Visible thread veins on the legs, also called telangiectasias, are small superficial blood vessels that appear red, blue or purple. They may be primarily an aesthetic concern or occur alongside reticular veins, varicose veins or venous insufficiency. Treatment is therefore chosen after a phlebological assessment, rather than assuming that all spider veins are the same problem.
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Leg spider veins: before and after comparisons
Photographic comparisons relating to the treatment of leg spider veins at Centro Medico Gargano in Naples. Before on the left, after on the right. Tap the photographs to enlarge them.
The photographs document individual cases. Position and lighting may differ between photographs; results vary from person to person.
Why an assessment before treatment is useful
Looking at the skin alone does not always reveal the origin of visible vessels. Some telangiectasias are isolated; others may be fed by reticular veins or associated with venous reflux. The consultation assesses their distribution, size and depth, and the characteristics of the skin. If sclerotherapy at Centro Medico Gargano is being considered, a vascular assessment with venous colour Doppler ultrasound is carried out beforehand to examine the venous circulation properly and plan treatment.
Sclerotherapy and VeinGogh: how the technique is chosen
Treatment with spider vein sclerotherapy involves injecting a sclerosant medicine into selected vessels. Different approaches may be used for telangiectasias, reticular veins and some superficial varicose veins. VeinGogh uses thermal energy to treat small, very superficial vessels selectively. In some cases, the two methods can be combined; in others, it is preferable to use a single technique or postpone treatment.
The choice depends on the location, diameter and depth of the vessels, the presence of feeding veins, skin sensitivity, skin phototype, previous treatments and the overall venous condition. No method is automatically the best for everyone.
VeinGogh for spider veins: a closer look at the procedure
Dr Ciro Gargano demonstrates a stage of spider vein treatment with VeinGogh.
Original commentary by Dr Ciro Gargano in Italian. The text below is a summary of the video.
Video summary: The video illustrates a technique that differs from sclerotherapy. The treatment choice is determined through an individual assessment.
Facial thread veins in Naples: VeinGogh treatment
At Centro Medico Gargano in Naples, VeinGogh treatment is considered for fine, superficial facial thread veins. The device delivers microbursts of high-frequency electrical current through a very fine probe to produce targeted thermocoagulation of small blood vessels.
Discomfort may be felt during treatment, and redness may develop afterwards; there is also a risk of scarring. The number of sessions and the response to treatment vary from person to person. New thread veins may develop over time, and the doctor assesses whether further treatment is appropriate.
Further information: VeinGogh technology; the manufacturer’s patient information.
The photographs document individual cases. Position and lighting may differ between photographs; results vary from person to person.
How many sessions may be needed
The number of sessions cannot be reliably determined without an assessment. It may depend on the extent of the spider veins, the individual’s response, the type of vessel and the agreed goal. Improvement is generally gradual and may require follow-up or further sessions. Even after a good result, new spider veins may appear over time because treatment does not remove the individual’s predisposition.
Possible adverse effects and limitations
Temporary redness, small bruises, local tenderness, vessel hardening or pigmentation may occur after treatment. The frequency and type of adverse effects depend on the technique and the patient’s characteristics. Less common events should be discussed during informed consent. It is not appropriate to promise complete freedom from pain, complete removal in a single session or a permanent result.
The pathway at Centro Medico Gargano
Assessment is carried out by Dr Ciro Gargano. Following the clinical examination, he advises whether it is appropriate to treat the visible vessels, investigate the venous circulation further or take a different approach. For an overview of venous conditions and the consultation, see the page on phlebology in Naples.
Frequently asked questions about spider veins and telangiectasias
Answers to frequently asked questions about spider veins on the legs and face, EcoColorDoppler assessment, sclerotherapy and VeinGogh at Centro Medico Gargano in Naples.
What are “broken capillaries”, and how do they differ from varicose veins?
Telangiectasias, commonly called spider veins or visible capillaries, are dilated small superficial blood vessels that appear as red, bluish or purple lines or branches. The expression “broken capillaries” is inaccurate: the vessels are dilated, rather than necessarily broken. Reticular veins are slightly larger and generally bluish; varicose veins involve larger veins that are often twisted and raised above the skin.
