Anatomy

Thread veins most commonly occur on the face and legs. They are in fact tiny blood vessels that run very close to the surface and are usually blue or red in colour. They are often called spider veins. They are in fact telangiectasia which are fine capillary veins. They normally develop as a consequence of age. They appear quite commonly after pregnancy and therefore there may well be an underlying hormonal cause. They are also associated with exposure to the elements and the sun. Long term use of oral steroids is also associated with formation. Thread veins may occur with varicose veins.

Indications

Thread veins are normally removed for cosmetic reasons only and laser surgery is only applicable if the veins are less than 4 mm in size. Larger veins may be treated by injecting a substance called a sclerosant which causes the vein to shrink over a period of 8 weeks.

Anaesthetic

Laser removal for thread veins does not normally need an anaesthetic although topical anaesthesia using a special gel may be used.

Technique

The best type of laser is a YAG laser which has a longer wavelength that is preferentially absorbed by the blood in the veins, thereby sparing any damage to the surrounding tissue. The laser produces pulse energy, each pulse being less than 1,000th of a second, this therefore reduces the heat generation tissue damage and hence it is normally quite painless. It may often feel like a rubber band hitting the skin.

Length of Operation

The length of operation depends on the area that needs to be treated.

Time in Hospital

It is normally performed as a day case.

Time off Work

No time off work is required.

Risks and Complications

Using a pulse laser carries very few risks although it needs to be carried out by an experienced consultant with the proper precautions such as using special eye protection. Occasionally if the power is set too high for the veins there might be a small localised burn which may be painful for a few days. Normally however the only side effects might be slight reddening of the area for the first few days. Healing is normally complete within 2 weeks.

Outcome and Prognosis

For small veins laser treatment is the treatment of choice and is usually successful as long as the vein runs very close to the surface of the skin.

Alternative Treatment

Sclerotherapy can be used for larger veins. It does carry more risks of complications such as infection and bruising.

By Mr Garth Titley, MSc, FRCS (Plast)