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Spider Veins Update: It’s What You Do – and Who You See

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Spider Veins Update: It’s What You Do, Who You See

Spider Veins Update: It’s What You Do – and Who You See

July 31, 2006

By: Jean Johnson for Veins1

“This is the first year for me – these spider veins,” said Sylvia Hammerstein who spoke to Veins1.com from a beach house her and her husband just bought out on the Oregon coast.

Take Action
Self Care Strategies for Keeping Spider Veins at Bay

Put your feet up when you’re resting as much as possible. Ideally, elevating the feet over the level heart is best and inverted yoga postures are excellent, but at the very least elevating the feet on an ottoman or sinking back into a recliner can help.

Take breaks from prolonged sitting or standing and go for a brisk walk. Prolonged standing particularly predisposes people to spider veins.

Do flex and point work with the ankles.

Try resistance training at the gym to keep the calf muscles strong.

Consider head stands or other inverted yoga postures if your physician and your health condition allows.

Wear sunscreen.

Keep your weight down to avoid placing too much pressure on the legs.

Try to avoid crossing your legs.

Avoid tight clothing that constricts the waist or groin.

“I pulled on my shorts one day when we got done here. I hadn’t noticed a thing until I was out on the deck sitting around with the neighbors. Then I looked down and there they were: Four ultra-thin maroonish-blue wiggly lines on the outside of my right thigh just above my knee,” Hammerstein said walking down a sandy path through the dune grasses. “‘Bummer’ I thought at the time. ‘They look like what you see on an old person.’ There’s one on my left leg too in about the same spot.”

Hammerstein tosses a piece of drift wood for the family dog and makes an effort toward taking the indignities of age in stride. “The measly little critters could have had the decency to at least wait until I was retired and living down here at the beach for good,” she said. “By then you know you’re out to pasture. But here I’m not 60 yet, and I don’t even have much gray hair. It would have been nice if my legs had cooperated as well.”

Will she join the 12 million Americans who, according to the American Society of Aesthetic Plastic Surgery, spent almost $12.5 billion on cosmetic procedures in 2005?

“I’m not sure. My mother had them in about the same place as mine are, and they never got very bad for her – just a patch about the size of a quarter or half dollar. So I don’t think they’ll bother me all that much. With me it’s more of a wake up call that I’m getting up there,” she said, reaching her deck and sitting down on the steps to brush the sand off her feet.

Then again, the salt air wafting in on the ocean breeze seems to give Hammerstein pause. “But it is a new era isn’t it? I might check around and see what the going rates are. If the procedure wouldn’t make too great a dent in the reserves I need for the cottage here, who knows, I might go for it. After all, I don’t plan on just beach combing and collecting sand dollars. My husband and I figure we have a good 20 years to give back to society, and I’d like to not look too decrepit.”

The Low-Down on Spider Veins

Spider veins – in medical parlance: telangiectasia or sunburst varicosities – lie close to the surface of the skin and are small, unsightly clusters of red, blue, or purple veins. They are most often seen on the thighs, calves, and ankles; and are caused by the back up of blood in aging veins that don’t have the stamina to overcome gravity as successfully as they once did. Genetics and hormonal factors can influence whether or not a person will develop spider veins, as can exposure to the sun, being overweight or obese, and prolonged standing.

While spider veins appear in both sexes, they are more common in women. Roughly 1 out of 2 people over age 50 have spider veins; 50 to 55 percent of women and 40 to 45 percent of men have them, although the hair on men’s legs often covers the problem. Spider veins are largely an aesthetic issue and usually do not need medical treatment.


The American Academy of Dermatology recommends sclerotherapy as the gold standard for treating spider veins and says patients can expect a 50 to 90 percent improvement. The treatment does not require anesthesia and can be done in a physician’s office. A solution is injected into the tiny veins and causes the vein walls to swell shut and blood flow to stop. Several injections are given to treat the affected area and generally several office visits are needed to treat all the veins in question.

