SCN: Exactly what are spider veins?

Doctor: Spider veins, so-called because the "arms" of these tiny dilated blood vessels appear to project outward from a central denser area like the legs of a spider from its torso, are also called sunburst varicosities for a similar reason. When they cover the face, they're called telangiectasia ("broken" blood vessels).

In fact, they’re simply diminutive, thick venules (literally: little veins) that lie close to the surface of the skin. And because they principally carry deoxygenated blood (blood that’s not saturated with oxygen needed by the tissues), they actually serve no useful function.

Even nutrition-wise, it’s the blood vessels hidden below the surface within the dermis that carry nutrients to the skin. In short, spider veins and telangiectasias are just plain, disfiguring nuisances.

SCN: How do spider veins develop?

Doctor: The precise cause of these unwanted vessels is still the subject of investigation. However, we believe that they develop as a result of a complex interplay of genetic, hormonal and environmental factors.

There is often a strong family history responsible for their formation. You might find, for example, a mother, daughter and sister suffering the same problem. Elevated estrogen levels also appear to aggravate the condition. Not uncommonly, spider veins worsen during pregnancy or while taking birth control pills.

Particularly vulnerable are individuals whose jobs require them to be on their feet a great deal, overweight persons, and those who have sustained some kind of injury to the area, including blunt trauma, cuts, lacerations or even surgical procedures. And while alcohol consumption has been associated with their development on the face, there are many tea totlers who complain of them, as well.

SCN: What’s an effective technique to remove spider veins?

Doctor: Despite the advent of lasers, sclerotherapy remains the gold standard treatment and the most common method for getting rid of spider veins on the legs. Sclero literally means "scar." Sclerotherapy works by irritating the lining of the unwanted blood vessels to such an extent that they collapse upon themselves and eventually scar over and disappear from view entirely. For this purpose, your doctor can choose from a number of different sclerosing agents, including super-concentrated salt solution (hypertonic saline).

SCN: What are the advantages of this treatment?

Doctor: One of the major advantages of sclerotherapy is that it’s fast and simple. A typical treatment session may take only 15 to 30 minutes depending upon the size of the area to be treated. A very tiny needle, smaller than most sewing needles, is inserted into the venule and the sclerosing material is then injected until it and the vessels in the region immediately surrounding it fade from view as the solution courses through. Each subsequent site is injected in a similar fashion until the entire area to be treated is completed.

Although mild stinging or burning may accompany the injection, most physicians opt to treat without injecting any "freezing" solution, except for the use of a topical anesthetic cream (e.g. EMLA or ELA-MAX). I’ve found, however, that combining the sclerosant with a small amount of lidocaine coupled with epinephrine, a blood vessel constrictor, not only makes the procedure entirely comfortable, but enhances the cosmetic result by promoting a tighter contact between the blood vessel walls and the sclerosing solution owing to the blood vessel narrowing.

SCN: Is it necessary to cover treated areas?

Doctor: Your doctor may cover the treated sites with compression bandages consisting of cotton balls that are taped in place and left for three days. Others additionally recommend that support hosiery be worn for several days or even weeks afterward. I personally find these measures unnecessary, except when treating larger varicosities.

SCN: How many sessions are required to remove spider veins?

Doctor: While some patients obtain a satisfactory outcome after just one treatment, optimal esthetic improvement generally requires two or more sessions, spaced at four to six week intervals. Each visit can be expected to yield a 50 percent improvement in appearance, but of course the results are highly individual.

Unfortunately, eliminating existing blood vessels does nothing to prevent new ones from developing at a later date , and additional treatments may be necessary at some point in the future.

SCN: What sort of side effects can we expect?

Doctor: Following treatment you might experience some mild leg cramping, bruising or redness, but in most cases, you’ll be able to return to work or social activities immediately — so, no downtime. Occasionally, the skin over the treatment sites can become temporarily stained a coffee color, and tiny clots may form under the skin, which will need to be drained. Tiny skin ulcerations and scarring are rare complications. Persons with diabetes, heart disease or circulatory problems aren't considered good candidates.

SCN: What’s the cost of sclerotherapy?

