What are leg thread veins?
Thread veins and spider veins become a cosmetic nuisance when they become unsightly and is a broad term for a number of different types of prominent leg veins. In some cases thread veins can cause symptoms including pain and itchiness. The gold standard treatment for thread veins on the legs is microsclerotherapy carried out by an expert and highly experienced practitioner.
It is important with all types of leg veins including thread lines, that patients have a duplex ultrasound scan to exclude valve dysfunction in the deep and large veins of the leg. Patients who have treatment for thread veins in the presence of underlying and untreated valve dysfunction then inevitably the thread veins will recur and / or demonstrate a poor response to thread vein treatment. Sometimes smaller thread veins can be fed by flat feeding vessels also known as reticular veins which are larger and have a bluish appearance compared to the smaller spidery and red coloured thread veins. The presence of these larger reticular veins can often only be detected with an ultrasound scan and if they are confirmed to be present then they should be treated first with foam sclerotherapy. An alternative treatment for reticular veins is long pulse Nd:YAG laser.
It is important to choose a microsclerotherapy provider who only injects medical-grade prescription-only sclerosants prescribed by a doctor with treatment either carried out by or under close medical supervision in a regulated environment. It is common to have sclerotherapy injections carried out in beauty salons and medispas using cheap and ineffective sclerosants by untrained beauticians. Techniques such as IPL are also relatively ineffective for the proper treatment of thread veins and are better suited to the treatment of facial thread veins.
At Centre for Surgery, our practitioners are expert in thread vein treatment for effective and long-term eradication. Unlike treatment for larger varicose veins which can be effectively eradicated in either one or two treatments, thread vein treatment often requires more treatments over a longer period of time for effective clearance.
Types of prominent leg veins
Thread veins or Spider veins
Spider veins are by far the most common type of prominent leg veins that are seen by dermatologists at Centre for Surgery. These veins are darker in colour, often a purple or black colour and measure no more than 0.5 – 1.5mm in width. These veins are treated very effectively using a combination of microsclerotherapy and laser.
Reticular veins are the flattened feeding vessels that are amenable to treatment with sclerotherapy as they are linked to the smaller spider veins. The treatment of spider veins is likely to fail if these larger reticular veins are not effectively sealed off. Reticular veins usually require a higher concentration of sclerosant or may require foam sclerotherapy for treatment of very large vessels.
Varicose veins are very large calibre leg veins that bulge outwards creating a very unsightly cosmetic appearance. Varicose veins can also be a cause of symptoms including leg aching and discomfort. The appearance of the veins often resembles the veins found in very muscular men who actively lift weights. In the case of varicose veins, they appear almost exclusively in the legs.
Treatment of leg thread veins
At your consultation, your practitioner will first undertake a thorough history and examination to diagnose the exact type of prominent thread veins you may have followed by a duplex ultrasound scan to rule out valve failure in the deeper veins of the leg. Our dermatologists are expert in the treatment of both spider veins and reticular veins.
For appropriately sized veins, the mainstay of treatment for these two types of prominent leg veins are microsclerotherapy and long pulse Nd:YAG laser for an effective clearance of the unsightly leg veins.
Most prominent leg thread veins need a number of treatment sessions for adequate clearance and this will depend on their extent, size and where the leg veins are located. Most people will require between one and three sessions and in most cases, a 90% improvement can be achieved.
The treatment of varicose veins is different to treatment of spider veins and reticular veins. Varicose veins need treatment using a more invasive technique carried out by a vascular surgeon or radiologist. There are a number gold standard method of treatments for varicose veins including Endovenous Laser Ablation, or EVLA, foam sclerotherapy and vein avulsions / phlebectomies. EVLA is carried under ultrasound guidance and is an outpatient procedure carried out under a local anaesthetic. Centre for Surgery are unique in being able to offer a comprehensive leg vein treatment service covering all types of leg veins by our vascular specialists in London.
When considering leg vein treatment, it is important to bear in mind that legs veins are not easy to treat. This is due to the recovery potential of the veins. Treated leg veins are slow to heal due to the vascular supply to the leg which is less good compared with other areas like the face. It may therefore be sensible to plan your leg vein treatment during the winter or spring months so you are fully ready for the summer months. Treatment courses can up to three months for optimum clinical effect.
When is it best to have leg vein treatment?
It is important to consider the optimal timing for leg vein treatment to achieve best results with the minimum of risk. Selecting the right patients for the correct treatment at the right time is crucial as always bit especially so with leg vein removal. Doctors who try to remove very fine spider veins which measure 0.3mm in width or less are unlikely to achieve good results as it often impossible to insert the sclerotherapy needle into such a fine vessel. Laser can also be ineffective as these very small vessels require the selection of laser parameters with high energies to address these smaller vessels. The risks of using higher energies for tiny vessels less than 0.3mm in width include the risk of scarring and discolouration, leading to a potentially worse appearance than before.
