By Jessica Cruel– Self
About two years ago, I was shaving my legs when I noticed a series of faint blue lines twisting around my thigh. Of course, the first thing I did was go to Dr. Google to find out how to get rid of spider veins. Some of the recommended home remedies include ginger tea, massage, and even exercise. Here’s the honest truth: That’s all BS. Visible veins aren’t something you can fix at home.
I talked to dermatologists and surgeons who specialize in treating spider veins and varicose veins (the larger, raised veins in the leg). What I learned is that these visible veins that typically appear on the legs are hereditary (thanks, Mom), but they can also be a sign of a much deeper vein problem that no home remedy is likely to fix. Here are the facts about visible veins and how to get rid of them.
There are two types of visible veins—spider veins and varicose veins.
Spider veins are the most common type of visible vein. “Spider veins are really small superficial veins that are in the outer layer of skin between the dermis and epidermis, so you can see them,” Christopher Hollingsworth, M.D., a vein surgeon at NYC Surgical Associates, tells SELF. “If you live long enough, most people are going to get them.” Bummer. These veins get their name because they look like thin, weblike blue and purple lines on the legs.
Varicose veins are larger veins that are deeper in the body. “You won’t see them as a discoloration, you’ll see them when they get so stretched out that they kind of bulge,” says Dr. Hollingsworth. Varicose and spider veins are connected. Patients who have varicose veins almost always have spider veins, too. However, some people get spider veins and never have a problem with varicose veins.
To understand why these visible veins happen, you’ve got to understand how blood flows through the body.
Get ready for a quick anatomy lesson. Your heart pumps blood to your entire body through your blood vessels. Blood circulates outward towards the extremities (legs, arms, head) through the arteries and back inward to the heart through your veins.
“Think of veins as being a hose that flows from bottom up toward your heart,” says dermatologist Alicia Barba, M.D., of Barba Dermatology. “And there’s a little valve. When they work well, the blood shoots up and the valve closes. When it doesn’t work, the blood falls back down instead of moving north.” When blood flows in the wrong direction because of a valve incompetence, it can get backed up in the veins of the legs. This causes spider veins and varicose veins. “About 60 percent of people with spider veins will have an underlying venous insufficiency behind it, and about 99 percent of varicose veins are due to venous insufficiency,” says Dr. Hollingsworth. (Doctors don’t know what causes the 40 percent of spider veins not due to insufficiency, but there’s likely a hereditary link.)
The underlying causes of vein issues are varied—some are preventable or reversible, while others aren’t.
Chronic venous insufficiency can be hereditary, which you have no control over. It can also be caused by things that put pressure on the veins like spending a lot of time on your feet, having a desk job where you sit all day, obesity, or pregnancy.
If you have a job where you are standing still for long periods of time, gravity is at work pulling the blood back down toward the legs, causing the veins to get stretched out and the valves to weaken over time. If you sit all day at your job, you can also start to see visible veins because there is a lack of muscle movement. The muscles in the leg help the veins push the blood back up toward the heart. Note: That rumor that crossing your legs can cause spider veins isn’t true, so go ahead and cross ’em if you like—just make sure that you get out of your chair and move around during the day to get the blood pumping.
Extra weight can also put pressure on the veins. “With obesity, there is fat inside your abdominal cavity between your organs called visceral fat,” says Dr. Hollingsworth. “When your visceral fat increases, it increases pressure inside your abdomen. As the blood is trying to get back from your legs through your abdomen, it reaches an obstruction that isn’t supposed to be there. That increased pressure dilates the veins, which extends all the way through the lower vein bridge and all the way up to the veins in your skin.”
A similar situation happens during pregnancy when the added pressure in the abdomen squeezes the veins. Hormones are also at work. “When women are exposed to excess estrogen or progesterone, what it tends to do is make your soft tissue a little more flexible,” says Dr. Hollingsworth. “That same process, we think, is affecting the veins, making them predisposed to dilate and stretch out.” After pregnancy, the veins generally go away and everything returns to normal. This vein weakening can also happen if you’re taking hormonal birth control.
Left untreated, visible veins can become painful.
“Spider and varicose veins make your legs sore because it’s an inflammatory process,” says Dr. Hollingsworth. “Those veins are getting dilated and stretched out. They’re trying to signal for help in the only way they know how, which is sending off a local inflammatory biochemical that causes your legs to swell and to be sore.”