Why do spider veins appear on the legs?
Several factors contribute to the development of telangiectasias. These may include a family predisposition, hormonal changes, pregnancy, increasing age and excess weight. Spending many hours standing or sitting can also contribute to venous problems. In some cases, spider veins are associated with reticular veins or venous insufficiency, but this association is not always present.
Are visible spider veins only a cosmetic concern?
They are often mainly a cosmetic concern, particularly when they occur in isolation and cause no symptoms. However, they may be associated with other venous changes. Pain, heaviness, swelling, skin changes or bleeding warrant a medical assessment. These symptoms should not automatically be attributed to spider veins: their cause needs to be identified.
Is an EcoColorDoppler scan needed before sclerotherapy?
At Centro Medico Gargano, a vascular assessment with a venous EcoColorDoppler scan is performed before sclerotherapy for leg spider veins. This non-invasive examination assesses blood flow and can identify venous reflux. The findings help plan treatment and take account of any associated venous abnormalities.
How is the choice between sclerotherapy and VeinGogh made?
Sclerotherapy involves injecting a medication into selected vessels to close them. VeinGogh uses thermal energy to treat very small superficial vessels. The choice depends on their location, size and depth, the characteristics of the skin and the overall venous condition. The two techniques can be used individually or combined, when indicated.
Is sclerotherapy painful? Does it require anaesthesia?
Sclerotherapy is a minimally invasive outpatient procedure, generally performed without anaesthesia. Very fine needles are used, and a prickling sensation or brief burning may be felt during the injection. Sensitivity varies from person to person. Any intense pain should be reported to the doctor immediately.
How many sessions are needed, and when do results become visible?
The number of sessions depends on the extent of the telangiectasias, the characteristics of the vessels and the individual response. Improvement is gradual: after sclerotherapy, the vessels may fade over the following weeks, while some areas need more time. The treatment plan is established during the consultation and reassessed at follow-up visits, without promising a fixed number of sessions.
What side effects can occur?
After sclerotherapy, small bruises, redness, local discomfort, hardening of the treated vessels and skin pigmentation may occur; pigmentation can sometimes persist. Matting, the appearance of a network of very fine spider veins, is also possible. Complications such as skin injury, significant allergic reactions or thrombosis are less common. Risks and contraindications are assessed before treatment.
When is the best time to treat spider veins, and what precautions are needed?
Cooler months can make sun protection and, when prescribed, wearing compression stockings more manageable. However, there is no single time of year that is right for everyone: scheduling depends on the technique and the patient’s habits. After the session, the doctor provides advice on sun exposure, physical activity and compression. Many everyday activities can generally be resumed within a short time.
Can spider veins reappear after treatment?
Treatment acts on existing vessels, but does not remove the predisposition to develop others. New telangiectasias may therefore appear over time, even after a good initial result. Any further treatment is assessed according to changes in the condition and the patient’s needs. A permanent result cannot be guaranteed.
Can visible small veins on the face also be treated?
Yes, after assessing their characteristics and any associated skin conditions. At Centro Medico Gargano, VeinGogh is considered for small superficial facial vessels. The response and number of sessions vary between individuals; possible side effects, including the risk of small scars, should also be discussed.
Can creams and natural remedies eliminate spider veins?
Creams, supplements and natural remedies have not been proven effective at eliminating existing telangiectasias. They should therefore not be presented as equivalent to procedures that act directly on the vessels. Before choosing a treatment, the characteristics of the spider veins and the condition of the skin should be assessed.
What can help limit the development of new spider veins?
Walking regularly, taking breaks from long periods of immobility and maintaining an appropriate weight support venous return. Graduated compression stockings can improve certain symptoms when recommended by the doctor, but they do not eliminate existing spider veins or guarantee that new ones will not appear. No preventive measure completely removes an individual’s predisposition.
Reference sources
The general information is consistent with the ESVS guidelines on chronic venous disease of the lower limbs and NICE guidance on the diagnosis and management of varicose veins. Clinical decisions remain individual and are made during the consultation.
FAQ references: the Cochrane review of treatments for telangiectasias and patient information from the American Academy of Dermatology and the American Society for Dermatologic Surgery.
