Aesthetic Treatments

Varicose & Spider Veins Are Not the Same! Doctors Share How to Treat Both

what causes varicose veins vs spider veins

Despite the options of flesh-toned leggings, body makeup, and self-tanner, covering up spider veins and varicose veins can be challenging.

Varicose veins are large blue, bulging veins in the legs and feet. What causes varicose veins is when the veins are unable to support themselves as the blood flows through them. Instead, the blood flows backwards into the vein, causing pressure. If the vein cannot withstand this pressure, it begins to bulge out of the skin, says Robyn Gmyrek, MD, a board-certified dermatologist at Union Square Laser Dermatology℠ in New York City. These veins look thick, ropey, and are much more noticeable (and less common!) than spider veins. 

Spider veins are considerably smaller and are typically pink, red, or purple in appearance, and can be found on the legs and face. These occur when tiny blood vessels widen, or dilate, and blood pools beneath the skin. Both varicose veins and spider veins can be attributed to numerous catalysts, ranging from genetics to hormones. Furthermore, varicose and spider veins are extremely common and occur more frequently in women.  

If you do not know what type of vein issues you have, or if you have a combination of both varicose and spider veins, it’s best to see a board-certified doctor for a diagnosis and consultation to determine next steps, because vein procedures are quite customizable. “If varicose veins are suspected, the patient is recommended to have an ultrasound to evaluate the vein or veins,” said Dr. Gmyrek. “This is vital to choosing and providing the patient with the appropriate treatment.”

Below, a breakdown of two of the main types of treatments for varicose veins and spider veins.  

Varicose vein treatment: Endovenous Laser Ablation (EVLA)

Number of treatments needed: 1

How it works: Local anesthesia is given in the area being treated, and then, under ultrasound guidance, a small laser fiber is inserted directly into the vein through a small tube. Pulses of laser energy are released along the vein to seal it completely, preventing blood from coursing through it (don’t worry, your blood will flow through other nearby veins instead). Once the laser has sealed the vein, the fiber is removed and a steri-strip or a stitch closes the area. As it heals, the vein itself will turn into scar tissue, and you shouldn't see it anymore.

Treatment time: In the span of one to two hours, depending on how many veins are being treated.

Post-procedure: The leg and/or foot are wrapped with elastic bandages and put into a compression stocking.

Other info to know: Before any varicose vein treatment, Norman Rowe, MD, a board-certified plastic surgeon in New York City, says your doctor may first recommend using compression stockings, exercising regularly, and elevating the affected area when resting.

This procedure requires only a small nick in the skin, so scarring is usually negligible — but bruising can occur and can last a few weeks, says Dr. Gmyrek, who recommends resuming exercise after one week post-procedure. 

Spider vein treatment: Sclerotherapy 

Number of treatments: Multiple visits, depending on the patient, at least six weeks apart.

How it works: Dr. Rowe says this is the most common spider vein treatment. The skin is cleaned with rubbing alcohol, and a very small needle is used to inject the vein with a chemical solution multiple times, which irritates and damages the vein wall, causing it to collapse. “Your body senses that this vein is no longer working well and reabsorbs it, and blood is re-routed to a healthy vein, restoring proper circulation in the area,” said Dr. Gmyrek. “Patients describe the injections as feeling like a pinprick, and they may sense a slight stinging sensation.”

Treatment time: In the span of 30 minutes to an hour, depending on how many veins are being injected.

Post-procedure: Dr. Gmyrek advises bringing compression stockings into the office with you so that you can put them on immediately after treatment. You can expect to wear them for about two weeks post-procedure, but ask your provider what’s right for you. Don’t be nervous if you observe some minimal to moderate bruising after treatment; this bruising is typical and can last a few weeks. Some patients can also develop a light brown pigmentation on the treated area as the veins heal, which can take a few weeks to resolve (if it doesn’t go away, be sure to tell your doctor). Vigorous exercise should be avoided for about two weeks, depending on your doctor’s recommendation, so consider this your all-clear to skip spin class.

Other info to know: Before the treatment, consider avoiding blood-thinners, says Dr. Gmyrek. And, while lotions are typically a nice touch on a regular day, she adds, “Do not put on any creams or lotions on the day of your treatment.” Many doctors also recommend avoiding lotion afterwards, too, in order to decrease any extra risk of irritation. Better safe than sorry!