Spider Veins

What are spider veins?

Spider veins are those small, often tangled patches of tiny blood vessels just under the skin surface that frequently resemble spider webs or tree branches.  They can occur across our face, on our nose, cheeks or forehead.  Spider veins most frequently occur on the legs primarily because when compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart because they endure much pressure.

Spider veins are the mildest form of venous reflux disease, or venous insufficiency.  They are different than varicose veins in that spider veins are smaller and do not bulge above the skin surface and rarely cause physical symptoms while varicose veins are normally darker in color, are usually larger in size and varicose veins tend to bulge.

A large nest of spider veins around the medial side of your ankle (corona phlebectatica) may indicate a problem you have inherited or it may indicate reflux in the great saphenous vein from higher in your leg to this point.

There is very little health risk associated with spider veins, but the social embarrassment can be a personal issue causing the individual to seek treatment for removal of the spider veins.

What are the causes and risks of spider veins?

When the valves controlling blood flow or the wall in the vein become weak, it leads to an enlargement of the blood vessels.  In medical terms, this is known as sunburst varicosities or telangiectasias.  Although most often associated with the legs and thighs in women, spider veins are common in men and can also occur on the face and nose as well.  This is why understanding the causes of spider veins is so important.

The causes for spider veins cannot be isolated as to one or two reasons.  There are different causes under different conditions.  Exposure to extreme temperature changes, wind and sun damage, use of oral contraceptives, hormonal issues particularly in women, aging, and genetic predisposition are among the most common causes for spider veins.  Spider veins may also develop at the site of an injury to the skin and sometimes even years after the injury occurred.

Spider veins and varicose veins have much in common and many of the risk factors are similar to those for varicose veins.  In addition to those discussed above, risk factors can include:

  • Smoking
  • Drinking alcohol
  • Obesity
  • Occupation (prolonged standing)
  • Poor blood circulation (vein health)
  • Heredity
  • Exposure to the ultraviolet rays of the sun, particularly in fair-skinned people
  • Nasal and facial veins are associate with Scotch, Irish and English heritage

In women a larger incidence has been documented with the use of oral contraceptives, issues relating to pregnancy, and obesity or overweight are among the common causes when we consider spider vein occurrence in women.

Men who spend large amounts of time outdoors in sun and wind in the performance of their job responsibilities have been found to be more susceptible to spider vein problems.

The singular factor common to all these conditions is poor blood circulation.  The blood that gets pumped up to the heart has a fair distance to travel on its return path before reaching the legs.  In summary, the causes of spider veins can be anything from genetic to traumatic.

What are the symptoms?

Spider veins are the mildest manifestation of venous reflux disease.  They are small, often tangled groups of blood vessels just under the skin surface that frequently resemble spider webs or tree branches. They are generally purple, blue or red in color and are clearly visible, usually on the legs and face.

Night cramps, swelling or discomfort localized over the affected area can be experienced by some.  In some other cases , the discomfort will be absent although the visible blotch of blue, red or purple bunch of veins right under the skin can be a cause for concern.

Some people do not have symptoms but may be concerned about the appearance of the veins.  If symptoms occur, they may include a painful sensation caused by either standing for too long or a certain feeling of tiredness.  However, that isn’t always the case.  Some people actually get surprised at the appearance of spider veins because they did not feel any pain.  Depending on the individual, and even on one’s genetics, spider veins can appear on the leg without any obvious indications.

Other common symptoms of spider veins, although it might not necessarily be painful, are the obvious appearance of veins that are either blue or black in color and the appearance of veins that are bulging and appear to form various shapes other than just a straight line.

Spider veins can be symptomatic.  Sometimes you might think that a certain burning feeling or an achy feeling on the legs is just normal after you have worked the whole day, but that can also be one of the primary indications that you might be a victim of spider veins.  The discomfort is usually scattered stings and are over the spider veins and the stings may come and go and can occur in one area and then another.  They may feel like ant bites and this usually resolves until another area stings or hurts.  This pain, again, is usually not long lasting and less than a day.  If this pain is constant, this is not from spider veins.  In much worse cases, spider veins can even be considered a serious medical condition. This happens when the throbbing pain on the legs does not end after resting and when the spider veins appear on the legs for days in and out and tends to be very difficult to control.

The good thing with spider veins is that after noticing them at the first indication and deciding to do something about it immediately can make all the difference.

How are spider veins diagnosed?

Spider veins are diagnosed visually.  The small red and blue vein tangles located just under the skin do not cause more than minor physical symptoms, but some physicians observing spider veins prefer to conduct ultrasound exams to determine the extent of the problem and the underlying causes of the condition before recommending treatment.  For spider veins that return in large numbers after being treated it is usually recommended to do venous duplex Doppler looking for reflux in the great saphenous and/or small saphenous veins.

What is the treatment for spider veins?

