Spider Veins
Management of small visible surface veins for cosmetic or symptomatic concerns
What is spider veins?
Spider veins are tiny veins in the surface layer of the skin that have widened until they are visible, appearing as fine red, blue or purple lines and webs. They are usually less than a millimetre across. No new vessels have formed; the ones already there have stretched and filled.
They collect on the thighs, calves and ankles, and on the face around the nose and cheeks. What widens them is pressure and time: an inherited tendency in the vein wall, years of standing at work, pregnancy and its hormonal changes, extra body weight, ageing skin, previous injury to the area, and for facial ones, sun exposure.
One point decides how they are approached. Surface veins often sit above a larger vein deeper in the leg whose valves have stopped working, and the raised pressure from that vein is what keeps feeding them. Treating the visible lines while that pressure remains gives a good result for a few months and then the same pattern returns, so your surgeon's first job is to establish whether a deeper vein is involved.
What you might notice
- Bulging bluish veins
- Leg heaviness after standing
How it is diagnosed
Your surgeon examines your legs with you standing, because veins empty when you lie down and the true extent only shows under gravity. They look at where the veins sit and how they are distributed, feel along the course of the larger veins for bulges and for the thrill of reflux, and check the skin around the ankle for discolouration, thickening or healed ulcer scars.
What they are deciding is whether this is a surface problem alone or the visible end of a deeper one. A duplex ultrasound is used where there is aching or heaviness by the end of the day, ankle swelling, itching, skin changes near the ankle, a family history, or veins that have returned after previous treatment. The scan watches the valves in the leg veins work in real time and shows whether blood is flowing backwards.
They will also ask about clots in the past, pregnancies, hormone treatment and how long you spend on your feet, since all of these shape what is offered.
Recovery
Spider veins themselves ask nothing of your daily life and need no recovery.
Where they are treated, the appearance gets worse before it gets better, and knowing that in advance saves a good deal of worry. Expect the treated lines to darken and look more prominent, with bruising and small firm cords along them, for two to four weeks. Brown staining of the skin along the treated vein is common and fades over three to twelve months.
Compression stockings are worn for a period afterwards, from a few days to a few weeks depending on what was done, and walking is encouraged the same day. Most people return to work the next day. Avoid strenuous exercise, hot baths and long flights for the first week or two as advised, and keep the treated area out of the sun while the staining settles, since sunlight makes it darker.
The final result is judged at about three months, and more than one session is usually needed to clear an area.
If it is left untreated
Spider veins carry no risk to the leg and cause no harm if they are left alone. Treating them for appearance is a choice, and choosing not to is entirely reasonable.
What happens over the years is that more of them appear, particularly where the work involves long hours standing and after further pregnancies. The existing ones rarely disappear on their own.
The situation that does need attention is the one where a deeper vein is driving them. Persistent aching and heaviness, ankle swelling that is worse at the end of the day, itching around the ankle, brown discolouration or hardening of the skin above the ankle all suggest sustained high pressure in the leg veins, and that pressure damages the skin over the years and eventually breaks it down into an ulcer that is slow to heal. Those changes are treatable and are much easier to treat before the skin gives way, so get them assessed instead of watching them.
A leg that becomes suddenly swollen, hot and painful, or a hard tender cord along a vein with surrounding redness, needs to be seen the same day.
Questions about spider veins
Are spider veins dangerous?
In themselves, no. They sit in the surface layer of the skin, carry very little blood, and pose no threat to the leg. What matters is whether they are the visible end of a larger problem deeper down. Aching or heaviness at the end of the day, ankle swelling, itching, or brown discolouration and thickening of the skin above the ankle all suggest that the valves in a deeper vein have stopped working, and that does damage the skin over the years. Those signs are worth an ultrasound. A leg that becomes suddenly swollen, hot and painful needs same-day assessment.
Will they come back after treatment?
The veins that are treated are destroyed and do not return, and new ones can appear over the years, particularly if you stand for long periods at work or have further pregnancies. The common reason for an early return is an untreated deeper vein pushing pressure into the surface network, which is what the ultrasound at the first consultation is for; treating the surface alone in that situation gives a result that lasts months. Wearing compression as advised, keeping weight in range and moving during long periods of standing all slow new ones down.
How many sessions will I need, and how soon will my legs look better?
Most areas need more than one session, commonly two to four, spaced several weeks apart, and larger or more extensive patterns need more. Be prepared for the legs to look worse first: treated lines darken and bruise for two to four weeks, and brown staining along them can take three to twelve months to fade. Keep the area out of the sun during that time, since sunlight makes the staining darker and longer-lasting. Judge the result at about three months after the last session, and expect substantial improvement in appearance instead of a completely clear leg.
Other vascular surgery treatments
Treatment for enlarged, twisted veins that may cause pain, swelling, heaviness or skin changes
Day CareDiagnosis and treatment of blood clots in deep veins, with management based on location and risk
InpatientTalk to a care coordinator about spider veins
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one