You're So Vein, You Probably Think This Article Is About You

Illustrated by Anna Sudit.
Harsh-truth time: You may have legs that rival Beyoncé’s backup dancers' or have ridden thousands of miles in your Flywheel class, and still have noticeable veins. By age 50, nearly 40% of women and 20% of men have vein problems, so unfortunately it's likely that you'll have to confront them at some point in your life — and they have nothing to do with your fitness level. “I often reassure my patients that if you have legs, chances are good you have some form of varicose veins,” says Miami dermatologist Jeremy Green, MD.

Awesome. But, even if varicose veins are kind of inevitable, you don’t have to adopt an Amish wardrobe to hide any skin above the ankle. Find out what you need to know about prominent veins, including how to prevent and treat them. Keep your miniskirts handy.
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Illustrated by Anna Sudit.
What are varicose veins?
There are two types of veins that fall under the category of varicose, explains New York City dermatologist Dennis Gross, MD. The large, bulging cords that may look twisted are what most people call varicose veins. These almost always develop on the legs and may feel painful and itchy or even cause fatigue and cramping, says Dr. Gross. While developing them on your legs is definitely frustrating, it could be worse: Men can develop them on the scrotum. (Cue the “Yikes!”)

Spider veins, a type of varicose veins, are fine lines that often appear red or blue and surface on the legs and face. They often look like spider webbing and don’t cause raised skin. When the smaller veins have dilated too far or too often, they burst. These broken capillaries are close to the surface of the skin and usually don’t cause any symptoms.
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Illustrated by Anna Sudit.
What causes varicose veins?
“Veins are designed to bring blood back to the heart and lungs,” Dr. Green says. “To fight gravity, there are valves in the veins that fight the backflow of blood.” If the valves become weakened or the vein walls lose their shape, the blood flows back to the feet. The turbulence of blood flowing through the veins can cause swelling and change their shapes.

“In addition, your skin becomes thinner and weaker over time, so veins become more visible through the skin,” says Jessica Wu, MD, a Los Angeles dermatologist. That goes for all veins, not just varicose ones.

While the natural course of aging is a culprit, other factors can cause varicose veins. Look to your relatives to see if the condition is part of your family tree. “Both spider veins and varicose veins tend to run in families,” Dr. Gross says. If your mom and grandma have them, odds are your DNA has predisposed you to weaker veins. Thanks, genetics!

Estrogen also plays a role. “Hormones seem to be connected to varicose veins, with estrogen especially being linked to spider veins,” Dr. Gross says. “That’s why you tend to start seeing varicose veins as early as your teens — estrogen levels are higher in your reproductive years.”

Pregnancy can also be the source of varicose veins, due to increased estrogen levels. In addition, the weight of the baby inhibits circulation, making it difficult for the blood to flow back to the heart. As a result, blood pressure builds up in the legs, causing it to pool in the veins and weaken the valves.

Standing for extended periods of time — for work or during a sport — stresses the blood vessels because they have to fight gravity as long as you’re upright. Sitting too long can also cause blood to pool in the legs.

Spider veins in the face tend to have different causes. They’re often a result of rosacea due to the repeated flushing associated with the condition. Aggressive scrubbing or exfoliation can cause capillaries to burst. And, repeated sun exposure damages capillaries over time. Spider veins can also be associated with alcohol consumption since drinking causes high blood pressure that can dilate blood vessels.
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Illustrated by Anna Sudit.
How can you prevent varicose veins?
Some simple habits can limit the number and severity of varicose veins. Dr. Gross suggests keeping your legs elevated whenever possible. “The more you can keep your legs straight and lifted when you’re sitting, the better.”

If your job requires standing, Dr. Wu says wearing support hose or snug leggings helps. The extra bit of pressure helps with circulation, she says. Shift your weight from leg to leg as much as possible to increase circulation. And, if you’re sitting at a desk, move around at least every hour to increase blood flow back to the heart.

Exercise also helps, because it promotes blood circulation. “Keeping muscles toned is a good preventative tactic, but it can backfire if you go into weightlifter territory,” Dr. Gross says. “If muscles get too big, the body expands veins to send more oxygen to them.”

Avoiding salty foods can help keep blood pressure low, which relieves strain on the valves and capillaries.

To avoid spider veins on your face, sunscreen is your best weapon. Fighting UV damage helps keep the skin healthy and prevents damage to the capillaries.
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Illustrated by Anna Sudit.
When are varicose veins more than a cosmetic problem?
It’s understandable if you don’t like their appearance, but varicose veins tend to be harmless unless you have some additional symptoms. “If you have a sharp pain in your calf that gets worse when you walk or straighten your leg, go directly to the emergency room,” Dr. Gross warns. That kind of pain could indicate you have a blood clot. “Anytime blood pools as it does with a varicose vein, the blood flow slows down and increases the likelihood of a clot, which is a serious health problem.”

The swelling associated with varicose veins can also injure the skin and cause itching or rashes. Those with eczema may experience flare-ups in the legs. Any pain or irritation is reason to see your doctor or dermatologist.
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Illustrated by Anna Sudit.
How can you treat varicose veins?
If you feel self-conscious about their appearance, there are several treatments available. A quick fix for spider veins is to wear self-tanner to help camouflage pigmentation.

Permanent fixes include lasers that target the pigment in the veins and seal them off so they are destroyed. Dermatologists use lasers including the Alexandrite, Excel V, and Vbeam to target smaller veins and capillaries. But, this may not work for medium or large veins.

For larger veins, doctors tend to use an injectable liquid that damages the wall of the vein and causes it to eventually dissolve. Sclerotherapy, a form of saline solution, has traditionally been used.

A newer treatment called Asclera is now available. This injectable can treat small varicose as well as spider veins, which have been challenging to inject in the past. In some cases, you may need surgery.
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