Dear Daniela: Is There A Safe Way To Remove Spider Veins?

Illustration by Olivia Santner
Dear Daniela,
What are my options for both treating and preventing spider veins? In the past few years I’ve developed them on my shins, chest and on the sides of my nose. The worst ones are on my shins. I hate the look of them and I'm worried they’ll get worse, especially as I’m only in my mid 20s. 
Olivia, 24
Thread veins, spider veins – or, to give them their proper name, telangiectasia – are a real beauty bête noire. They can spring up in the blink of an eye and there’s no super serum or wonder ingredient to treat them. Annoyingly, if you’re predisposed to them, there’s not a great deal you can do to stop yourself from getting them, but that doesn’t mean all hope is lost. Once you understand how they function and why they form, you can think about what kind of treatment plan works for you and assess how far you’re willing to go to tackle them.
Firstly, despite what you may think, having them has nothing to do with having sensitive or delicate skin. "The most common causes of spider veins are age and genetics," confirmed Dr David Jack, a cosmetic doctor who treated my mum’s spider veins pretty miraculously. "While it’s true that the paler your skin, the more likely they are to show through, having pale or sensitive skin doesn’t make you more predisposed to them. In fact, when people talk about 'thin skin' in relation to spider veins, it’s a bit of a misnomer. The part of the skin that can be thinner isn’t the part where the spider veins appear."

Instead, spider veins are caused when the blood vessels dilate to try and compensate for irregular or constricted blood flow. While certain external factors like sun damage can certainly make them worse, the primary causes are almost all internal. "Aside from genetics and age, high blood pressure and stress can also bring about spider veins," confirmed Dr Jack. "It’s not like rosacea where you flare it up by using the wrong skincare. It’s more about how your body is functioning internally."
While Dr Jack did advise avoiding overly irritating products that might cause blood vessel dilation and stressed the importance of daily UV protection to keep the skin firm, in terms of prevention, there’s not a great deal you can do. "Steroid use and higher oestrogen levels can also play a role (the latter explaining their higher prevalence in women), but there’s not any general consensus on a spider vein avoidance plan, as it were."

Instead, your best option is to treat them once they appear and maintain vigilance from there on out. Dr Jack’s method of choice is IPL or intense pulsed light: "It’s the gold standard for thread veins, with a high success rate and very little downtime." IPL attracts and heats up the haemoglobin in the blood, forming small clots which then encourage the veins to seal up. This removes the appearance of the broken vein from the skin. "It works incredibly well. Even one session can remove most of them, and then usually I would suggest one more after just to tidy up what’s left. Very occasionally you might need a third session, but that’s rare," he added.
Dr Jack also uses laser where needed on some of the larger veins, which are more common on legs or the chest. "Generally speaking, the bigger the vein, the bigger the reaction, so you might have swelling or inflammation after a session, but this tends to go down within a few days." If they do come back, and they may well do, you can continue to treat them with IPL once or twice a year, with Dr Jack noting that both smoking and alcohol can increase your tendency to develop them. 
Please don’t beat yourself up about these, Olivia. There’s likely nothing you’ve done to cause them. In fact, pretty much everyone will develop some spider veins if they live long enough. If you want to get IPL, if at all possible, try and see either an aesthetic doctor or a dermatologist (always check that they are properly qualified by searching their name on the General Medical Council register) as in some very rare cases, spider veins can be indicative of conditions like liver disease or skin cancer.
Someone with a medical background will be able to take a full assessment for you and advise on possible interactions with any medications you might be taking. For example, if you’re on antibiotics, you might need to wait until the course finishes before beginning treatment as they can increase your skin’s sensitivity to light. Just something to think about.
Good luck!
Got a question for our resident beauty columnist Daniela Morosini? No problem, qualm or dilemma is too big, small or niche. Email, including your name and age for a chance to have your question answered. All letters to 'Dear Daniela' become the property of Refinery29 and will be edited for length, clarity, and grammatical correctness.

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