Heredity, gradual vessel weakening with aging, estrogens, birth-control pills and pregnancy are some of the most common causes of spider veins and varicose veins of the legs.

The gold standard for the treatment of spider veins of the leg remains sclerotherapy. Sclerotherapy is the injection of a substance (a "sclerosant") which causes the vessel to collapse. Sclerotherapy agents used in the US include hypertonic saline, SDS, and aetoxysclerol (polidocanol). Hypertonic saline, or a highly-concentrated salt solution, can be painful and may be more likely to cause side effects and complications.

Aetoxysclerol (polidocanol), although not an FDA-approved sclerosant, is extensively used for sclerotherapy by dermatologists and plastic surgeons in the United States, Canada, and Europe, because it is safe, effective and well-tolerated. It is my sclerosant of choice for this procedure.

Lasers in general, can be more painful and are considered by most experts as being more risk-prone for potentially causing hypopigmentation and scarring.

Patients with protuberant veins may be a candidate for ambulatory phlebectomy, a procedure which locally hooks and strips veins through a small incision, or endovenous radiofrequency treatments. We do not perform these latter procedures.