Uh oh. A Mother’s Day post on another thing to put on your “blame my mother” list. That’s awkward. So let’s shift our focus to how you can get rid of spider veins on your legs, and how you can get your kids to pay for it.

Unfortunately, we have these ugly spider veins and summer is fast approaching. Whether your legs look like a map of rural Montana or Houston, Texas, there are options to help treat and get rid of spider veins. All of the treatments involve altering the lining of these abnormal veins so that they shut down, seal shut and re-route the blood to other nearby normal veins. When no blood is flowing through the abnormal spider veins, you can’t see them and from your standpoint they are gone.

The options for treatment include sclerotherapy treatment of spider veins, ambulatory phlebectomy, Intense Pulsed Light (IPL) and laser vein removal.

Sclerotherapy is the injection of a solution into the vein with a tiny needle. The solution alters the vein wall. The body absorbs the vein and it disappears. Blood flow is shifted from the abnormal vessel to other healthy veins.

• Number of Treatments— when we do sclerotherapy in our office, for the usual patient we will treat all of the veins at each 45 min-hour session. Because each vein often requires several injections to disappear, an average patient needs 3-4 treatment sessions at 10 week intervals for 60-90% improvement. Some other offices treat a lesser number of veins in a shorter treatment session, and therefore would require more sessions.
• Discomfort— there may be stinging or discomfort at the injection sites at the time of treatment, and some aching afterwards.
• Time to See Results— in ten weeks, the effects of one injection to an individual vein is noticeable.
• Duration of Results— most treated smaller veins do not reoccur but over time new veins may develop in the same area. New veins may be more resistant to treatment.
• Recovery Time/Side Effects— most patients have bruising/darkening along the vein fading over several weeks. Very fine red blood vessels may develop at the site of treatment usually disappearing spontaneously. Occasionally as the vein disappears brown pigmentation occurs but usually resolves spontaneously. Because the solution is strong enough to destroy the lining of the vein, if it leaks out of the vein it can damage the skin over the vein. Uncommonly a small sore may develop which may take several weeks to months to heal and may leave a small scar. Very rarely a patient may have an allergic reaction to the medication injected. Sometimes an individual vein develops a superficial clot that may be tender but is not significant medical problem. Deeper phlebitis is a very rare complication.

Laser spider vein removal involves the use of one of several lasers that target hemoglobin in blood, heating it up thereby damaging the lining of the vein wall, and as in sclerotherapy, causing it to close down. One of the common misapprehensions regarding treatment of spider veins is that laser leg vein treatments give better results without pain for spider veins on the leg. It is not unusual for me to see a patient who has had laser treatment for spider veins elsewhere and is quite surprised that it didn’t work, gave them pigmentation or even scarring and that it hurt! Because it is more high tech than injection sclerotherapy, the assumption is that it must be better. It is not. Although laser treatment at times can be helpful for treatment of spider veins, it is both more painful and less effective than injection sclerotherapy.

• Recovery Time/Side Effects— as with sclerotherapy, most patients have bruising/darkening along the vein fading over several weeks or longer. Very fine red blood vessels may develop at the site of treatment usually disappearing spontaneously. It is not uncommon for the vein to develop brown pigmentation after treatment, which may take months or years to resolve. Burns to the skin, healing with a scar may also occur.

Ambulatory phlebectomy involves making very small incisions into the skin over sections of a reticular or small varicose vein and pulling a section of the vein out through the skin, cutting it and removing the section of the vein. When the section of the vein is gone, the blood flow through the vein is interrupted and blood flow is shunted to other, nearby veins. It is appropriate for sections of veins in certain patients under certain circumstances. It is usually combined with injection sclerotherapy.

IPL (Intense Pulsed Light) —works very well for dilated blood vessels, redness, flushing and blushing on the face, neck, chest, arms and the back of the hands. It can be helpful for the very tiny blood vessels that sometimes occur after sclerotherapy, but is less effective than sclerotherapy for removing spider vein on the legs. It is very easy to burn the skin of the legs resulting in permanent brown pigmentation or scarring when attempting to treat spider veins on the legs with IPL. Since it doesn’t work well and the risk of complications is moderately high, it is not one of the best choices for primary treatment of leg veins.

So what is the most effective spider vein treatment? Physicians who are experienced in the treatment of spider veins of the leg most often use injection sclerotherapy, as it usually the most effective with the least number of treatments, and with the least amount of discomfort. I almost always treat spider veins on the leg with sclerotherapy, although we have a spider vein laser sitting in the back room. Sclerotherapy is much more technically demanding to perform well compared to laser vein treatment. I do all the sclerotherapy in our office. It is tedious, but worth it. See photos of patients who we have helped get rid of their spider veins.

On another note—I am intermittently asked about some cream that is being promoted online, on TV or in a magazine ad that supposedly can be applied to the skin to get rid of small broken capillaries. While there are many topical therapies to lessen skin redness, there is no topical therapy to decrease small broken capillaries, called telangiectasia. If it sounds too good to be true, it often is. So don’t waste your money. Use your money for sclerotherapy if you want effective spider vein removal.

How are you going to get your kids to pay for your spider vein removal? Well, it is at least in part their fault, so one would think they would want to help. If not, the old reliable guilt trip may work. And if all else fails, it is Mother’s Day.