TL;DR
Spider veins (telangiectasias) affect up to 80 percent of women and 25 percent of men, causing both cosmetic concern and, in some cases, physical symptoms. This guide provides a comprehensive…
Last updated: 5 March 2026
Spider veins (telangiectasias) affect up to 80 percent of women and 25 percent of men, causing both cosmetic concern and, in some cases, physical symptoms. This guide provides a comprehensive overview of sclerotherapy and laser therapy with evidence-based guidance on when each is most appropriate.
Reviewed by the Axiom Aesthetics Clinical Team | Last updated: February 2026
Understanding Spider Veins
Spider veins are dilated superficial venous networks measuring 0.1-1.0mm in diameter, appearing as red, blue, or purple linear, branching, or web-like patterns most commonly on legs and face. They develop when one-way valves in small veins weaken or fail, allowing blood pooling and vessel dilation. Risk factors include genetics, female sex, pregnancy, prolonged standing, obesity, and hormonal changes. While often cosmetic, they can cause aching, burning, and restless legs.
Sclerotherapy: Gold Standard for Leg Spider Veins
How Sclerotherapy Works
A sclerosing agent is injected directly into the spider vein using a 30-32 gauge needle. The agent damages the endothelial lining, causing inflammation, fibrosis, and eventual obliteration. The treated vein is absorbed over 4-8 weeks with blood rerouting through healthier vessels.
Sclerosing Agents and Protocol
Common agents include sodium tetradecyl sulphate and polidocanol, available in various concentrations and also in foam form for larger vessels. A typical session involves 20-40 injection points of 0.1-0.5ml per site, taking 30-60 minutes without anaesthesia. Compression stockings (20-30mmHg) are worn for 1-2 weeks post-treatment.
Expected Results
Most patients see 60-80 percent improvement after 2-3 sessions spaced 4-6 weeks apart. Results develop gradually over 6-12 weeks. New spider veins may develop over time requiring maintenance treatments due to ongoing genetic and lifestyle risk factors.
Laser Treatment for Spider Veins
Mechanism of Action
Laser and IPL work through selective photothermolysis: light absorbed by haemoglobin converts to heat damaging the vessel wall. Key wavelengths include Nd:YAG (1064nm) for deeper blue leg veins, KTP (532nm) for superficial red facial vessels, and pulsed dye laser (585-595nm) for facial and fine telangiectasias.
When Laser Is Preferred
Laser is preferred for facial spider veins where sclerotherapy is technically difficult, very small matting too fine for needles, needle-phobic patients, and sclerotherapy-resistant vessels. Nd:YAG is particularly effective for leg veins up to 3mm diameter.
Making the Right Choice
For leg veins 0.5-3mm, sclerotherapy remains the gold standard with superior efficacy and lower cost. For facial veins, laser is preferred. For very fine matting or resistant vessels, laser is the effective alternative. Combination approaches may be used for comprehensive treatment.
Pre-Treatment Assessment
Before treating spider veins, underlying venous incompetence must be excluded with duplex ultrasound. Treating spider veins without addressing the source of venous reflux leads to rapid recurrence. If saphenous or perforator reflux is identified, this should be treated first.
Frequently Asked Questions
Will treated spider veins come back?
Successfully treated veins do not return. However, new spider veins can develop over time due to ongoing risk factors such as genetics, hormonal changes, and prolonged standing. Annual maintenance treatments may be beneficial.
Is sclerotherapy or laser painful?
Sclerotherapy causes mild stinging similar to a mosquito bite. Laser produces a snapping sensation with each pulse. Both are well tolerated without anaesthesia. Numbing cream can be applied for sensitive areas.
Can spider veins indicate a more serious problem?
Yes, they can signal underlying venous insufficiency affecting larger veins. We recommend duplex ultrasound before treatment. Symptoms such as leg swelling, aching, heaviness, or skin changes suggest deeper venous issues requiring priority attention.
How many treatment sessions will I need?
Most patients require 2-3 sclerotherapy sessions or 2-4 laser sessions for satisfactory results. Sessions are spaced 4-6 weeks apart. The number depends on the extent and density of spider veins and individual response to treatment.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results vary. Always consult a qualified medical or aesthetic professional for personalised advice.
This content is provided for informational purposes only and does not constitute medical advice. Individual results may vary. Always consult with a qualified medical professional before undergoing any treatment. All treatments carry potential risks and side effects which will be fully discussed during your consultation.
Medical Disclaimer: This content is provided for informational purposes only and does not constitute medical advice. Individual results may vary. Always consult with a qualified medical professional before undergoing any treatment. All treatments carry potential risks and side effects which will be fully discussed during your consultation.