Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at

Treating Unsightly Spider Veins

Wednesday, 18 January 2012 09:22 AM

As we get older, many of us suffer from unsightly spider veins, those tiny unwanted blood vessels that appear on the surface of our skin. But you don't have to put up with them — spider veins can usually be treated in the dermatologist's office. Before I give you the details, though, let's begin by answering a few FAQs.
What is the difference between spider veins and varicose veins? Where do spider veins most commonly appear? Do we know what causes them? Are fair-skinned people more susceptible to spider veins? At what age do they start to appear?
The difference between spider veins and varicose veins is largely the size of the vessels. Spider veins tend to be about 1-2 mm (the size of a paper clip). Varicose veins tend to be larger, usually about 2-6 mm. Another difference is that varicose veins are the result of backflow, which is caused by a broken valve or vessel. This results in a higher than normal pressure in the vessels that then bulge outwards as more blood flows in this abnormal circuit.
We know that hormones play a role in both spider veins and varicose veins, and the conditions are much more common in women than in men. They also arise with greater frequency after pregnancy. Genetics play a part as well, and women whose parents had varicose veins are more likely to develop them. Jobs that keep you on your feet will also increase the chances of having varicose veins. This is because the pressure on the vessels increases with the added pressure from standing. People that have standing jobs will also be more likely to have vessels that hurt.
Spider veins begin in women in their late 20s and early 30s. Onset usually corresponds to childbirth. Varicose veins have a later onset, usually in the late 30s and 40s.
Treatment options for spider veins depend on their size and cause. Smaller vessels can be injected with either saline or Asclera, which is a new product approved last year in the United States. Asclera has several advantages over other products used: It tends to hurt less when injected, work faster, and cause minimal adverse events. Saline is also frequently used. It is very effective, but can be a little more uncomfortable and cause erosions when it leaks from the vessels. While different physicians have their preferences between these (and a few other agents), I use both.
Varicose veins need more evaluation before they are treated. Prior to any type of treatment, it is important to find out where they are and what is causing them. If they are caused by broken valves in the upper thigh or knee area, treatment with injections won’t do anything until the underlying problems are fixed. For deeper vessels, I refer my patients to a vascular surgeon who has the ability to image the deeper vessels and also to fix the underlying problem. Some dermatologists do ultrasound and fix the deeper vessels, but I do not.
The number of office visits required depends on how large and how plentiful the vessels are. I tell my patients to expect between 3-10 visits but most are pleased after 4-5 visits. Surgical treatments and lasers may also be used to treat large vessels. These typically require one treatment for surgery and 1-2 for laser treatments.
Insurance covers the treatment of some of these vessels. To get a procedure covered, the evaluation typically has to be submitted for approval. Payment for a procedure usually requires documentation of a large size, pain associated with the vessels, and ultrasound confirmation. Smaller vessels treated for cosmetic indications are not covered. The upside of this is that they are not as costly to treat as the larger vessels and can by treated without a large workup.
For vessels on the face, treatment is usually accomplished using a laser or intense pulsed light. These vessels are usually part of a disease called rosacea that is very common in fair-skinned people, especially those of Celtic or English backgrounds. Laser treatments are quite effective for these facial vessels, and typical treatment involves 2-3 visits. When some lasers are used with high energy, bruising will occur, and it can last for 7-10 days.
Veins are a common reason to seek dermatologic care. In my office, we see different kinds of veins every day, and most are easily treated in the office. For larger varicose veins, I refer patients to a vascular surgeon, while smaller veins are treated in my office. If you have any type of problem veins, see your dermatologist for information on what can be done to treat them.
For more information about Dr. Beer's practice or his line of skin care products, go to: or

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