Elimination and treatment of spider veins

Here you will find detailed information about laser therapy

Laser therapy of spider veins

In principle, spider veins on the legs can also be treated with a particular type of laser (Nd:YAG laser). However, laser therapy is only successful when the spider veins are small, not very pronounced, and when there is no inflow from deeper-lying veins. The reason for such limitations is that the penetration depth of laser beams is not sufficient to reach and obliterate any deeper-lying diseased veins. For effective treatment, however, it is essential to treat these more deeply lying veins as well, because the spider veins will otherwise reappear again and again.
According to national and international guidelines, micro-sclerotherapy is the treatment of choice for spider veins and reticular varicose veins at the present time, as it is considered to be not only more effective, but also less painful and usually more cost-effective.
Lasers are generally classed as medical devices and not as medicinal products, so the available database on laser therapy, with respect to its efficacy and safety, is not as comprehensive as for sclerotherapy, which uses a strictly evaluated medicinal product.

Advantages and disadvantages of laser therapy at a glance

Advantages of laser therapy

  • Acts through the skin without any injections
  • Compression stockings are not recommended
  • Fewer systemic reactions

Disadvantages of laser therapy

  • Often ineffective; the penetration depth is not sufficient to reach reticular varicose veins
  • Can only be used to treat fine, small spider veins without an inflow from deeper-lying veins
  • No adequate studies
  • Painful
  • Scarring is more common
  • Heat damage is possible
  • Cooling is necessary
  • Treatment is not recommended in the guidelines
  • More expensive
  • Often needs to be combined with sclerotherapy for optimal success

How laser therapy works

Laser beams are electromagnetic waves that strike human tissues as strongly bundled beams emitted from the laser device. Depending on the duration and intensity of the exposure, the thermal effects that can be seen range from slight warmth to charring of the tissues.

When the laser beam penetrates to a sufficient depth, haemoglobin (which gives the blood its red colour) in the spider veins absorbs the laser light and converts this energy into heat. The blood is sort of boiled and clots. The thermal action damages the inner layer of the vein walls and causes them to stick together at these points. However, the effects of laser therapy are seen only at the points where the bundled beams meet the tissues. This means that, under cooling, the skin of the spider veins must be (repeatedly) treated with the laser at intervals along their entire length; the points of application have to overlap in order to obliterate the whole blood vessel. If the overlap is too great, the heat generated may damage the skin. If the points of application are too far apart, the diseased vein may not stick together along its whole length, leaving open segments of the vein filled with blood. Parts of the spider vein will then remain visible.

Successful laser therapy results in the formation of a connective tissue strand that is resorbed into the body after a few weeks or months.

Success rate

There are hardly any high-quality clinical studies on the laser therapy of spider veins. The number of patients in the few available studies is too small to allow any definitive conclusions on the efficacy and safety of laser therapy. In addition, different types of laser are used under different conditions, so that the results of one study cannot be compared directly with those of another.

The problem with laser therapy is that it is unable to obliterate reticular varicose veins and feeder veins that lie deeper beneath the skin, as the laser beams do not penetrate far enough to reach them. These veins have to be treated, however, since blood will otherwise continue to flow into the spider veins and they will not disappear. Using a stronger laser could theoretically be a solution, but the laser beam would then damage not only the diseased vein, but also the surrounding healthy tissues causing burns and other side effects. For this reason, laser therapy often has to be combined with sclerotherapy to obliterate the more deeply lying veins.

In summary, the guidelines of the German and European phlebology associations do not recommend laser therapy for the treatment of spider veins.

Lasers can usefully be employed where micro-sclerotherapy is not possible, for example, if there are tiny dilated vessels (telangiectasia) in the skin of the nose and cheeks or port-wine stains on the face. Laser treatment can also be tried for spider veins on the legs that are so fine as to make injection impossible.

