Treatment for Leg 'Thread Veins'
Questions and answers about Thread Vein Removal

Fine red or purple blood vessels lying in the surface layers of the skin are often referred to as thread veins or spider veins. This is a misnomer as they are not veins but dilated capillaries, the finest blood vessels in the body. These vessels are normally so fine that they are not visible to the naked eye and only become when they dilate to 2 or 3 times their normal size. The cause of the dilatation is not known but is commoner in women, often runs in families and is made worse in pregnancy.

It is not possible to prevent thread veins from appearing but they can be removed. If varicose veins are also present they should be treated first with either injection sclerotherapy or surgery.

Thread veins on the legs are usually best treated by injection using a very fine needle; this is called microsclerotherapy. A sclerosing solution is injected into the blood vessel which causes the vessel walls to stick together so that blood can no longer flow. The redundant vessels are then slowly absorbed by the body’s own immune system.

Sometimes it may be necessary to use a laser or a combination of mirosclerotherapy and laser therapy to treat leg ‘thread veins’.

Microsclerotherapy for leg ‘thread veins’

Here are some of the important facts you need to know regarding treatment

• No specific preparation is required but you should not take aspirin or non steroidal anti inflammatory drugs (eg Brufen) for 7 days prior to treatment
• Anticoagulant medication is contraindicated and you should advise the doctor or nurse about any medication you may be taking.
• Treatment should not be undertaken during pregnancy
• When an injection is administered a sharp pricking sensation may be experienced.
• After treatment the skin may be slightly red and inflamed, but this will subside within a few days. Bruising may also occur which will resolve spontaneously after approximately 2-3 weeks.
• Allergic reactions can occur with any medication but are relatively rare with microsclerotherapy. Please inform the doctor or nurse about any known allergies you may have
• Your legs will look worse for about 3-4 weeks after the treatment so don't do it just before you go on holiday!
• Treatment normally takes about 30 minutes but does depend on how many injections are required
• A single treatment will normally remove approximately 60% of vessels injected and therefore a course of treatments is usually required i.e. between 3-5 at 4 weekly intervals.
• No guarantee can be given that all vessels will be removed; you will be given a realistic expectation of what can be achieved at your initial consultation
• Microsclerotherapy can result in small areas of ulceration around the injection site, which can result in a small scar, every effort is made to minimise this risk.
• Brown staining can occur from the iron contained in the red blood cells, this is usually temporary lasting up to 6 months but in rare cases can be permanent.
• No bandages are needed after treatment, but small cotton wool balls will be stuck on for 24 hours to prevent bleeding and excessive bruising.
• You should not exercise vigorously after treatment for 24 hours but otherwise can continue a normal lifestyle
• Treatment will remove existing vessels but will have no effect on the appearance of new ones

Laser treatment of leg ‘thread veins’
Very fine thread veins or spider veins on the legs may sometimes be amenable to laser treatment as are spider veins on the face. Sometimes a combination of microsclerotherapy and laser treatment may be recommended in order to achieve optimum results.

How does the laser work?
The laser emits light of a specific wavelength, or colour, that is specially selected so that when it is directed into the skin, it can target the visible blood vessels. These blood vessels absorb the light, which causes them to heat up and undergo a process called thermocoagulation. This destroys the entire vessel while causing minimal damage to the surrounding skin. Following treatment, the damaged vessels are absorbed by the body and little or no trace of the initial lesion remains.

How is the treatment carried out?
The laser is placed directly over the offending blood vessels and then a pulse of light is fired from the laser onto the blood vessel. This should cause the vessel to blanch, fade or ‘grey’, depending upon which laser is used. The laser is then moved along the length of the vessel so that the whole vessel is treated. During treatment you must wear protective goggles to protect your eyes from the laser light.

Which patients can be treated?
Many laser systems can not be used to treat dark skins because the light emitted by the laser will be absorbed by the melanin in the skin and will heat the skin up as well as the vessel. However, one of the lasers we use, the Nd:YAG laser, is very gentle on dark skin types, so almost all skin types can be treated with this system. However, very tanned skins should not be treated.

Some vessels are not suitable for laser treatment. Very large vessels (more than approximately 4mm) or varicose veins cannot be treated. Some deep lying or blue veins may require more treatments than smaller red veins. If there are any areas of broken skin, the treatment should be delayed until the area has completely healed.

Does it hurt?
As the light energy is absorbed by the skin, it heats it up, and creates a sharp pinprick, burning sensation. Most patients describe the discomfort as moderate and acceptable. No anaesthesia is usually required.

What should I expect after the treatment?
Redness and a slight burning sensation are normal after treatment. A cooling pack may be applied to the skin to ease these symptoms. You may see a temporary ‘greyness' in the vessels, which will pass, and you might notice that some vessels have disappeared immediately. Around the vessel you might see some bruising or purpura, the extent of which will depend upon which laser is used.

What are the side effects?
A ‘cat-scratch' type reaction occurs in some people along the length of the vessel. Hyperpigmentation, hypopigmentation or blistering may occur, but will generally heal with no long-lasting side effects. If the treated area blisters following treatment, the blistered area should be left alone to heal naturally. It is important to avoid scratching or picking scabs or blisters as this could result in scarring. Very rarely, scarring may occur.

How do I prepare for treatment?
Patients should avoid strong sunlight during the course of treatment and for at least 3-4 weeks afterwards. It is recommended that an SPF 30 is used on treated areas. Tanned skin cannot be treated and patients must not use any fake tan 6 weeks ahead of and during the entire treatment period.

How long does treatment take?
The length of each treatment will depend on the type and size of lesion(s) present, but a typical session will take in the region of 15 to 30 minutes.

How many treatments are necessary?
The length and number of treatments will depend on the type and size of lesion present, but typically 3-5 treatments will be needed. Treatments should take place approximately every 4 to 6 weeks.