Spider Veins Treatment in Los Angeles, CA
Evidence-based care at Vein & Wound Center of LA
Spider veins (telangiectasias) are small red, blue, or purple vessels near the surface of the skin. They are most common on the thighs, calves, and ankles, and can sometimes appear on the face. While they are often considered a cosmetic concern, spider veins can occasionally indicate underlying venous reflux. That’s why a careful evaluation by a vein specialist is important.
What Are Spider Veins?
Spider veins are tiny blood vessels that form web-like or starburst patterns. They often appear as:
- Fine red, blue, or purple lines
- Clusters resembling a “spider web”
- Veins most visible on the legs, sometimes the face
They are more common in women and may worsen with age, pregnancy, prolonged standing, or family history.
Anatomy of Spider Veins — Skin and Vessel Structure
Spider veins develop within the dermis and superficial subcutaneous tissue, the layers just beneath the skin surface.
Histology and why spider veins form:
- Epidermis – the outer skin layer, protective but without blood vessels.
- Dermis – contains small capillaries, venules, and connective tissue where spider veins appear most visible.
- Subcutaneous tissue (hypodermis) – fatty layer beneath the dermis, containing larger feeder veins (reticular veins) that may supply spider veins.
- Spider veins are dilated dermal venules, usually 0.1–1 mm in diameter.
- The venous walls are thin and lack the strong muscular layer found in deeper veins. With age, hormonal changes, or valve dysfunction, these vessels can lose tone and become permanently dilated.
- In many cases, there is a reticular vessel or perforating vessel (feeding vein) which causes high pressure at the point where spider veins emerge from.
- Spider veins can vary significantly in size, and different sizes dictate what types of treatment may be required or underlying disease may be present.
- Pregnancy is a key factor: hormonal shifts (estrogen, progesterone) cause relaxation of vein walls, while increased blood volume and pressure from the uterus compress pelvic veins. This raises venous pressure in the legs, stretching superficial venules. After childbirth, some regress, but many remain as persistent spider veins.
References: Goldman MP & Weiss RA, “Treatment of Leg Telangiectasia and Reticular Veins” (Dermatol Surg 2017); SVS/AVF/AVLS Guidelines 2023.
Why Duplex Ultrasound Matters
Most spider veins are harmless and primarily cosmetic. However, in some patients they may be a visible sign of chronic venous insufficiency (CVI) — a condition where valves in the deeper veins don’t work properly, allowing blood to pool.
Why it matters:
- Treating only the surface veins without identifying reflux if it is present may lead to faster recurrence.
- Duplex ultrasound (DUS) is the gold-standard test to map blood flow and confirm whether deeper reflux is present.
- Clinical guidelines recommend DUS when symptoms (burning, itching, aching), clusters fed by reticular veins, or coexisting varicose veins are observed.
- Ultrasound can be used during procedures to identify and locally map feeding vessels which may be causing the spider veins. Failure to treat these vessels can cause increased recurrence, matting, or treatment failure. Spider veins can occur with or without a feeding vessel and the types of treatment indicated depend on the individual situation.
- While in some cases truncal (axial) reflux from the Great Saphenous Vein (GSV) may be present, there are also many cases where it is minor or not related to the spider veins being evaluated.
At Vein & Wound Center of LA, we perform DUS when indicated so treatment addresses both cosmetic concerns and any underlying circulation issues.
References: SVS/AVF/AVLS Guidelines 2023; NICE CG168.
Treatment Options for Spider Veins in Los Angeles
We offer safe, effective, and minimally invasive treatments — performed in-office with little to no downtime. We currently do not offer laser treatment of spider veins.
Non-Invasive Care
- Compression stockings to support circulation
- Lifestyle strategies such as exercise, weight control, and avoiding prolonged standing
- There is no quality evidence that suggests that conservative therapy will improve or slow down the progression of spider veins.
Minimally Invasive Procedures
- Liquid Sclerotherapy – the gold standard; tiny injections close down the veins, and eventually they fade away as they scar down. This treatment is appropriate in most cases for people looking to remove spider veins without any underlying venous hypertension or reflux.
- Foam sclerotherapy – ideal for larger clusters or feeder veins which may be causing larger, aneurysmal spider veins. Stronger and more potent than liquid sclerotherapy.
- Laser vein treatment (long-pulsed 1064 nm Nd:YAG) – used for very fine spider veins or when injections aren’t appropriate; often preferred for facial veins
- Microphlebectomy – removal or disruption of vein segment, typically used for feeder or perforating veins.
Multiple sessions are often required for best cosmetic results, especially in dense networks or when feeder veins are involved. Sessions may involve combinations of techniques. However, most of the time liquid sclerotherapy with polidocanol or sodium tetradecyl sulfate is sufficient for good aesthetic results.