Doctor: Sclerotherapy sessions typically range from $200 to $400, depending on the number of syringes used and the area covered.

SCN: Is sclerotherapy the treatment of choice for all blood vessels?

Doctor: Very tiny, dense "mats" or conglomerations of red blood vessels, known as telangiectatic matting, are difficult to treat with sclerotherapy and may respond better to microneedling, laser or other light therapies. Microneedling (see below), which uses a roller with thin spokes attached, can penetrate and break up these dense, superficial mats of vessels and permit the skin's reparative mechanisms to more easily clear them away.

On the other extreme, larger varicose blood vessels are best treated by venous stripping and ligation, ambulatory phlebectomy and the newer, endoscopic radiofrequency surgical technique.

Although larger blood vessels, especially around the nose, or on the temples, may likewise be treated by sclerotherapy with good results, facial telangiectasias are generally best treated by other methods. These include the use of radiowaves, microneedling, electrolysis and light therapies. As with sclerotherapy for the legs, most people require between two to four treatments per area with any of these techniques, spaced at two to four week intervals, in order to see a 60 to 80 percent overall cosmetic improvement.

SCN: What’s involved in laser light therapy?

Doctor: Laser light, which targets and heats up the red hemoglobin pigment within blood cells, works by thermal destruction of the tiny blood vessels. With Intense Pulsed Light therapy (IPL), which technically isn't a laser, gentle pulses of light penetrate the skin and are absorbed by the abnormal blood vessels, heating them and leading to their destruction and eventual absorption by the body. Patients may experience a transitory stinging during light treatments, as well as some redness in and around the treated sites that may last for a few days.

SCN: What about electrolysis?

Doctor: Electrolysis involves the use of a high-frequency electrical current to generate tissue-destroying heat that is discharged into the skin via a tiny probe inserted through the skin to the tiny blood vessels. Before the introduction of lasers, this was the only modality available for dealing with facial capillaries and was quite successful. Since tiny pit scars occasionally develop at treatment sites, electrolysis is a less attractive treatment option than the other methods currently available. Fees per session for any of these techniques parallel those for sclerotherapy.

SCN: What’s your preferred treatment?

Doctor: Radiowaves are my treatment of choice and over the years have yielded consistently gratifying results. A high-tech device using a radio frequency current, similar to the kind that operates an ordinary radio, is used. The radio waves, which work by sealing off the blood supply to the troublesome little vessels, are introduced through an ultrafine probe that is placed directly on the skin surface and moved rapidly from site to site.

Sessions usually last no more than 10 or 15 minutes and typically require only the prior application of a topical anesthetic cream. Two to four treatments are generally needed per site for best results.

As opposed to light therapies, it's been my experience that radiowave treatments are less likely to result in prolonged facial redness or long-lasting blotchy or brownish discoloration. The average fee is $300 per treatment for the cheeks and nose.

SCN: What does microneedling accomplish?

Doctor: Microneedling, using an instrument known as a Dermaroller, helps to break up larger blood vessels, such as those often seen around the nose. The instrument, which can be likened to a rolling pin to which numerous, tiny, thin, acupuncture-like needles are attached, can be used to criss-cross the dilated blood vessels. Disrupting them in this fashion promotes their disappearance. Healing is usually complete in a few days and treatments may be repeated at monthly intervals as needed. Typically two to four treatments are required. Fees range from $500-$800 per treatment session.

SCN: After finishing a series of treatments, when will patients typically need to return for more work?

Doctor: In general, those people exhibiting a tendency to create broken blood vessels on the face or spider veins on the legs will continue to do so throughout their lives. It's difficult to predict, but it's been my experience that a whole new batch will crop up every two to five years.

SCN: Because broken blood vessels can return every few years, should patients wait until they have a massive batch before seeking treatment?

Doctor: Telangiectasia and spider veins are typically part of a large network of interconnected tiny blood vessels that spread out like the limbs of a tree into ever-smaller branches. The earlier one is treated, the easier it is to keep the proliferation at bay. In short, sooner is better than later.

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To learn more about cosmetic dermatologist Nelson Lee Novick, M.D., F.A.A.C.S., F.A.A.D., please visit his bio.