Spider Veins: How They Are Removed and Why They Come Back

Patients frequently come to see me at M-Clinic in Tashkent with the same request: «Doctor, please get rid of these spider veins — I'm so tired of them». And every time I explain the same thing: removal is possible, but first we need to understand where they come from. Because if the underlying cause is not addressed, they will return — sooner or later.

What Spider Veins Are and Where They Come From

Spider veins are dilated small vessels beneath the skin: capillaries, venules, arterioles. The medical term is telangiectasias. On their own they are not dangerous, but they often signal that something in the venous system is not functioning as it should.

They appear for a number of reasons:

• hereditary predisposition to weakness of the vessel wall;
• hormonal changes (pregnancy, use of contraceptives, menopause);
• prolonged static loading — standing or sitting jobs;
• excess weight;
• venous reflux — reverse blood flow through the veins, which creates elevated pressure in the small vessels.

That last point is the key one. That is precisely why I insist on vein duplex ultrasound before any cosmetic treatment.

Why Ultrasound First, Treatment Second

This is not a formality or a way to «charge for something extra». Vein duplex ultrasound makes it possible to see what the naked eye cannot: whether there is reflux in the great or small saphenous vein, whether the valves are functioning properly, and whether there are varicose tributaries feeding those very spider veins from below.

If reflux is present and we proceed straight to removing the spider veins, they will return within a few months — because the pressure has not gone anywhere. The source must be eliminated first — the varicose veins closed — and only then should we address the cosmetic issue.

The rule is simple: treat the cause, then the consequence. Otherwise time and money are wasted.

If the ultrasound shows normal findings, we can proceed directly to spider vein removal.

Removal Methods: What Works Best

Several methods are currently available:

1. 1Microsclerotherapy — injection of a sclerosing agent through a fine needle directly into the vessel. The gold standard. Effective, accessible, and well tolerated.
2. 2Laser coagulation — application of a light pulse through the skin. Well suited to very small vessels with a diameter of up to 0.3 mm that are difficult to cannulate with a needle.
3. 3Combined method — sclerotherapy + laser. Used when vessels vary in calibre.

I most often use microsclerotherapy — it allows precise work with each individual vessel and delivers predictable results. I add laser where a needle is technically unsuitable.

How a Microsclerotherapy Session Proceeds

There is nothing frightening about it. The patient lies on the treatment table, and I inject a small amount of sclerosant directly into the vessel using a fine needle (0.3–0.4 mm). The agent damages the inner wall, the vessel collapses, and over the following weeks it is gradually reabsorbed.

Key points to know:

• the session lasts 20–40 minutes depending on the area to be treated;
• anaesthesia is generally not required — discomfort is minimal;
• compression stockings are put on immediately afterwards and should be worn for 3–7 days;
• slight darkening at the injection sites is possible in the first few days — this is normal and resolves on its own;
• physical activity is encouraged; saunas and tanning beds are prohibited for 2–4 weeks.

Before the procedure, be sure to inform your doctor of any medications you are taking — particularly anticoagulants — and of any allergies.

How Many Sessions Are Needed

The honest answer: it depends on the area and the number of vessels. A defined zone can be treated in one session, but not everything at once — otherwise the burden on the body becomes excessive.

On average:

• a small area (for example, the inner thigh) — 1–2 sessions;
• widespread spider veins on both legs — 3–5 sessions at intervals of 3–4 weeks;
• when combined with varicose veins, we close the veins first and then address the spider veins — this is a separate stage.

I assess the result 6–8 weeks after the final session: that is how long it takes for the vessel to disappear completely.

Why Spider Veins Come Back

The most common question after treatment. Here are the honest reasons:

• Reflux has not been eliminated. If varicose veins or valve insufficiency are present, the pressure continues to act on the small vessels — they dilate again.
• Hormonal status. During pregnancy or hormonal therapy the risk of new spider veins appearing remains.
• Lifestyle. Prolonged standing, excess weight, and lack of movement all put strain on the veins.
• Heredity. If a predisposition exists, new vessels may appear in other locations — this is not a recurrence, but new elements forming.

Correctly performed treatment eliminates the treated vessels permanently. However, it does not confer immunity against new ones. This is why ongoing monitoring is important, and maintenance sessions once every one to two years may be needed.

When to Book an Appointment

If you are concerned about spider veins on your legs — spider veins, vascular networks, or red or bluish streaks beneath the skin — I recommend not putting off an examination. This is especially true if you experience heaviness, swelling by the evening, or a feeling of fullness in the legs: these are already reasons to have your veins evaluated more thoroughly.

If redness, hardening, or sudden pain along a vein develops against a background of varicose veins, see a doctor that same day — do not wait.

You can book an appointment with me at M-Clinic (Tashkent) by calling +998 99 883-93-21. If getting there is difficult, please ask about a home visit: in certain cases an initial consultation and vein duplex ultrasound can be carried out at your location. Further details are available on the website phlebo.uz.

This article is for informational purposes only and does not replace a consultation with a qualified physician. If you are experiencing symptoms, please see a specialist.