Our dermatologists recommend that if you have to look closely at your legs at less than 30cm distance to see the leg veins then it is likely to be too early to see a leg vein specialist. It is best to wait until they become more larger.
The ideal laser for leg vein removal
It is commonly thought that a laser works well for a wide variety of skin concerns. In reality a laser is often great at treating only a very narrow range of skin concerns due to its single wavelength. Different types of lasers work well for different kinds of skin conditions. At Centre for Surgery we have the full range of laser devices for comprehensive treatment of most if not all common skin concerns. The gold standard laser in the treatment of leg veins is the long pulse Nd:YAG laser. No other laser comes close to achieving the results attained from the Nd:YAG laser in the treatment of leg veins. This includes diode lasers, pulsed dye lasers and KTP lasers. Many non-medical clinics will attempt to treat leg veins with low powered IPL devices. This approach is doomed to failure in most if not all cases and with a risk of skin damage if treatment is carried out in unqualified hands.
Leg thread vein removal before and after
Risk and complications of leg vein treatment
- Post-inflammatory hyperpigmentation. PIH is the most common complication after leg vein removal but in the vast majority of cases, it settles within a few months provided the legs are kept out of sunlight. The risk of PIH can reduced by wearing well fitting compression stockings continuously for the first 3 days following treatment. PIH can develop following both microsclerotherapy and laser vein removal.
- New vessel formation or matting. This complication develops when the body reacts to leg vein destruction by forming new smaller veins in the vicinity of treatment and can happen after both microsclerotherapy and laser treatment. These new smaller veins often settle and disappear without active treatment after a few months. Persistent small veins can be efficiently removed with long pulse Nd:YAG laser.
- Skin breakdown / ulceration. This is a rare complication of microsclerotherapy but does not occur with laser treatment. Ulceration occurs when the sclerotherapy liquid enters a small artery and not a vein. This occurs more commonly at the ankle as the the arteries and veins are often in closer proximity to one another in this region. Our specialists will often prefer to use laser treatment for leg vein removal in these areas to avoid this risk. Ulcers once formed can be a cause of discomfort and take about 6 weeks to heal completely. Any resultant scarring is often inconspicuous and often no larger than 3-4 mm.
- Deep vein thrombosis. This risk only applies to microsclerotherapy treatment only. Thankfully it is a rare occurrence (less than 1 in 1000) and is related to the following risk factors: patients who smoke, use of the combined oral contraceptive pill, those who are overweight or obese, those with a personal or family history of DVT, patients with cancer or are undergoing cancer treatment, diabetic patients.
- Burns. The risk of burns arises from the use of laser treatment. It does not occur with microsclerotherapy. Avoidance of this risk os related to skill with laser treatment which is why it is important to choose a practitioner with plenty of experience in using laser for leg vein removal.
- Tissue staining caused by haemosiderin. This is a rare complication caused by leakage of iron containing pigment from veins that have been previously treated. It takes time to appear and is often appears as a permanent bruise over the area of treatment. Although it can develop as a result of treatment with both microsclerotherapy and laser, it is more common with microsclerotherapy treatment.
What does thread vein removal involve?At Centre for Surgery we offer the most effective treatments for leg thread veins including both sclerotherapy and laser thread vein removal.
Microsclerotherapy treatment involves using tiny microneedles to precisely inject a sclerosing agent into the affected veins. This results in the veins initially fading followed by their disappearance. The improvement in appearance is often immediate and comes with an associated relief in symptoms such as leg ache. It may take up to 3 months for the final results to become evident. In many cases, the veins will continue to improve for up to one year. Treatment is customised to each patient and a number of treatment sessions may be needed depending on the number of veins and their distribution on the leg. In most cases, between three to five treatments are optimal to get the best results.
The Fotona Nd:YAG laser can also be used for laser thread vein removal on the legs. In many cases, laser thread vein treatment may be more appropriate when small spider veins prededominate and these can be difficult to treat with microsclerotherapy as they are too small to insert the needle accurately. The use of the laser involves the targeting of veins with intense laser energy deep into the skin to target the blood within the veins. The laser energy causes the blood to coagulate which leads to a diversion of blood flow to veins found deeper within the leg which is the correct pattern of blood flow in normal legs.
When can I see results from thread vein treatment?It is common to observe almost instantaneous results during both microsclerotherapy and laser treatment for thread veins. Although the initial result is very impressive, these veins quite quickly fill again with blood and permanent disappearance often takes anything from a few days to a couple of weeks. During this period it is common for the thread veins to look worse than what they were before treatment due to the development of a haemorrhagic blister but these go on to settle after a period of time.
How long do results last?Once the leg thread veins have been eliminated either via microsclerotherapy or laser treatment, they should not recur. It is important to bear in mind that new leg thread veins can develop in other parts of the leg and there are a number of recognised causes of new leg veins. These include pregnancy, jobs that involve standing on your feet for long periods of time, weight gain and hormonal changes.