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Spider Veins

Spider veins are small damaged blood vessels visible just below the skin surface, appearing as thin red, blue or purple lines that often branch into the web-like pattern behind the name. They form when small vessels weaken and dilate. Unlike varicose veins, which bulge above the skin, spider veins are flat and sit closer to the surface. Where they are matters more than how they look. On the legs, the standard treatment is sclerotherapy, and Wall Street Dermatology uses it as the first-line approach for leg veins, as clinicians have done since the 1930s. A sclerosant is injected through a fine needle, scarring down the vessel wall so it disintegrates and blood reroutes into the main circulatory branches; each injection permanently reduces 50 to 80 percent of the treated vessels. Dr. Julia Tzu uses polidocanol, which is less painful and carries a lower risk of tissue necrosis than the older hypertonic saline and sodium tetradecyl sulfate options. Facial vessels are a different problem and are treated with the pulsed dye laser instead. Leg spider veins occasionally signal underlying venous insufficiency, which is assessed before cosmetic treatment begins.

4 min read·Last updated: 2026-01-29·Reviewed by Dr. Julia Tzu, MD, FAAD, FACMS

At a Glance

  • Spider veins form when small blood vessels weaken and expand, becoming visible under the skin[1]
  • Sclerotherapy causes treated spider veins to go away in approximately 3-6 weeks[1]
  • Laser therapy is typically preferred for facial spider veins, while sclerotherapy works well for leg spider veins[1]
  • Spider veins are flat and near the skin surface, unlike raised, bulging varicose veins[2]

What are the symptoms of Spider Veins?

  • Thin red, blue, or purple visible lines
  • Web-like or branching patterns under skin
  • Flat appearance (not raised like varicose veins)
  • Usually painless
  • May cluster in specific areas
  • Occasionally accompanied by mild aching in legs
  • Can appear on legs, face, chest, or other areas

When should you seek care for Spider Veins?

  • Visible web-like veins on the legs or face that bother you cosmetically
  • Leg pain, aching, or a feeling of heaviness accompanying the veins
  • Swelling in the legs or ankles alongside the veins
  • Skin changes or discoloration near the affected veins, which need evaluation before anything cosmetic
  • Concern about underlying venous insufficiency, particularly with a family history
  • Veins that appeared or worsened during pregnancy or with hormonal medication
  • Interest in treatment where your work involves long periods standing, which both drives the problem and affects aftercare planning

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What causes Spider Veins?

  • Weakening of blood vessel walls
  • Valve dysfunction in leg veins
  • Sun damage (facial spider veins)
  • Hormonal changes
  • Pregnancy
  • Prolonged standing or sitting
  • Obesity
  • Genetic predisposition
  • Aging
  • Previous trauma or injury

How are Spider Veins treated?

We offer a service to help manage this condition: Laser Treatment.

Prognosis

  • Spider veins are typically benign
  • Sclerotherapy success rates are high (60-80% improvement)
  • Treated veins usually go away in 3-6 weeks
  • Multiple sessions often needed for best results
  • New spider veins may develop over time
  • Underlying venous issues may require additional treatment

Frequently Asked Questions

What are spider veins?
Spider veins are small, visible blood vessels beneath the skin that appear as thin red, blue, or purple lines, often in web-like patterns. They form when tiny blood vessels weaken and dilate. Unlike varicose veins, spider veins are flat and closer to the skin surface. They're usually harmless and primarily cosmetic.
What is the difference between spider veins and varicose veins?
Spider veins are smaller, flat, and closer to the skin surface, appearing as thin colored lines. Varicose veins are larger, raised, bulging, and often cause symptoms like aching or heaviness. Both involve weakened blood vessels, but varicose veins indicate more significant valve dysfunction.
When should I see a doctor about spider veins?
See a doctor if spider veins bother you cosmetically, if you have leg pain, heaviness, or swelling along with spider veins, if skin changes occur near the veins, or if you want to discuss treatment options. Leg symptoms may indicate underlying venous insufficiency requiring evaluation.
How are spider veins treated?
Sclerotherapy is the main treatment for leg spider veins–a solution is injected to close the vein. Laser therapy is preferred for facial spider veins. Treated veins typically fade within 3-6 weeks. Multiple sessions may be needed for best results. Compression stockings can provide supportive care.
Can spider veins be prevented?
While not all spider veins can be prevented, you can reduce your risk by maintaining a healthy weight, exercising regularly, avoiding prolonged sitting or standing, wearing compression stockings if at risk, protecting skin from sun damage, and elevating legs when resting.
Is spider vein treatment permanent?
Treatment closes the existing spider veins, which typically don't return. However, new spider veins can develop over time, especially if risk factors like prolonged standing or hormonal changes continue. Maintaining a healthy lifestyle helps reduce the chance of new veins forming.
How many sclerotherapy sessions does it take?
Each injection permanently reduces roughly 50 to 80 percent of the vessels it treats, so a given area usually takes more than one session to clear fully. Appointment length runs from about five minutes for a single vein to an hour for extensive involvement. Results appear over weeks to months as the body reabsorbs the treated vessels.
Which sclerosant is used, and does the choice matter?
Polidocanol, sold as Asclera. It is noticeably less painful on injection than hypertonic saline and carries a lower risk of skin necrosis. The alternatives, hypertonic saline and sodium tetradecyl sulfate, are both effective and both less comfortable, which is why polidocanol is the default here.
What happens straight after a sclerotherapy session?
Compression stockings go on, which is why patients are asked to bring them along with comfortable shoes. Normal activity resumes quickly. Hot baths, saunas and direct sun on the treated areas are avoided while the vessels are clearing. Bruising, mild discomfort and temporary discoloration are common and settle within days.

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Sources & References

This article draws from 3 peer-reviewed sources.

Medical Institutions

Medically reviewed by Dr. Julia Tzu, MD, FAAD, FACMS · Last reviewed: 2026-08-05