The fortunate thing about spider veins is that when recognized early and, in consultation with a vascular specialist diagnosed, treatment is most often non-invasive and effective.  If they have been injected and keep coming back, again, you should have supine and standing venous duplex  exam in the office of a vascular specialist to be sure there is no reflux in larger veins, such as the great saphenous and small saphenous veins.

Most spider veins are considered to be more a cosmetic condition.  However, if you and your vascular specialist agree that treatment is appropriate, there are several options available all of which can be done right in the doctor’s office.  These are briefly discussed here.


Sclerotherapy has been used to remove superficial and unsightly red, blue or purple spider veins for decades and is the oldest and most frequently used form of treatment.  It involves the direct injection of a solution into the targeted veins.  The solution irritates the walls of the veins causing them to become inflamed and then stick together.  Over time, the blood vessels which are now no longer being used fade away and are naturally removed by the body.  Sclerotherapy is generally not recommended for spider veins on the face but is used primarily on the legs.  (Go to Sclerotherapy for more detailed information.)

Laser therapy

Laser uses a focused beam of light.  The wavelength of light used can be targeted to the pigment of the blood vessels and the water in the vein and the wall of the vein.  Thus, the laser heats the small vein and destroys it.  The laser beam is focused and does not damage the surrounding skin or tissues.  Over a period of usually four to six weeks, the vein is reabsorbed by the body, it disappears and the blood flow is re-routed to healthy veins.  There are many good laser wave lengths that can be used.  (Go to Laser Therapy for more detailed information.)

Intense-Pulsed Light (IPL, PhotoDerm)

This technique of treating spider veins uses intense-pulsed light  (multiple wave lengths at once) to selectively damage or destroy small abnormal veins which includes small spider veins.  This treatment may be recommended when sclerotherapy or laser therapy does not effectively treat the superficial vein and it may require treatment over two to possibly four sessions, depending on the number and size of the lesions. 

It is most useful if your skin has brown, sundamaged spots and spider veins.  It is often alternated with laser treatment in treating spider veins.  Each form of treatment has a different target.

Ligation and stripping

Spider veins are almost never treated with any form of surgery.  This is a treatment procedure reserved for the larger veins found in varicose veins.

What happens after treatment?

Any of the above procedures usually take less than one-half hour depending on the number of veins treated.  Following the procedure, your vascular specialist will likely encourage you to walk and go about your regular activities, although you should avoid strenuous physical activity for a few days.  You may also be instructed to wear support stockings or some form of compression over the treated area for a brief time.


Prevention of spider veins can be easier once those things that put you at risk are understood. 

There is no way to completely guarantee the prevention of spider veins; however, the following measures will help to decrease the probability and will aid in decreasing the severity of existing spider veins and the development of new spider veins.

Exercise – Taking periodic walks or other similar exercises works the calf muscles which will ‘pump’ the blood out of the legs reducing pooling in the veins and pressure.  This is critical to the prevention of spider veins.  Additionally, maintaining good general muscle tone will improve your overall circulation and help in weight control.

Weight control – Maintaining a sensible weight with balanced diet and exercise will reduce blood pressure and put less stress on your veins.

Watch what you wear – While high-heel shoes to many are attractive on a woman, wearing flat or low heels requires the calf muscles (or your venous muscle pump) to work during walking and thereby improves circulation of blood in the legs.  The American College of Phlebology now recommends never wear high-heel shoes because they keep your venous muscle pump from working.

Leg elevation – Proper elevation of your legs while resting (feet higher than your heart) will assist blood flow in the veins and, thus, less pooling and better drainage in the leg veins.

Avoid long periods of sitting or standing – If you must sit or stand still for extended periods, take a periodic walk or at least flex your feet up and down every hour 10 to 20 times.

Wear compression stockings – Graduated support stockings can assist your venous circulation and help prevent conditions such as deep vein thrombosis.  Consider wearing them when taking long airplane trips or car rides and observe the need to take a walk or flex your ankles as mentioned above.

Pregnancy – It is now recommended that women wear medical-grade compression stockings beginning the day they get pregnant and throughout the entire pregnancy and postpartum.  You begin secreting hormones at the start of pregnancy that relaxes your veins.  This only gets worse during pregnancy when the baby gets large, pushes your inferior vena cava slowing venous return to your heart and increasing pressure in your veins.


We hope the information on these pages is both informative and helpful, but it is intended for education only.  Please do note that no web site, no matter how much information is shared, can replace a consultation with your doctor and a vascular specialist.  Medical technology and treatment are continually improving and evolving so before making any decision on treatment, it is always advisable to see your doctor first for a comprehensive evaluation of your vascular disease and other medical conditions.

At the Vascular Center of Wichita Falls, we work closely with your other physicians.  If you have concerns about your arteries or veins, contact us.  A referral is not necessary to make an appointment.