Thread Veins on the Face and Legs (Spider Veins): Why Do They Appear, and How Are They Treated?

What are thread veins?

Telangiectasia is when small blood vessels close to the skin surface widen and become visible for a long time. These vessels can form fine lines, net-like branching patterns or small spider-like clusters radiating out from a centre. Their colour can range from red to purple and blue.

Thread veins on the face are seen most often on the sides of the nose, the cheeks and the chin. On the legs, they appear on the thighs, around the knees and on the calves. Beneath some of the fine veins on the legs there may be larger, blue-green feeder veins.

Why do they appear?

• Genetic predisposition: a family history of thread veins or varicose veins is common.
• Sun damage: blood vessels become more visible in facial skin that has been exposed to the sun over many years.
• Rosacea: thread veins are common in this disease, which involves facial redness and flushing.
• Hormonal changes: thread veins may increase during pregnancy and some hormone treatments.
• Standing or sitting for long periods: can increase the pressure in the leg veins.
• Venous insufficiency: when the valves in the leg veins do not work well, blood flows backwards; this can lead to thread veins and varicose veins.
• Age, excess weight, frequent and severe flushing, injury to the area and applying cortisone creams to the face for a long time

Widespread and rapidly increasing thread veins, or many spider-like vessels elsewhere on the body as well, can rarely be a sign of other health problems such as liver disease or certain inherited blood vessel disorders. In this case, consult your physician.

Thread veins on the face and the link with rosacea

If, on the face, especially on the nose and cheeks, thread veins come together with persistent redness, frequent flushing, burning or acne-like bumps, this picture may be due to rosacea. In this case, treating the vessels alone is not enough; the disease itself also needs to be assessed and treated. For details, see the article “Rosacea”.

Redness on the face is not always caused by blood vessels. For conditions that can be confused with pigmentation, the article “Dark Spots and Melasma” may also be helpful. For a correct diagnosis, it is advisable to see a dermatologist.

Treatment options: an overview

Thread vein treatment is usually done for cosmetic reasons. Which method is suitable depends on the location and size of the vessel, your skin colour and whether there is an underlying vein problem. Treated vessels can disappear; however, because the predisposition remains, new vessels may form over time and repeat treatment may be needed.

Laser and IPL on the face

Vascular lasers and IPL target the colour of the blood inside the vessel. The light energy turns into heat, and over time the vessel closes and is cleared away by the body. Several sessions are usually needed, with weeks between sessions.

After the procedure there may be redness and swelling for a few days, and with some types of laser, bruising. Occasionally there may be burns, blistering, changes in colour and scarring. These risks are higher on tanned or dark skin; that is why sun protection before and after treatment is important.

Sclerotherapy and laser on the legs

In sclerotherapy, a medicine that irritates the vessel wall is injected into the vein with a fine needle; over time the vein shrinks and closes. It is a method commonly used for thread veins on the legs. After the procedure, there may be bruising, temporary brown discolouration and the appearance of very fine new vessels around the treated area.

Uncommon but serious complications include a skin wound (ulcer), an allergic reaction and a blood clot forming in a deep vein. For this reason, before sclerotherapy it is recommended to assess whether there is venous insufficiency in the leg and, if necessary, to examine it with ultrasound.

Laser on the legs can be an option for vessels that are too fine for sclerotherapy or difficult to treat with a needle. The effect of laser on leg veins is generally more limited than on facial vessels.

Who should carry out the treatment?

Thread vein treatments are medical procedures. For laser and IPL on the face, an assessment by a physician who knows skin diseases and light-based treatments is recommended. On the legs, especially if there is swelling, pain, varicose veins or skin change, an assessment by a physician experienced in vein diseases is needed. You can look at the article “Who Can Perform Medical Aesthetic Treatments?” on this subject.

Which signs in the legs need a vein assessment?

Thread veins on the legs are usually harmless. However, the signs below suggest that there may be a problem in the underlying veins and call for a vein assessment before any cosmetic treatment:

• Swelling of the legs and ankles that gets worse in the evening
• Pain, a feeling of heaviness, cramps or itching in the legs
• Prominent, raised and twisted varicose veins
• Brown discolouration around the ankle, hardening of the skin or eczema-like changes
• A wound that does not heal

Compression stockings and everyday advice

Compression (pressure) stockings can reduce swelling and the feeling of heaviness by supporting the return of blood in the leg veins to the heart. They do not remove existing thread veins. They are also commonly recommended for a certain period after sclerotherapy.

The pressure level and the size of compression stockings matter. In people with poor circulation in the leg arteries, these stockings can be harmful; that is why you should decide together with your physician which stocking to use and for how long.

• Avoid standing still or sitting for long periods; take breaks and walk.
• When resting, raise your legs above the level of your heart.
• Regular walking supports circulation by working the calf muscles.
• Protect your face from the sun; sun damage can make facial vessels more visible.
• Do not apply cortisone creams to your face without a physician’s advice.