Spider Veins vs Varicose Veins — What's the Difference?
Both are visible veins, but they differ in size, symptoms and treatment. A simple guide to telling them apart and choosing the right care.
Spider veins and varicose veins are both signs of vein disease, but they sit at very different ends of the spectrum. Knowing which you have decides whether you need a 15-minute injection, a 45-minute laser, or just reassurance.
Spider veins (telangiectasia)
- Tiny, web-like red, blue or purple veins under the skin surface.
- Less than 1 mm wide — usually on the thighs, behind the knees or on the face.
- Mostly cosmetic; occasionally mild burning or itching.
- Caused by hormonal changes, sun damage, pregnancy or minor genetic predisposition.
Varicose veins
- Bulging, rope-like veins you can see and feel — 3 mm or larger.
- Most often on the calves and inner thighs.
- Cause heaviness, aching, night cramps, itching, swelling, and sometimes skin pigmentation or ulcers.
- Caused by leaking one-way valves in the great or small saphenous vein (true venous reflux).
How a vascular surgeon tells them apart
A bedside examination plus a 15-minute duplex ultrasound shows whether the deeper saphenous veins are leaking. If they are, you have true varicose vein disease — even if only spider veins are visible on the surface. Treating the cosmetic veins alone in such cases almost always leads to recurrence.
Treatment options compared
- Spider veins — sclerotherapy (micro-injections) or surface laser; 2–4 short clinic sittings.
- Reticular feeder veins — foam sclerotherapy under ultrasound guidance.
- Varicose veins with reflux — endovenous laser ablation (EVLA), radiofrequency ablation, MOCA or VenaSeal glue, often combined with phlebectomy or sclerotherapy of tributaries.
When to see a specialist
See a vascular surgeon if you have visible bulging veins, evening leg heaviness, night cramps, itching at the ankle, skin colour change, or a non-healing ulcer above the ankle. For purely cosmetic spider veins without symptoms, sclerotherapy or laser by an experienced clinician gives excellent results.
