Spider veins are the small unsightly clusters of red, blue or purple veins that most commonly appear on the thighs, calves and ankles and also on the nose or face, formed by the increased pressure to the veins, due to

• Heredity
• Pregnancy and other events that cause hormonal shifts
• Weight gain
• Occupations or activities that require prolonged sitting or standing
• The use of certain medications.

They are treated to collapse the veins and fade them from view.
Spider veins can be treated either by

• Sclerotherapy – To remove spider veins appearing on the thighs, calves and ankles
• Laser treatment- To remove spider veins appearing on the thighs, calves and ankles , and facial spider veins on the nose or face

Spider veins require treatment when they

• affect the appearance and colour pattern of the skin
• cause restless legs, aching, burning, and/or cramps

Ideal candidates for the procedure are those who

• Enjoy good physical and psychological health
• Do not smoke
• Want to improve their appearance  and are well informed about the procedure
• Hold realistic expectations about the outcome
• Do not have a blood-borne disease or condition affecting the vascular system
• Are not currently pregnant or nursing

Ideal candidates for the procedure are those who

• Enjoy good physical and psychological health
• Do not smoke
• Want to improve their appearance  and are well informed about the procedure
• Have superficial spider veins that will respond to laser treatment
• Have fair skin or the appropriate skin tone for the type of laser used
• Are not taking Accutane, nor have taken it for the previous 18 months
• Do not have unusual scar formations, such as keloids
• Hold realistic expectations about the outcome
• Do not have hepatitis, AIDS or other blood-borne diseases, circulatory problems, heart conditions, or diabetes

Risks and complications associated with the sclerotherapy procedure

• Formation of blood clots and severe inflammation in the veins
• Adverse allergic reactions to the sclerosing solution
• Skin injury that could leave a small but permanent scar.
• Discoloration and blotchiness
• Telangiectatic matting, in which fine reddish blood vessels appear around the treated area, requiring further injections

Risks and complications associated with the laser procedure

• Semi-permanent or permanent skin lightening in the treated areas
• The skin may become hyperpigmented (darker) immediately following the surgery, which can often be successfully treated with a bleaching cream.
• The skin may become lightened
• Heat from the laser may cause burns or injuries

• During the initial consultation, the expectations of the patient are understood.
• The surgeon shall perform a medical evaluation to rule out factors that may affect the procedure such as uncontrolled high blood pressure, blood clotting problems, or the tendency to form excessive scars.
• The doctor may draw a simple sketch of the legs, mapping out the areas affected by spider veins or other problems.
• The patient will be checked for signs of more serious deep vein problems, often indicated by swelling, sores, or skin changes at the ankle
• Elaborate tests such as ultrasound or Doppler may be performed to clearly differentiate between spider veins and varicose veins
• Photographs are taken for further comparison after procedure.
• The doctor discusses and advises on options of anaesthesia, treatments best for the patient, surgery, type of facilities and cost with the patient.
• The patient must inform doctor of any previous injury or surgery, allergies, infections, smoking habits, recreational drugs and medications being taken.
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications
• The patient will be instructed not to apply any type of moisturizer, sun block or oil to the legs on the day of the procedure.
• In case of laser treatment, the patient may undergo an initial calibration session, where several settings of the laser are tried on very small portions of the skin. This helps to determine the optimal setting to be used for the treatment session based on the results seen when the patient returns after a week.

Sclerotherapy

• The patient is made to lie down on the examination table and the skin over the spider veins is cleaned with an antiseptic solution.
• The skin is stretched taut with one hand to inject the sclerosing agent into the affected veins.
• Approximately one injection is administered for every inch of spider vein
• A cotton ball and compression tape is applied to each area of the leg as it is finished.
• The patient will feel small needle sticks and possibly a mild burning sensation during the procedure.
• Pain is usually minimal as the needle used is very thin and the sclerosing agent is of a mild nature.

Sclerotherapy normally takes fifteen minutes to one hour, depending on the number and length of the spider veins.
Laser treatment

• The face or area to be treated is cleaned to remove oils on the skin.
• Brief intense, emissions of light from the laser are then used to remove the superficial blood vessels at precisely controlled levels of penetration.
• The treated area will be covered with an antibiotic ointment to eliminate any surface bacteria and then bandaged
• If the areas treated involved the legs or thighs, they are bandaged from foot to thigh.

The amount of time varies from fifteen minutes to one hour, depending on the size of the area being treated, as well as the severity of the problem.

Both of the treatments are performed as outpatient procedures
Sclerotherapy

• The patient experiences minimal pain
• The patient may experience some temporary itching and cramping in the legs for the first day or two after the injections.
• The treated veins will look worse before they begin to look better.
• Tight-fitting support hose may be prescribed to guard against blood clots and to promote healing which must be worn for 72 hours or more. The area must be kept dry during this period.
• The tape and cotton balls are removed after 48 hours
• Once the compression dressings are removed, the patient will notice bruising and reddish areas at the injection sites, which will diminish within one month.
• There may be some residual brownish pigmentation which may take up to a year to completely fade.

Laser treatment

• The patient may experience some redness and swelling of the treated area, which should disappear within a few days.
• The patient must keep the leg elevated for the remainder of the day.
• The patient may remove the original bandage, bathe, and reapply a compression garment to the legs the next day.
• Tight-fitting support hose may be prescribed to guard against blood clots and to promote healing which must be worn for 72 hours or more. The area must be kept dry during this period.
• The veins will turn a purple colour that resembles a small bruise, which will gradually fade within 5-10 days. Ice packs or frozen aloe vera gel is recommended to reduce the swelling

Sclerotherapy

• The patient is advised a regular walking program to increase circulation and promote healing.
• Prolonged sitting and standing, squatting, should be avoided during the period of treatment completion.
• The patient may have the second series of injections in the same site after a healing interval of one month.  After each treatment, the patient will notice further improvement in the legs' appearance
• The patient should avoid activities that put pressure on the treated area such as heavy lifting or jogging for a few days

Laser treatment

• The patient must avoid hot baths and strenuous exercise
• The patient must use the compression stockings for a short term.
• Patients can resume most normal activities immediately.
• Patients must refrain from vigorous activities for the first 24 hours.
• For the maximum long-term resolution, multiple treatments may be necessary.
• If new veins appear, additional treatments are required.
• Treatments may be in three to four week intervals.