Vein disease is very common and can affect up to 50% of the population. Sometimes it can be hard to tell whether to be concerned about those pesky veins that you see on your legs. The purpose of this post is to help you determine if the problem you have is simply cosmetic or if there may be something more going on beneath the surface.
Quick Answer: The difference between spider veins and varicose veins is mostly size, depth and cause. Spider veins are tiny red, blue or purple threads less than 1 mm wide that sit in the skin and are usually a cosmetic concern. Varicose veins are larger than about 3 mm, raised and rope-like, and usually come from leaking valves in deeper veins (venous insufficiency), so they often cause aching, heaviness and swelling. Spider veins are typically treated with sclerotherapy, while varicose veins need an ultrasound to find the source and treatment such as ablation.
Spider veins are the tiny threadlike veins. They appear often on the outside of the thighs but can appear anywhere on the legs or even on the abdomen, chest, and face. They typically do not cause pain but in some cases can cause burning or itching. Spider veins are genetic so it is likely that if one or both parents have them, you will get them too.
Varicose veins are larger, and appear like bulging ropes on the legs. They are also inherited but can even be seen in people without a family history. They typically cause heaviness and discomfort in the legs, particularly after periods of prolonged standing. Varicose veins are not simply cosmetic, but arise from an underlying problem of venous insufficiency.
Just because you have spider veins does not mean that you will go on to have varicose veins or that the spider veins will become varicose veins. However, spider veins around the ankle can sometimes be a sign that there may be an underlying problem of venous insufficiency.
Varicose veins and spider veins are also treated differently. While spider veins are treated with cosmetic injections (sclerotherapy), varicose veins need to be addressed by treating the underlying cause of venous insufficiency. An ultrasound will need to be performed on your legs to determine the underlying cause.
No matter what type of veins you have, the experts at Premier Vein and Vascular are here to help take care of all of your vein care needs!
Meet your vein specialist
Dr. Syed Raza, MD
Vascular & Interventional Radiology · Founder, Premier Vein & Vascular Center
Fellowship-trained interventional radiologist certified by the American Board of Radiology and the Royal College of Radiologists (UK). Former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, with 15+ years treating varicose veins, venous reflux and peripheral arterial disease.
Spider Veins vs Varicose Veins at a Glance
Patients often come to us pointing at a cluster of veins and asking one question: is this cosmetic or is it a medical problem? The answer depends on what kind of vein it is, where it sits and what is happening in the veins underneath. The table below summarizes the main differences we look for in clinic.
| Feature | Spider veins | Reticular veins | Varicose veins |
|---|---|---|---|
| Size | Less than 1 mm | About 1 to 3 mm | 3 mm or larger |
| Appearance | Flat red, purple or blue threads, webs or starbursts | Flat blue-green veins visible through the skin | Raised, twisted, rope-like or bulging veins |
| Depth | In the skin itself | Just beneath the skin | In the fat under the skin, fed by larger veins |
| Usual symptoms | Often none; sometimes mild itching or burning | Usually mild; may feed spider veins | Aching, heaviness, throbbing, swelling, cramps |
| Usual cause | Genetics, hormones, sun exposure, local pressure | Mild local reflux | Venous insufficiency from leaking valves |
| Typical treatment | Sclerotherapy | Sclerotherapy | Ultrasound mapping, then ablation, foam or phlebectomy |
| Insurance | Usually considered cosmetic | Usually considered cosmetic | Often covered when symptomatic and reflux is confirmed |
What Are Reticular Veins, the Veins In Between?
Many people have a third type of vein that sits between spider veins and varicose veins in size. Reticular veins are the flat, blue or greenish veins you can see through the skin, often behind the knee, on the inner thigh or along the side of the ankle. They do not usually bulge.
Reticular veins matter because they often act as feeder veins. A spider vein cluster frequently has a reticular vein running into it, supplying blood under slightly higher pressure. If only the visible spider veins are treated and the feeder vein is left alone, new spider veins can appear in the same spot within months. Part of a good sclerotherapy session is finding and treating those feeders first.