Points to note before treatment

  • The hereditary connective tissue weakness, which means a life-long tendency to develop spider veins, cannot be cured. Even when spider veins have been successfully eliminated, new ones may appear at a later date and require further treatment. There is therefore no treatment that can make spider veins disappear once and for all. No matter how successful the treatment is, no doctor can guarantee that you will never have any spider veins again.
  • There is no treatment that makes spider veins disappear from one day to the next. One treatment session is not enough to eliminate spider veins, so you need to accept that you may have to go to the doctor’s several times. Nor will the effects be obvious immediately after treatment – it may be several weeks before your body has broken down the diseased veins and the final results can be seen.
  • In principle, you can have treatment at any time of the year, but as you have to avoid sunbathing for some weeks after treatment, it is preferable that the summer holiday season is already over before starting treatment. Most people have treatment between October and May.
  • It is best not to start treatment just before going away on holiday; treatment sessions should be completed not less than 2-3 weeks before going on a longer trip.
  • As a rule, spider veins and reticular varicose veins are considered to be purely aesthetic problems and the statutory health insurance will not reimburse the costs of treatment. Doctors usually offer cosmetic treatment of this nature as an individual healthcare service, which basically means you will have to pay for it yourself. Spider veins differ greatly in their size, severity, and extent, so only the treating physician can realistically assess the costs you are likely to face. Have your doctor draw up a treatment plan before you start; in many cases, costs are between 50 EUR and 220 EUR per treatment session.

When is laser therapy not possible?

Given the lack of studies, it is not possible to make a full assessment of the contraindications to treatment. The general opinion seems to be that patients who have a tendency to scarring should not have laser therapy. Patients undergoing laser treatment should have their normal skin colour and not have a suntan.
Your doctor will discuss any illnesses that have to be considered.

How laser therapy is performed

A thorough examination and diagnosis is also required for laser therapy, especially to find out whether the veins feeding the spider veins can even be reached with the laser.

Your doctor will tell you exactly how the treatment will be carried out and discuss the possible risks and chances of success.

The treatment itself is carried out with the patient lying down. The laser is held against the skin and applied several times along the length of the spider veins, so that the laser light penetrating the skin hits as much of the vein as possible. A cooling system prevents the surface of the skin from becoming overheated. Adequate cooling of the skin is important to reduce pain and prevent scar formation. Ice or coolant sprays can be used as well as more sophisticated cooling systems. However, if not used correctly, they may freeze the tissues and cause discolouration of the skin.
As many patients perceive laser therapy as painful, some doctors also use a local anaesthetic.

Laser therapy sessions normally last for 10-20 minutes.

At the first treatment session, the doctor usually sets the laser energy relatively low, in order to reduce the possibility of thermal damage, redness, and discolouration. As everyone reacts differently to laser light, the doctor has to gauge the optimal settings for the individual patient. Doctors therefore prefer to increase the laser energy in the sessions step by step rather than cause permanent side effects. As the settings have to be relatively low at the start, several treatment sessions are the norm. Treatment is repeated once or as often as necessary at intervals of 2-4 weeks, depending on the severity of the spider veins.

Points to note after laser therapy

  • Skin reactions such as reddening, swelling, and wheals often occur immediately after laser therapy. These reactions may last for several hours.
  • A scab may form after a few days; this will come off in about 10 days’ time.
  • The treated veins may be more obvious after laser therapy than they were before. The final results of treatment are not seen until a few weeks later.
  • There are no studies available on whether compression improves the effectiveness and safety of laser therapy. As a rule, compression stockings are not worn after laser treatment.
  • You can resume your normal daily activities immediately and go back to work without delay.
  • You are advised not to take part in any strenuous sporting activities (intensive jogging, long mountain hikes, or football) for the first 2 weeks after treatment. Physical exercise without strenuous exertion is permitted (walking or swimming).
  • Avoid the sauna, long hot baths or showers, solaria, or prolonged sunbathing for a few weeks after treatment. If you do have to go out in the sun, use a sunscreen with a light protection factor of at least 25. It is difficult to give a precise length of time, so you should rely on the experience and recommendations of the doctor treating you.
  • On the day after treatment, you can shower with moderately warm water.
  • Tell your doctor without fail if you notice any signs of scar formation.
  • Do not have a massage involving the treated area for at least 2 weeks after treatment.
  • Please be sure to attend the follow-up examinations.

Risks of laser therapy

Any medical treatment or procedure may have unwanted side effects. Relatively little information has been gathered on the complications of laser therapy, so no firm statements can be made on the nature and frequency of the risks.

It is well known that reddening, swelling, wheals, and transient discolouration of the skin occur in the area of treated spider veins, although these changes usually resolve soon after treatment. Many patients experience severe pain during the laser application. Slight scab formation is normal. Thermal damage to the skin and even burns or scarring may occur. The chronic nature of the underlying disease means that spider veins may reappear in the treated area at a later date.

Your doctor will explain the possible side effects in detail before you start treatment.