Varicose, Reticular, and Spider Veins

Varicose, reticular, and spider veins can all cause unsightly blemishes on the legs. Each are different in appearance, but the causes are the same. They are produced by an increase in the venous pressure. Veins unlike arteries have a system of valves to halt the back flow of blood as it is returned to the heart. Veins are not subject to blood pressure like the arteries, this pressure dissipates in the capillary system before the blood transitions to the venous system. Veins require internal pressure from muscle contractions and in some cases gravity to move blood toward the heart, the valves in the veins then catch the blood and make it a one way trip. When the valves fail, blood is allowed to pool and venous pressure increases. As the venous pressure increases the veins expand becoming more visible.  The size and depth of the veins affected will determine the treatment required to resolve the problem.

How Laser Spider Vein Removal Works


The target or chromophore in the laser spider vein removal is the hemoglobin of the blood in the veins.  Therefore, the energy must pass through the layers of the skin through the vein walls to reach the targeted hemoglobin. When the energy from the laser reaches the hemoglobin it gets very hot and cauterizes or destroys the veins eliminating the venous pressure and blood from reappearing in the vein.  Now there are obviously some factors limiting the capabilities of the laser and how effective they can be.  These factors include melanin in the skin, depth and size of the target, and color of the target.  As you have learned from the Understanding Lasers and Laser Treatments page, energy from the laser is highly absorbed by hemoglobin and melanin. Darker complected individuals (increased melanin in the skin) will have more energy being absorbed in the skin and less energy getting to the hemoglobin.  This will increase the heat in the skin above the vein and reduce the energy getting to the hemoglobin in the vein.  Because melanin is what makes people tan, it is not recommended people tan or have any skin dyes (paint on tan) placed on the skin prior to the treatment.

The depth and size of the target affect the energy reaching the target and the amount of energy needed to effectively reduce the appearance of the vein.  Varicose veins are too deep and large for superficial laser systems to effectively reduce the appearance without burning the skin.  Reticular veins are Spider veins are more superficial in the dermal layer and able to be reached with conventional superficial laser treatments.  Laser spider vein removal treatments do require a large amount of energy so we cool the skin before and during treatments.

The color of the spider veins does matter to some degree.  The darker purple veins are easier to treat than the red.  They absorb energy more easily.

As with all treatments there are some risks of complications.  Because we are using increased energy levels, burns and bruising can occur.  Burns are minimized by the pre and post cooling during the procedure.  Because we are treating the symptoms of a greater problem, venous insufficiency, it is not uncommon for other spider veins to form over time.

Varicose Veins

Varicose veins are deeper, larger, contorted, and typically less colored. Because these veins are deeper and less colored, varicose veins can NOT be treated superficially with a laser. The Sclerotherapy or endovenous thermal ablation treatments are used to destroy these veins from the inside. Sclerotherapy requires a chemical to be injected into the vein, this chemical then reduces the pressure in side the vein and the bulge disappears. Endovenous thermal ablation requires a laser to be inserted into the vein so it can cauterize internal walls the vein.

Reticular Veins and Spider Veins

In the treatment of reticular and spider veins, the parameters on the laser must be set at a higher level than some other treatments. These treatments require cooling of the skin prior to and after each burst of the laser. This protects and numbs the area. These treatments can cause mild pain, but do not require anesthesia. There is no down time or post operative care normally. During the treatment of reticular or spider veins, the laser passes through the superficial skin to the vessels. Spider veins are from 0.5mm to 1.5mm and red, blue, or purple color, this hemoglobin absorbs the energy from the laser and cauterizes the veins.  Reticular veins are larger 1mm to 4mm in diameter, deeper and usually blue/purple.  It is not uncommon to have a browning or hyperpigmentation in the treatment area. These can be made worse with sun exposure, it is important to limit sun exposure after these treatments by clothing or using 50 SPF sunblock.

Laser Spider Vein Removal Expectations

  • Patients will normally need 2-3 treatments to get 80% resolution.
  • Redness and raised tissue surrounding the vessels is expected
  • Bruising is expected for the first few weeks
  • Small mild blisters are undesirable but may occur
  • Thrombosis or hardening and darkening of the vessels is expected for larger veins- these will be absorbed over time
  • Hemosiderin a biproduct of the hemoglobin will darken the skin and slowly fade over time- this may require many months.

Spider Vein Treatment and Pricing

As with many conditions laser spider veins come in many varieties of severity and surface area coverage.  This requires a common sense approach when determining pricing for treatments.  Someone who has spider veins the size of a playing card should not pay as much as someone who has 3 times that surface area.  You will see many specials or deals offered on discount websites, most of these are for limited areas and only include certain areas.  It is very important to get these questions answered prior to purchasing any treatment package.  Because their is no one size fits all for spider veins we offer a free consultation to those who are serious about reducing the appearance of their spider veins. 

Important Documents for Laser Spider Vein Removal