The spider veins  are small purple and red blood vessels. They arehereditary and most commonly are found on the thigh or lower leg. They also can form virtually anywhere on the leg, from the uppermost region of the thigh to the ankle. Occasionally, spider veins will appear on the face. Sclerotherapy for the bigger ones and ND/YAG laser (for the purple) and Diode laser/hand cautery for the (red) smaller ones are the treatments of choice. 

The veins to be treated with sclerotherapy, are marked while the patient is standing. Larger veins are usually treated first. A sclerosing agent (such as athexoxysclerol), is injected into the vein with a micro-needle. The solution causes the vein to turn white (blanch), and then gradually disappear. A typical treatment lasts from 30 minutes to an hour. The discomfort is very little. Color changes and small clots can develop in the skin where the treatment has been performed.

Complete correction is not expected on the first treatment. Only about 50 to 70% of the treated vessels will be permanently gone. 3 to 4 treatments are generally required for optimal results. If there is an underlying problem with the venous system, the veins will recur.

Management of Facial Telangiectasias with Hand Cautery