References: Cochrane Review 2021; Lupton JR et al., 2002; Ianosi G et al., 2019.
Potential Complications of Spider Vein Treatment
Spider vein procedures are generally safe, but like all medical treatments, they carry some risks. Patients should be aware of:
- Pigmentation (hyperpigmentation): Brownish discoloration along the treated vein. Very common after sclerotherapy, but usually fades over months.
- Matting: Fine red networks of tiny veins that can form after treatment. Often temporary, but many times requires repeat sclerotherapy to over several sessions to resolve. Why this occurs is not clearly defined, but will often resolve spontaneously after several months.
- Clotting: Spider veins feel large, bulky, and appear black after treatment. Occurs if treated vessel was large, inadequate compression was applied, or they are very close to the surface of the skin. Often need evacuations to limit hyperpigmentation.
- Mild burning, stinging, or itching at the injection site (short-lived).
- Bruising or redness for a few days.
- Rare but serious complications (e.g., allergic reactions, skin ulceration, or inadvertent injection into arteries) are very uncommon when performed by experienced specialists.
At VWCLA, we use careful technique and follow evidence-based safety protocols to minimize risks. Spider vein treatment should be done slowly, spread over many sessions, so that results are excellent with minimal complications. Most patients will have some type of minor complications and our goal is to walk with you during the process so that you will have the result you want.
References: Cochrane Review 2021; Tan MKH et al. 2021; SVS/AVF/AVLS Guidelines.
Why Choose Vein & Wound Center of LA?
- Accurate Diagnosis
- Successful spider vein treatment starts with understanding what’s feeding them. Our highly trained vascular ultrasound technologists identify whether your spider veins are being caused by deeper reticular or perforating veins. By mapping reflux patterns precisely, we ensure treatments are effective and long-lasting—not just surface-level.
- Expert Experience
- With thousands of vein procedures performed, we know how to recognize subtle patterns and choose the best approach for your spider veins. Our experience helps us treat both the cosmetic clusters you see on the surface and the underlying issues that often cause them to return.
- Advanced Treatment Options
- We offer minimally invasive treatments tailored to spider veins, including sclerotherapy and targeted laser therapy, with results that improve both appearance and comfort. Our goal is natural-looking results and durable improvements.
- Convenience & Comfort
- Treatments are performed in-office with no general anesthesia, no stitches, and minimal downtime—most patients return to normal activity the same day.
- Patient-Focused Results
- We take time to individualize every treatment plan. Whether you’re seeking cosmetic improvement, relief from discomfort, or both, we create a plan that addresses your unique needs.
Frequently Asked Questions
Is sclerotherapy effective for spider veins?
Yes. Randomized and controlled studies show sclerotherapy clears telangiectasias and reticular veins more effectively than placebo.
When is laser preferred over sclerotherapy?
Laser treatment is best for very small (<1 mm) spider veins, facial veins, or in patients with needle phobia or sclerosant allergy. It may be a good option as well for people who have large amounts of scattered, diffuse telangectasias. For most leg spider veins, sclerotherapy remains first-line. Sclerotherapy will work the best especially in traditional situations where a reticular or feeding vessel is involved.
Do I need an ultrasound before treatment?
Yes, if symptoms or clustering suggest reflux. DUS ensures hidden vein disease isn’t missed.
Should I wear compression after treatment?
Short-term compression may improve cosmetic outcomes and reduce minor side effects. Evidence is mixed, so we tailor it to each patient. Small areas of spider vein treatment may not require full compression garment wear, and local compression only for a few days may be adequate.
How many sessions will I need and what side effects can occur?
Multiple sessions are common, especially for dense clusters. Temporary pigmentation, bruising, or matting may occur; pigmentation typically fades over time. Serious complications are rare with proper technique. Vein treatments should be considered a process rather than a one time event.
References
- Society for Vascular Surgery (SVS), American Venous Forum (AVF), American Vein & Lymphatic Society (AVLS). Clinical Practice Guidelines (2023/2024). J Vasc Surg: Venous and Lymphatic Disorders.
- Cochrane Review (2021). Treatment for telangiectasias and reticular veins. Cochrane Library.
- Lupton JR, Alster TS. Comparison of sclerotherapy vs. long-pulsed 1064 nm Nd:YAG for leg telangiectasias. PubMed.
- Ianosi G et al. Nd:YAG laser for <1 mm telangiectasias; polidocanol more efficient for larger. PMC.
- Tan MKH et al. Post-sclerotherapy compression — systematic review. JVS: Venous and Lymphatic Disorders.
- NICE CG168. Varicose veins: diagnosis and management. National Institute for Health and Care Excellence.
- Goldman MP, Weiss RA. Treatment of Leg Telangiectasia and Reticular Veins: Clinical, Anatomic, and Histologic Perspectives. Dermatol Surg. 2017.