Treating visible veins isn’t something you can DIY—you’ll need to see a specialist.
Dr. Hollingsworth says that home remedies won’t work. Dry brushing? Nope. Massage? It might feel good, but there won’t be a visible difference. Exercise? Not really. “There’s nothing really that you can do aside from the small minimally invasive treatments we have that is going to make spider veins look any better,” he says. “Creams, ointments, or rubbing aren’t going to make spider veins go away.”
The primary way that spider and varicose veins are treated is by closing off the vein so that it collapses, and the residual scar tissue stops the blood flow completely. Don’t worry, these are all superficial veins, so other healthy veins just take over the circulation.
Sclerotherapy is one of the more popular options for spider veins and varicose veins. A doctor injects a foamy detergent or concentrated saltwater solution into the problematic vein, which irritates the walls of the blood vessel, explains Neil Sadick, M.D., founder of Sadick Dermatology. This causes scar tissue to form, which leads the blood vessel to close. If someone is allergic to the sclerotherapy solution, there are other treatment options.
A vein surgeon or dermatologist might use a laser treatment to heat the vein, causing it to contract and scar over. Hollingsworth uses a hand-held nd:YAG laser (the same machine that can be used in laser hair removal) on small spider veins. Or if it’s a larger varicose vein, a laser is inserted inside the vein using a catheter to stop blood flow.
For varicose veins, doctor’s might also use is the medical version of super glue. “Cyanoacrylate glue is a biologic glue that’s very similar to Krazy Glue,” says Dr. Hollingsworth. Surgeons close off a varicose vein by gluing it shut from the inside. “You inject it, wait for the glue to set and move further down and so on and so on.”
Radiofrequency ablation is another option for varicose veins that are so large that glue and sclero just float away. “RFA runs radiofrequency through the inside of the vein and turns the inside of the vein into a lightbulb filament, heats it up, scars it, and kills it,” says Dr. Hollingsworth.
To prevent visible veins from getting worse, a surgeon might use RFA or internal laser techniques to close off a larger vein deeper in the leg that feeds the smaller varicose veins and spider veins. “There’s a central pipe in the leg called the saphenous vein, it’s the main superficial vein. Coming off those veins are truncal varicose veins,” Dr. Sadick says. Once the larger vein is taken care of, the smaller veins can be treated with sclerotherapy, glue, or a handheld laser.
Those with very serious, bulging varicose veins can have them removed completely once the vein is closed off.
The key is to go to a doctor who specializing in vein treatments, whether that’s a dermatologist or a vein surgeon. There are often vein centers that see hundreds of spider and varicose veins a year. “If you want have anything done, go to whoever does a lot of it,” says Dr. Hollingsworth. The good news is that insurance will cover many vein treatments. “Oftentimes when it is a deeper vein problem insurance covers it because it’s not a cosmetic issue,” says Dr. Barba. Without insurance, these treatments can cost $300 to $8,000.
The procedures are generally quick and painless, but they’re not a perfect, permanent fix.
All of these treatments are done through small micropunctures in the skin, so you can schedule it in the morning and go back to work in the afternoon. But Dr. Barba warns about getting these treatments on darker skin tones, especially laser and RFA. “Patients need to know that it’s not a magic thing that’s risk free and boom it’s going to be gone. There’s always a small risk of pigmenting in skin of color,” she says. “Sometimes the pigmentation is a part of the healing process. If you care about a little spider vein, you might care about the pigment that’s going to be there for a couple months.”
Dr. Hollingsworth points out that treating visible veins with any of these treatments is only a temporary fix. Spider and varicose veins can return in other nearby veins once the original veins are closed off or removed. “If you get them and don’t treat them, they’ll multiply,” says Dr. Hollingsworth. “If you stay on top of them with injections, you can keep them at bay. You just need a touch up every year, every two years.”
There is one way to keep visible veins from returning faster, but you’re not going to like it.
“The cure is graduated compression stockings and nobody likes wearing them. They’re tight, and they’re hard to get on,” says Dr. Hollingsworth. These stockings help push the blood forward toward the heart and don’t allow it to pool back in the legs. “If you wear stockings religiously during the day, they significantly reduce your spider veins coming back. It won’t make them go away, but it will slow the advance significantly.”