Spider Vein Treatment Spider veins or thread veins vary in appearance and colours, depending upon their depth within the skin or the presence of underlying larger reticular veins and the management of these veins differ. The spider veins have three components. The dermal red or blue thread veins, the subdermal green veins and the invisible deeper branch veins. The dermal thread veins respond to Light based therapy such as IPL or Cutaneous Laser for thread vein removal. Microsclerotherapy is used for the treatment of spider veins and depends on the size of the thread veins and skill of the provider. The subdermal veins do not respond to Laser, as they do not penetrate deep and are best treated with Microsclerotherapy. The spider veins that do not respond to treatment have a deeper branch vein that is only visible on ultrasound scan and will need to be injected under ultrasound guidance. The failure to obtain a successful resolution following spider vein treatment is because of inadequate assessment. The best results are obtained by treating the larger component first and the dermal red thread veins last. This also reduces the chance of recurrence and pigmentation.  
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