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Leg veins
Telangiectasias and visible veins: when they are only cosmetic and when they say more.
The red or bluish small veins that appear on thighs, knees and ankles are one of the most frequent reasons for seeing a phlebologist, and the initial question is almost always cosmetic: they show, they are unpleasant to look at, and one would like them gone. It is a legitimate request, but the first thing to establish is different: whether they are an isolated fact or the visible part of something underneath.
Telangiectasias are small dilated vessels in the superficial layer of the skin. They can appear through family predisposition, hormonal factors, after pregnancy, or in those who spend many hours standing or sitting. In some cases, however, they accompany deeper venous insufficiency, which is not visible from outside and which would keep producing new ones even after treatment.
This is why assessment begins with colour Doppler ultrasound where there are elements justifying it — heavy legs at the end of the day, ankle swelling, night cramps, larger tortuous veins alongside the thin ones. Treating the surface without having looked underneath often means repeating the treatment a few months later, wondering why they return.
When the deeper picture is clear, treating telangiectasias is a purely cosmetic choice, and should be set up as such: with clear expectations about how many sessions are needed and what can be achieved. Here too results reduce rather than erase, and anyone promising otherwise is describing something the vessel does not do.
Before removing, look underneath
Telangiectasias are superficial, but in some cases they are fed by deeper venous insufficiency that is not visible from outside. If it is present and not detected, cosmetic treatment works for a few months and then the veins return — not because it was poorly performed, but because the cause lay elsewhere. This is why, when symptoms such as heaviness or evening swelling are present, colour Doppler comes first and not afterwards.
How it shows
- Red, purple or bluish veins, thin and branching
- Typical sites: thighs, behind the knees, ankles
- Progressive increase in number over time
- Appearing or worsening after pregnancy
- Sometimes associated with heavy legs or evening swelling
- Sometimes alongside larger, raised, tortuous veins
How we proceed
- 1Phlebological visit: symptoms, family history, pregnancies, hours standing or seated
- 2Examination of the legs and assessment of visible veins, thin and large
- 3Colour Doppler ultrasound when symptoms or examination justify it (Siena practice)
- 4Distinction between a purely cosmetic picture and venous insufficiency to treat
- 5Definition of the pathway and, if cosmetic, clear expectations on the result
Available treatments
- Phlebological visit
- Colour Doppler ultrasound
- Sclerotherapy
- Scheduled follow-up
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Frequently asked questions
Are they only a cosmetic problem?+
It depends, and that is exactly what the visit establishes. In many people yes: they are isolated telangiectasias with nothing underneath. In others they accompany deeper venous insufficiency, and in that case they are not the problem but the symptom. The elements that shift suspicion are heaviness at the end of the day, ankle swelling, night cramps and larger veins alongside the thin ones.
Why do they return after treatment?+
There are two causes and they should be distinguished. First: the predisposition remains, so new ones can form over time — this is physiological and managed with follow-up. Second, and more important: if undetected venous insufficiency lies underneath, it keeps feeding them. This is why colour Doppler comes before treatment, not after.
Can they be treated in summer?+
Scheduling takes the season and sun exposure in the following weeks into account, so the less sunny months are generally more convenient. It is not a rigid rule, however: it depends on the treatment chosen and on your habits, and is decided at the visit along with the rest of the pathway.
Is colour Doppler available at both practices?+
No: vascular ultrasound is performed at the Siena practice, where the centre's phlebologist and sonographer works. The phlebological visit is available at both. If the visit indicates the examination, it is scheduled in Siena.
Related reading
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