April Long answers all your beauty-related questions with practical advice and zero judgment.
Photo-Illustration: by The Cut; Photo: Getty Images
Spider veins are one of those things you don’t notice until you suddenly can’t stop noticing them. Fifty percent of us are going to have them by the time we turn 40, but they can make an appearance earlier thanks to pregnancy, hormonal fluctuations, and genetics. The good news? They’re usually harmless, and treatable.
Spider veins — known medically as telangiectasias — are tiny dilated blood vessels that sit close to the surface of the skin. They often appear as fine red, blue, or purple lines that resemble tree branches, webs, or marks left behind by a rogue ink pen. Although they can develop almost anywhere, they’re most commonly found on the legs, particularly on the thighs just above the knees.
The root cause often comes down to pressure inside the venous system. Veins contain one-way valves that help push blood back toward the heart. When those valves weaken, blood can flow backward and pool inside the vessel, causing smaller veins near the skin’s surface to expand. You may be genetically predisposed toward this happening, says Dr. Justin Ha, a board-certified vein specialist at Metro Vein Centers in New York.
The other big culprits are pregnancy, prolonged standing or sitting, weight gain, hormonal shifts, aging, and previous injuries to the legs. You may even have those days at the beach to blame: Sun exposure can make veins more noticeable over time by breaking down collagen and thinning the skin.
Spider veins are very small surface vessels, generally less than a millimeter in diameter. Varicose veins are significantly larger — typically more than three millimeters wide — and may appear ropelike, twisted, or bulging beneath the skin. Even though we tend to think of varicose veins as protruding, that’s not always the case. Many are visible through the skin without creating a raised bump.
Spider veins are usually considered a cosmetic concern. Varicose veins, however, are more likely to be associated with underlying venous insufficiency, a condition in which the veins struggle to return blood efficiently to the heart. Symptoms such as leg heaviness, swelling, aching, throbbing, nighttime cramping, or a feeling of fatigue in the legs warrant evaluation by a vein specialist, who can conduct an ultrasound to determine what’s going on.
For spider veins, the gold-standard options are laser therapy, sclerotherapy, or a combination of both.
Laser treatment with an Nd:YAG laser such as Cutera uses focused light energy to heat and collapse tiny blood vessels. It’s not totally pain-free, but it’s bearable, especially since the session typically takes less than 20 minutes. The sensation is similar to a rubber band snapping against the skin.
Laser treatments tend to work best for very small veins, but skin tone can influence whether they’re the ideal choice. “If the patient has more melanin and they’re darker, it’s harder to do laser treatment,” says Ha. “The melanin pigment can absorb some of that energy, so there’s a greater risk of irritation or burns.”
Sclerotherapy, meanwhile, involves injecting a saline solution directly into the vein. The solution irritates the lining of the vessel, causing it to collapse and eventually be reabsorbed by the body. Blood is naturally redirected through healthier veins nearby. Even though it’s more involved than laser treatment, it’s often the best and first choice for larger veins. “We’re unlikely to do a laser on a bigger vein, because it would require a lot of energy and be very painful for the patient,” Ha says. “And similarly, we wouldn’t do sclerotherapy for tiny veins because the smaller the veins are the harder it is to get a needle in.”
Neither treatment requires significant downtime. You’ll be told to avoid direct sun exposure on treated areas for approximately two weeks to minimize the risk of hyperpigmentation, skip intense exercise for at least several days to a week, and refrain from getting on an airplane for about a week. If you do sclerotherapy, you’ll be advised to wear medical-grade compression stockings for seven-to-ten days afterward (you don’t need to wear them after the laser).
Either way, you might want to schedule the procedure for a time when you won’t mind wearing long skirts or pants for awhile. “Sometimes it looks a little bit worse before it gets better,” Ha warns. “You may have a little bruising.” Most people start seeing improvement in the look of the veins in about four weeks as they begin to retreat from the surface of the skin. You may be fine with only a single treatment, or you may need multiple sessions of either laser or sclerotherapy, depending on the severity and the number of veins being treated.
The frustrating news is that spider-vein treatments aren’t really permanent. Treatment can eliminate existing veins, but it can’t prevent new ones from cropping up in the future. The best you can do, says Ha, is try to adopt some habits that will help prevent them. “We encourage you to continue to wear compression stockings — or start, if you don’t already, especially when flying,” says Ha. “You should also elevate your legs at night, avoid sitting more than 30 minutes at a time, and have a regular exercise routine. All of those things are great for circulation, and over time gravity will affect you less.”
If you want to wait to get your spider veins treated — at least until fall — you can always try leg makeup to disguise them. Dermablend Leg and Body Makeup is a gold standard that gets great reviews, as does Sally Hansen Airbrush Legs. A good self-tanner can also help make the veins less noticeable.
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