What spider veins are
Spider veins — telangiectasias, medically — are tiny vessels just beneath the surface of the skin that have dilated enough to become visible. They are typically under a millimetre across, red or blue-purple, and arranged in the branching or web-like pattern that gives them their name. They are flat, unlike varicose veins, and they sit in the skin rather than bulging above it.
They are extremely common, particularly in women, and the tendency runs strongly in families. Pregnancy, long periods of standing, hormonal changes and sun exposure on the face all contribute.
The question worth asking first
Spider veins are frequently treated as a purely cosmetic problem, and often that is exactly what they are. But a proportion of them are the visible end of a larger plumbing problem higher up the leg — a vein whose valves have failed, pushing pressure downward into the small surface vessels.
There are clues: clusters concentrated around the ankle or inner calf, legs that ache or feel heavy, a pattern that keeps returning after treatment, a family history of varicose veins. Where those are present, Dr. D’Alessio will map the leg with duplex ultrasound before treating anything, because injecting surface veins fed by an untreated source is a course of treatment that works and then undoes itself.
Where they are absent, the ultrasound is unnecessary and will not be suggested.
Sclerotherapy, in practice
Sclerotherapy is the standard treatment and has been for decades. A very fine needle delivers a small amount of sclerosant solution directly into the vein. The solution irritates the vein’s lining, the walls seal together, and over the following weeks the body breaks the closed vessel down and absorbs it. Blood reroutes through healthy veins nearby — there is no shortage of them, which is why removing a vein costs the leg nothing.
A session takes about thirty minutes depending on how much ground there is to cover. You lie down; there is no anaesthetic, no incision and no stitches.
What it looks like afterwards
Honestly: worse before better. The treated veins usually darken and look bruised for two to four weeks, and this is the part patients are least prepared for. The colour then fades and the vein disappears over roughly four to eight weeks. Larger vessels can take longer, and some need a second pass.
You will be given compression stockings and asked to wear them, to walk, to stay out of hot baths and saunas for a couple of days, and to keep the area out of direct sun while it settles — sun on a healing vein can leave a brown mark that outlasts the vein itself.
What this practice will tell you
If your spider veins are cosmetic, we will say so and treat them as a cosmetic procedure with a cosmetic price. If they are the surface expression of venous disease, we will say that too, and explain what treating the cause involves before you spend anything on the symptom. Those are different conversations and they should not be blurred together.