Broadly speaking, superficial veins on the legs fall into 2 categories:
“Subcuticular” (spider and blue veins) and “subcutaneous’ (varicose-bulging veins).
The very tiny-almost hair thin purple/reddish veins you see on your legs are called ‘telangiectasia’ – it’s a cool word but we’ve decided to call them “spider” veins to keep it simple. Because, let’s be honest, they look a bit like spiders. They are the most superficial and live just below the surface of the skin.
These veins are completely harmless and will never develop into bulging (varicose) veins. However they can be quite unsightly and can be eliminated with sclerotherapy injections. This usually takes 2 or 3 injections (2 weeks apart) and is quite effective.
The blue, (not bulging) veins you often see just under the skin are called reticular veins. We all have a greater or lesser degree of these veins. They are more visible in light skinned people and more visible in females than males. They are also harmless but are usually the underlying source of the overlying spider veins. They are also best treated with sclerotherapy (liquid or foam).
The last category are the varicose veins. These are the veins you see bulging on the skin. These veins are generally larger and have a problem with the valves within them that control the flow of blood.
The bulging portions on the skin are just the branches and “low lying fruit” or rather… just the “ tip of the iceberg.” The real problem is below the skin in the trunk of these veins. These veins can be a problem-functionally and pose significant cosmetic undesirability. The state-of-the-art treatment for these veins is the endovenous laser procedure. (EVLA or EVLT) Microphlebectomy is also useful in removing some of these veins that the laser can’t reach.
The reality is that most patients have a combination of all of these veins and they can all be successfully treated.
