonal changes
  • Family history
  • Obesity
  • Standing or sitting for long periods of time
  • Sedentary lifestyle

Treatment: sclerotherapy

While myriad treatments exist on the cosmetic market, studies show sclerotherapy is the most versatile and effective treatment for spider and reticular veins. Larger varicose veins typically require more advanced techniques (see table above).

Sclerotherapy involves a series of microinjections of a saline solution with a very small needle directly into varicose or spider veins. The saline irritates the lining of these veins, causing them to close. The body naturally resorbs the collapsed veins and redirects blood to healthier vasculature, thus improving circulation.

Here I am performing sclerotherapy

The Need-to-Know:

  • Are there side effects? Side effects of sclerotherapy are usually minor and may include bruising, swelling, mild stinging during injection, and redness at injection sites.
  • Are the results permanent? The treated veins do permanently resolve, but new veins may form.
  • Does sclerotherapy hurt? Any injection that pierces through the skin may be slightly uncomfortable, and pain tolerance varies among people. In my experience, most agree that this treatment is virtually painless.
  • How long does it take to see results? Typically, some veins disappear within three to six weeks, while others may take three to four months. You may need only one or two sessions, but depending on the number and severity of the veins, you could require up to six sessions.
  • Is sclerotherapy safe for pregnant women? Be sure to let your provider know prior to treatment if you’re pregnant or think you may be. Treatment is not advisable until the postpartum phase and, ideally, until you’re finished having children.
  • Is there any downtime after a spider vein treatment? There is no downtime required after the procedure, and most patients immediately resume normal activities. Movement is advisable to stimulate good blood flow. However, you should avoid strenuous exercise, such as high-impact aerobics, as well as hot showers and baths, hot tubs, saunas, and air travel for a week. Continued sun protection of the legs is paramount. The provider may also advise you to wear pressure bandaging or compression stockings for a brief time to maximize healing.

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Categories: Cosmetic Dermatology


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