When it comes to vein health, two of the most common terms you’ll hear are varicose veins and spider veins. At first glance, both conditions may seem like simple cosmetic nuisances—blue, purple, or red veins that become visible on the legs. But while they are related, they are not the same.

As a vein specialist here at Sheen Vein (Aesthetics and Functional Medicine) in St. Louis, I often meet patients who are surprised to learn just how different varicose veins and spider veins really are—both in appearance and in the way they affect your health. Understanding the differences between the two is the first step toward proper treatment and long-term relief.

Let’s break down varicose veins vs spider veins, including their causes, symptoms, complications, and modern treatment options.

What Are Spider Veins?

Spider veins (medically called telangiectasias) are small, dilated blood vessels that appear near the surface of the skin. They often look like thin, web-like networks of red, purple, or blue lines.

• Size: Usually less than 1 mm in diameter.
• Appearance: Flat or slightly raised; often form clusters that resemble a spider web or tree branch.
• Location: Commonly found on the thighs, calves, ankles, and sometimes on the face.

Spider veins are generally considered a cosmetic concern, but they can sometimes cause burning, itching, or aching—especially when linked to underlying venous insufficiency.

What Are Varicose Veins?

Varicose veins are larger, rope-like, bulging veins that develop deeper under the skin. They result from weakened valves inside the veins, which allow blood to pool and create excess pressure.

• Size: Typically 3 mm or larger in diameter.
• Appearance: Twisted, bulging, and ropey; can be blue, purple, or flesh-colored.
• Location: Most often on the legs, behind the knees, or along the calves.

Varicose veins are more than cosmetic—they are a sign of chronic venous insufficiency, a medical condition that affects circulation.

Causes: How Do They Develop?

Both spider veins and varicose veins share common risk factors, but the severity of venous damage differs.

Spider Veins Causes

• Hormonal changes (pregnancy, menopause, birth control pills)
• Sun exposure (especially for facial spider veins)
• Standing for long periods
• Genetic predisposition
• Minor valve weakness or surface vessel dilation

Varicose Veins Causes

• Chronic venous insufficiency (weakened or damaged vein valves)
• Prolonged standing or sitting
• Obesity (extra pressure on leg veins)
• Pregnancy (increased blood volume and hormone changes)
• Age-related weakening of vein walls
• Family history of vein disease

In short: spider veins are usually smaller, surface-level vessel problems, while varicose veins reflect deeper circulation issues.

Symptoms: Cosmetic vs Medical

One of the most important differences between spider veins and varicose veins lies in the symptoms they cause.

Spider Veins Symptoms

• Most often asymptomatic
• Occasionally cause mild itching, burning, or tingling
• Can cause cosmetic distress, especially when visible on the legs or face

Varicose Veins Symptoms

• Aching, throbbing, or heaviness in the legs
• Swelling around ankles or calves
• Cramping, especially at night
• Restless legs
• Burning or itching near affected veins
• Worsening discomfort after long periods of standing or sitting

In other words, spider veins are usually a cosmetic problem with mild discomfort, while varicose veins are often associated with chronic pain and circulation issues.

Complications: Why It Matters

Ignoring spider veins may not be dangerous in most cases, but ignoring varicose veins can put you at risk for serious complications.

Spider Veins Complications

• Mostly cosmetic
• Occasionally linked to deeper vein problems (if numerous or symptomatic)

Varicose Veins Complications

• Skin changes (discoloration, thickening, eczema-like rashes)
• Venous ulcers (painful sores that heal slowly)
• Superficial thrombophlebitis (inflammation or blood clots in surface veins)
• Increased bleeding risk from thin vein walls

This is why varicose veins should always be evaluated medically.

Diagnosis

At Sheen Vein (Aesthetics and Functional Medicine), the evaluation process looks different depending on whether spider veins or varicose veins are present:

• Spider veins: Usually diagnosed visually during a physical exam.
• Varicose veins: Require a venous ultrasound to evaluate blood flow and detect valve problems or hidden diseased veins that aren’t visible on the surface.

This diagnostic step is critical, since treating spider veins without addressing underlying varicose veins can lead to poor results and recurrence.

Treatment Options

The good news: both varicose veins and spider veins can be treated with minimally invasive procedures—most of which are performed in our office without the need for surgery.

Spider Vein Treatments

• Sclerotherapy: A solution injected directly into spider veins, causing them to collapse and fade.
• Laser Therapy: Surface laser treatments that close tiny spider veins, often used on the face or smaller leg veins.

Varicose Vein Treatments

• Endovenous Laser Therapy (EVLT): Uses laser energy inside the vein to close diseased veins.
• Ultrasound-Guided Sclerotherapy: Injection therapy for deeper or hidden varicose veins.
• Varithena® Foam Sclerotherapy: Specialized foam injection for larger, tortuous veins.
• Microphlebectomy: Tiny incisions to remove bulging veins (used in select cases).

Lifestyle Measures That Help

While medical treatment is the only way to eliminate diseased veins, lifestyle changes can help manage symptoms and prevent progression:

• Compression stockings to support circulation
• Regular exercise to improve leg muscle pump function
• Elevating the legs to reduce swelling
• Maintaining a healthy weight to reduce pressure on veins
• Avoiding prolonged standing or sitting when possible

Varicose Veins vs Spider Veins: Quick Comparison

Feature                                               Spider Veins                                                 Varicose Veins

‍Size                                                               < 1 mm                                                           > 3 mm

‍Appearance                                 Thin, web-like, flat or slightly raised          Rope-like, bulging, twisted

‍Location                                             Surface skin (legs, face)                                Deeper veins (legs)

‍Symptoms                                Mostly cosmetic, mild itching/burning         Aching, swelling, cramping, heaviness

‍Complications                                                 Rare                                  Ulcers, blood clots, bleeding, skin damage

‍Diagnosis                                                Visual exam                                        Ultrasound + physical exam

‍Treatment                             Cosmetic sclerotherapy                         EVLT, foam sclerotherapy, ultrasound-guided injections

Why Choose Sheen Vein in St. Louis?

At Sheen Vein (Aesthetics and Functional Medicine), we specialize in the full spectrum of vein care—from cosmetic spider vein treatments to advanced interventions for chronic venous insufficiency. What sets us apart is our comprehensive, patient-centered approach:

• Accurate diagnosis with state-of-the-art ultrasound
• Minimally invasive treatments with little to no downtime
• Insurance-based coverage for medically necessary varicose vein procedures
• Aesthetic and functional care for both appearance and long-term circulation health

Our goal is not only to help your legs look better but also to help you feel better, move better, and prevent long-term complications.

Final Thoughts

While varicose veins and spider veins may seem similar, they are quite different in terms of size, symptoms, and health impact. Spider veins are mostly a cosmetic issue with minimal discomfort, while varicose veins signal underlying vein disease that can cause pain, swelling, and serious complications if untreated.

If you live in the St. Louis area and notice visible veins on your legs—or if you’re experiencing leg pain, heaviness, or swelling—it may be time for a professional vein evaluation.

At Sheen Vein (Aesthetics and Functional Medicine), we offer compassionate, advanced vein care tailored to your unique needs. Don’t ignore your veins—healthy circulation is vital to your overall wellness.

👉 You may also like:

• Why Varicose Veins Are Not Just Cosmetic
• How Varicose Veins and Spider Veins Cause Pain
• Endovenous Laser Therapy (EVLT) in St. Louis

‍