A high percentage of the adult population has visible veins. In fact, in the United States, over 40 million people suffer from varicose veins, and about 80 percent have spider and reticular veins. Studies show that around 70 percent of women and 42 percent of men will develop a vein-related issue by age 60. While they rarely point to any serious underlying health issues, they often cause cosmetic concerns due to the web-like patterns under the skin or swollen, bulging veins. If this is an insecurity you’re facing, there are several options for treatment.
Dr. Lawrence Presant is the Chief Medical Officer at Arizona Vein Specialists in Phoenix and is a certified diplomate of the American Board of Venous & Lymphatic Medicine.
Sclerotherapy
Sclerotherapy is the gold standard treatment for spider veins. It also helps treat veins on the hands, chest and face. A variety of factors, including genetics, sun damage, and certain medical conditions, cause spider veins. They appear as small, dilated blood vessels near the skin’s surface, often appearing as red, blue, or purple, creating a pattern similar to a spider web. They are typically harmless and often don’t cause symptoms; however, some may experience a mild itchy feeling.
Sclerotherapy is a minimally invasive procedure that involves an injection of dilute medications into the veins, which causes them to collapse permanently and disappear. The veins are visible because the vein wall has been stretched to the point it’s transparent, and you can see the blood inside them. To make it disappear, the injection used in sclerotherapy closes it so red blood cells can’t get through. Depending on the severity, multiple treatments may be required to achieve full closure.
The average patient will need 2-3 sessions, approximately a month apart, each lasting about 20 minutes. If performed correctly, there are only a couple of possible side effects, including mild aching, bruising, or swelling at the injection site. Most patients can continue normal activities immediately, but should avoid strenuous exercise for a few weeks.
Phlebectomy
A phlebectomy is the removal of larger varicose veins. Varicose veins are swollen, bulging, and twisted veins. They are caused by weak or damaged valves in your veins. When these valves are damaged, blood can back up and pool in the veins, causing Varicose veins. They are most common in the legs because gravity makes it difficult for the blood to flow up. While often a cosmetic concern, symptoms can also include a heavy or achy feeling in the legs, nighttime cramping, and skin irritation.
A phlebectomy is a minimally invasive surgical procedure that removes Varicose veins, or veins 4mm or larger. In preparation for the procedure, the patient is marked to outline the bulging veins, then the skin and surrounding vein tissue are numbed with local anesthesia.
During the 90-minute procedure, small 2mm incisions are made to extract the vein from the skin. Since the patient is completely awake during this procedure, extreme delicacy and dexterity are required so that the patient can get up and walk afterward. If performed correctly, recovery should not be painful.
After the procedure is complete, the patient’s legs will be wrapped for a few days to add compression. Small butterfly tapes will also be placed over the incision to help them heal without scarring.
Eligibility and Aftercare
When considering cosmetic vein treatments, expertise isn’t just important — it’s essential. Always seek out a board-certified phlebologist with a proven track record in both sclerotherapy and phlebectomy. If you’re advised to undergo multiple or more aggressive procedures, don’t hesitate to get a second opinion.
Precision is critical: an inexperienced provider could mistakenly inject an artery instead of a vein — a potentially catastrophic error. Improper techniques can also result in unwanted side effects, such as hyperpigmentation or, in more severe cases, blood clots due to over-injection.
Visible veins are an incredibly common concern — the majority of adults experience them at some point. If they’re affecting your confidence, know that safe, effective cosmetic solutions are available. The key is finding a qualified physician you trust, one who listens and makes you feel at ease throughout the process.
And remember: beautiful results take time. With both sclerotherapy and phlebectomy, the transformation typically becomes noticeable at the end of the treatment series, not immediately. Patience, paired with the right provider, is your best path to smooth, confident skin.