Why Varicose Veins Form: The Valve Problem Underneath
Leg veins carry blood uphill against gravity, helped by the squeeze of the calf muscles and one-way valves that stop blood from falling back. In varicose veins, those valves no longer seal. Blood falls backward each time you stand, a process called reflux, and the pressure in the vein rises.
Over time that pressure stretches the vein wall. The vein lengthens, widens and starts to twist, which is why varicose veins look like ropes or knots. The faulty valve is usually not in the bulging vein you can see. It is commonly higher up, in the great saphenous vein along the inner thigh or the small saphenous vein behind the calf. That hidden source is why we never treat varicose veins without first mapping the veins with ultrasound.
Why spider veins are different
Spider veins are tiny dilated vessels in the skin. They can be caused by inherited vein wall weakness, pregnancy and other hormonal changes, sun damage, injury or simply standing for long hours. In most people they are not a sign of reflux in the larger veins, which is why they are usually considered a cosmetic issue.
When Spider Veins Can Signal Something Deeper
There are a few patterns where spider veins deserve a closer look. A dense fan of small veins around the inner ankle or the arch of the foot, sometimes called corona phlebectatica, is a recognized early sign of chronic venous insufficiency. So are spider veins that appear together with:
- Swelling of the ankles by the end of the day
- Heaviness, aching or restless legs in the evening
- Brown or reddish discoloration of the lower leg skin
- Itchy, dry or eczema-like skin near the ankle
- Spider veins that keep coming back quickly after sclerotherapy
In these situations, a venous duplex ultrasound is the right first step, because treating the surface veins without addressing reflux underneath tends to give short-lived results.
Symptoms That Point Toward Varicose Vein Disease
Varicose veins do not always hurt, but many patients have symptoms they have accepted as normal. Vein-related symptoms typically worsen as the day goes on and improve with elevation. They include:
- Heavy, tired or achy legs after standing or sitting
- Throbbing or burning over the bulging veins
- Night cramps and restless legs
- Swelling in the ankles and lower legs
- Skin changes, thickening or slow-healing sores near the ankle
Varicose veins are also more likely than spider veins to cause complications, including superficial thrombophlebitis (a painful, inflamed clot in a surface vein), bleeding from thin veins near the skin, and in long-standing cases, venous ulcers. You can read more on our vein disease symptoms page.
Seek urgent medical care if you notice:
- A varicose vein that bleeds and does not stop with firm pressure and leg elevation
- Sudden swelling, pain and warmth in one calf or thigh, which can signal a deep vein thrombosis
- Sudden shortness of breath, chest pain or coughing up blood
- A hard, red, very tender cord along a vein that is spreading toward the groin
- A leg wound with spreading redness, fever or chills
How We Evaluate Spider and Varicose Veins
At Premier Vein & Vascular Center, the first visit is about deciding whether your veins are a surface concern or part of an underlying circulation problem, because that determines everything that follows.
- Focused history. We ask about symptoms, how they change through the day, pregnancies, prior clots, previous vein treatments and family history.
- Standing examination. Veins fill when you stand, so we examine your legs upright and look for varicose veins, reticular feeders, ankle swelling and skin changes.
- Venous duplex ultrasound when indicated. If you have varicose veins, symptoms or ankle signs, our IAC-accredited vascular lab maps the superficial and deep veins and measures reflux at each valve. The scan is painless and takes about 30 to 60 minutes.
- A clear plan. We explain whether your veins are cosmetic or medical, what we recommend treating first, how many sessions to expect, and what insurance is likely to cover.
Treatment Options: Matching the Vein to the Method
For spider and reticular veins
Sclerotherapy is the standard treatment. A very fine needle delivers a medication into the vein that irritates its lining, causing it to seal and gradually fade as the body absorbs it. Sessions usually take 15 to 45 minutes with no downtime. Most people need more than one session, spaced several weeks apart, and the veins fade over weeks to a few months. Temporary bruising or light brown staining along the treated veins is common and usually resolves. See our spider vein treatment page for more.
