Sclerotherapy: This is one of the more popular options for spider veins and varicose veins. A doctor injects a foamy detergent or concentrated saltwater solution into the problematic vein, which irritates the walls of the blood vessel, explains Neil Sadick, M.D., founder of Sadick Dermatology. This causes scar tissue to form, which leads the blood vessel to close. If someone is allergic to the sclerotherapy solution, there are other treatment options.
Laser treatment: A vein surgeon or dermatologist might use a laser treatment to heat the vein, causing it to contract and scar over. Dr Hollingsworth uses a handheld Nd:YAG laser (the same machine that can be used in laser hair removal) on small spider veins. Or, if it’s a larger varicose vein, a laser may be inserted into the vein using a catheter to stop blood flow.
Medical glue: For varicose veins, doctors might also use is the medical version of superglue. “Cyanoacrylate glue is a biologic glue that’s very similar to Krazy Glue,” Dr. Hollingsworth says. Surgeons close off a varicose vein by gluing it shut from the inside. “You inject it, wait for the glue to set, and move further down, and so on and so on.”
Radio frequency ablation (RFA): This is another option for varicose veins that are so large that glue and sclero just float away. “RFA runs radio frequency through the inside of the vein and turns the inside of the vein into a lightbulb filament, heats it up, scars it, and kills it,” says Dr. Hollingsworth.
To prevent visible veins from getting worse, a surgeon might use RFA or internal laser techniques to close off a larger vein deeper in the leg that feeds the smaller varicose veins and spider veins. “There’s a central pipe in the leg called the saphenous vein; it’s the main superficial vein. Coming off those veins are truncal varicose veins,” Dr. Sadick says. Once the larger vein is taken care of, the smaller veins can be treated with sclerotherapy, glue, or a handheld laser.
All of these treatments are performed through tiny punctures in the skin, so you can likely schedule your procedure in the morning and go back to work in the afternoon. However, Dr. Barba warns about getting these treatments on darker skin tones, especially laser and RFA procedures, because those with darker skin tones have a higher risk for hyperpigmentation issues following the treatments. Plus, those pigmentation issues can be stubborn to treat. “Sometimes the pigmentation is a part of the healing process,” Dr. Barba says. “If you care about a little spider vein, you might care about the pigment that’s going to be there for a couple months.”
Whatever treatment you go with, the key is to go to a doctor who specializes in vein treatments, whether that’s a dermatologist or a vein surgeon. “If you want have anything done, go to whoever does a lot of it,” Dr. Hollingsworth says. The good news is that insurance will cover many vein treatments. Without insurance, these treatments can cost $300 to $8,000. “Oftentimes, when it is a deeper vein problem, insurance covers it because it’s not [just] a cosmetic issue,” Dr. Barba says.
How can you prevent spider veins from coming back?
Although effective, all of these surgical treatments are really temporary fixes, Dr. Hollingsworth says. Spider and varicose veins can return in other nearby veins once the original veins are closed off or removed. So, if you decide not to treat them at all, they can multiply, Dr. Hollingsworth says. But if you stay on top of them—which will require repeated treatments every one to two years—you can keep them at bay.
After treatment, one thing you can do to effectively prevent spider veins from returning is to wear compression stockings daily, which can be difficult to get on and uncomfortable to wear. “Nobody likes wearing them,” Dr. Hollingsworth says. But, “if you wear stockings religiously during the day, they significantly reduce [the chance that] your spider veins [will come] back.” In some cases, your health insurance may actually cover the cost of medical-grade compression stockings, Medline Plus explains, so check with them before buying any.
Ultimately, if you’re dealing with spider veins or varicose veins, it’s important to check in with a doctor or dermatologist. They can help you understand how serious your particular issue is, talk about what may underlying issues may have caused it, and, if necessary, walk you through your treatment options.
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