According to the National Women’s Health Information Center, patients who undergo sclerotherapy will often see their spider veins fade after a few weeks. “The treatment is very effective if done the right way.” The Center also notes, however, that treatments do nothing to stop the appearance of new spider veins.

Laser surgery is also used to treat spider veins, but physicians need to be highly skilled in this technique in order to direct the strong bursts of laser energy accurately on the spider veins and not damage adjacent tissue.

“Ice and topical anesthetic help protect the skin and reduce pain,” explains the February 2006 Harvard Women’s Health Watch. “Laser therapy usually requires two to three treatments in a physician’s office and is suitable only for very fine veins. There may be some temporary redness or swelling after the procedure. Like sclerotherapy, laser treatment doesn’t prevent new spider veins from appearing near the treated ones.”

As far as what Harvard Women’s Health Watch calls “quick fixes” available over the Internet and elsewhere, its comment is “don’t waste your money.”

Creams containing Vitamin K, which can reduce bruising after laser treatment of spider veins, does nothing to treat the problem itself. Topical creams marketed to other leg aesthetic treatments have also been under fire.

For example, the Harvard publication noted that “in March of 2005, the FDA warned one company to stop advertising that its supplement, Veinocal, would make 94.6 percent of varicose veins disappear like magic in days. According to the FDA’s warning letter, the company has provided no documentation that the pills are safe or effective. One of the ingredients in Veinocal is horse chestnut seed extract, which has been shown to reduce leg swelling and pain in people who have a condition called chronic venous insufficiency.”

Seeking Professional Care for Spider Veins – It’s Who You See

One thing to be aware of in seeking professional care is that cosmetic procedures like sclerotherapy or laser treatment for spider veins were formerly the purview of dermatologists, interventional radiologists, plastic surgeons or vascular surgeons. More recently however, as patients have been driving the market, increasing numbers of family physicians and ob/gyns are expanding their practices to include a range of cosmetic treatments that are in demand.

The debate centers on whether or not physicians not trained in these areas while in school have the expertise to do the procedures after taking only short courses. On the other side, some argue that patients prefer seeing their regular physician where they have a relationship developed instead of going off to specialists where they are just another semi-anonymous case.

As Stephen Izard, M.D., a family practice physician in Columbia, S.C., told the Washington Post in July 2006, “I saw that there was a need [for a range of aesthetic treatments], and so I decided to give it a try.”

Another Columbia gynecologist, contacted by the Washington Post, expressed similar sentiments. “I began to see that the care of the skin and the care of women overlapped a lot with what we were doing in our office,” said Lily Filler, M.D. “As a woman I know what I want in a doctor’s office. We try to provide that for our women.”

Robert Austin, a patient of Izard’s who spoke to the Washington Post, confirmed that “It made it very convenient. They were right there where I go for my medical needs. And, it was discreet. No one knows what you’re there for.”)

The Washington Post also found other experts to weigh in on the matter. Plastic surgeon John D. Newkirk II, M.D., told the newspaper, “I’m not sure the public is well served by going to anybody whose residency does not include training in those areas. A weekend course in liposuction is inadequate training and experience to allow any physician to carry out that procedure in his or her office.”

For his part, New Jersey gynecologist Marco Pelosi II, M.D., who founded the International Society of Cosmetogynecology and offers training courses for physicians, said “The gynecologist is probably in the most ideal position to provide cosmetic service.” Although Pelosi acknowledges that training needs to be sufficient to handle situations in which something goes wrong or needs modification, he maintains that short courses are adequate.

“It’s all politics, and it’s all about money. It has nothing to do with the practice of medicine,” Pelosi told the Washington Post. “The American Medical Association… states that education, training, and experience are the qualifications needed to be able to practice any procedure, whether it’s brain surgery or taking a hangnail out.”

Who to trust? Luis Navarro, M.D., and founding surgeon at the Vein Treatment Center in New York City told Shape Magazine that consumers should, “Look for a specialist who has the newest tools and is aware of the newest techniques to get the best results.” Additionally Shape recommends visiting the American College of Phlebology’s Web site at www.phlebology.org to find listings of physicians registered with the organization.

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