For varicose veins
The goal is to close the leaking source vein, then deal with the visible branches. Depending on the ultrasound, options include:
- Endovenous thermal ablation with radiofrequency or laser energy to close a refluxing saphenous vein from the inside
- Non-thermal ablation, which closes the vein without heat
- Ultrasound-guided foam sclerotherapy or Varithena for twisting branch veins
- Ambulatory phlebectomy, which removes bulging surface veins through tiny nicks
These are done in the office under local anesthesia, usually in under an hour. Most patients walk out and return to normal light activity within a day or two, wearing compression stockings for a short period afterward.
Can You Prevent Spider and Varicose Veins?
You cannot change your genes, which are the biggest single factor for both types. But you can lower the pressure on your leg veins and slow the progression of symptoms:
- Keep your calves moving: walk daily and flex your ankles if you sit or stand for long periods
- Raise your legs above heart level for a few minutes after work
- Wear graduated compression stockings if your legs ache or swell
- Maintain a healthy weight to reduce pressure in the abdominal and leg veins
- Protect skin on the face and legs from sun damage, which can contribute to spider veins
These steps help, but they do not reverse veins that are already visible. Treatment is the only way to remove them.
Why new veins can appear after treatment
Patients are sometimes disappointed when new spider or varicose veins show up a year or two after successful treatment. The veins that were treated have usually stayed closed. What happens is that the underlying tendency, which is often inherited, keeps producing new dilated veins elsewhere, particularly after pregnancy, weight gain or years of standing work.
Recurrence is also more likely when only the surface veins were treated while a leaking source vein or feeder vein underneath was missed. That is why an ultrasound matters before treating anything larger than simple spider veins, and why a follow-up visit is worthwhile if aching or new bulging veins return. Most patients find that occasional touch-up sessions keep their legs comfortable and looking the way they want, and that the touch-ups are smaller and quicker than the original treatment.
When to See a Vein Specialist in Houston
If your veins bother you only for how they look, sclerotherapy is a simple option whenever you are ready. If you have bulging veins, aching or swelling, ankle skin changes, or spider veins that keep coming back, it is worth seeing a vein doctor in Houston for an ultrasound before choosing a treatment. Dr. Syed Raza, a fellowship-trained interventional radiologist with more than 15 years of experience treating varicose veins and venous reflux, leads our team. We see patients from across Houston and Katy, same-week appointments are usually available, and most insurance plans, including Medicare, are accepted for medically necessary care.
Talk With a Specialist at Premier Vein
Have questions about your symptoms or treatment options? Dr. Syed Raza and the team at Premier Vein & Vascular Center can evaluate your concerns and explain your options clearly. Same-week appointments are usually available, and most insurance plans are accepted.
Frequently Asked Questions
Do spider veins turn into varicose veins?
No. Spider veins do not grow into varicose veins. The two can appear together because they share risk factors such as genetics and pregnancy, but they are different types of vein with different causes.
Are varicose veins worse than spider veins?
From a medical standpoint, usually yes. Varicose veins typically reflect leaking valves and higher vein pressure, so they are more likely to cause aching, swelling, skin changes and complications, while spider veins are mostly a cosmetic concern.
Does insurance cover spider vein treatment?
Spider vein treatment is usually considered cosmetic and is not covered by insurance. Varicose vein treatment is often covered by most insurance plans, including Medicare, when you have symptoms and an ultrasound confirms venous reflux.
Can spider veins come back after sclerotherapy?
Treated veins usually do not return, but new spider veins can form over time because the tendency is often inherited. Treating feeder reticular veins and checking for underlying reflux helps results last longer.
How can I tell if I have varicose veins or just visible veins?
Varicose veins are raised, twisted and usually 3 mm or wider, and they often bulge more when you stand. Flat blue veins you can see through thin skin are often normal or reticular veins. An exam and ultrasound give a definite answer.
Do I need an ultrasound for spider veins?
Not always. If you have only spider veins with no symptoms, sclerotherapy can often proceed after an exam. If you also have aching, swelling, varicose veins or a cluster of veins around the ankle, an ultrasound is recommended first.
Trusted Health Resources
- Chronic Venous Insufficiency, Society for Vascular Surgery
- Venous Insufficiency, MedlinePlus Medical Encyclopedia (NIH)
- Varicose Veins and Spider Veins, MedlinePlus (NIH)