Thread Vein Treatment in Istanbul, Turkey

You know those little red or purple lines that appear on your legs or face out of nowhere like spider webs? These capillary ruptures, medically referred to as telangiectasia or spider veins, are a common condition that affects 80% of the world’s population. While they are often just an aesthetic issue, they can at times cause complaints such as aching, burning, or a sensation of heaviness in the legs.

So what makes these veins grow? And what does contemporary medicine have to offer us in terms of solutions?

What are thread veins?

In medical terminology, thread veins, also called telangiectasia or spider veins, are formed by the expansion of very small vessels, typically 0.1 to 1 mm (sometimes up to 2 mm) in diameter, located just beneath the surface of the skin. These vessels develop due to a combination of genetic, biological and environmental factors, not due to a single cause.

Capillaries are generally vessels which have lost their normal functions, such as, for example, the regulation of the temperature balance of the skin. These vessels may sometimes be a cosmetic concern only, but if they are grouped in the inner parts of the legs, it is advisable to evaluate them with Doppler ultrasound because they may be a sign of underlying chronic venous insufficiency.

Genetic Susceptibility and Ageing

Genetic inheritance is one of the most important and determining factors in the formation of capillaries. In individuals with a familial incidence of this problem, there is a genetic predisposition to weakness of the vascular wall. But with age the walls of the blood vessels lose their elasticity, and a degenerative process sets in that causes the vessels to expand more readily and become more visible.

Increased Venous Pressure and “Feeder” Vessels :

Capillaries don’t always just appear; often they are a reflection of a deeper pressure problem on the surface.

• • Feeder Veins: Larger (2-4 mm) veins located just under the skin that feed the capillaries. More than 50% of the capillaries are fed by reticular veins.
• • Venous Reflux: High pressure from the blood flowing backward (reflux) through the valves in the deeper veins is transferred to the fine capillaries on the surface, which become dilated and rupture. It can be a sign that the varicose veins are hidden and have not been treated.

Endocrinal Changes

The main reason for the far greater number of capillaries in women than in men is due to hormones.

• • Pregnancy: Blood volume increases and hormonal changes cause blood vessel walls to relax and expand during pregnancy.
• • Use of medication: Medications including birth control pills or Hormone Replacement Therapies (HRT) that contain oestrogen can influence the vascular tone and increase the risk of capillary formation.

Factors External and Environmental

External factors are especially prominent in the capillaries of the facial area (around the nose and cheeks):

• • Sunlight (UV): This is the commonest factor for causing telangiectasia. Prolonged exposure to sunlight damages the vascular structure and elastic fibres of the skin.
• • Weather Conditions: Very high or very low temperatures, or extreme wind, can cause a disruption in the mechanism of blood vessels contracting and expanding (heat control function).
• • Cosmetics and Chemicals: Extended use of steroid creams can make the skin thin and more transparent, increasing the visibility of capillaries.

Physical and Lifestyle Factors

• • Orthostatic Stress: Working while standing or sitting still all day keeps the leg vein pressure high all the time and accelerates the dilation of capillaries.
• • Obesity: Extra weight means more pressure on the venous system in the legs, disturbing the structure of the veins.
• • Injuries: blows to the skin or old traumas to the leg may interfere with the microcirculation in that area, resulting in permanent clusters of capillaries.

What are The Symptoms of Thread Veins?

Thread veins or spider veins usually do not cause any serious health problems, but the symptoms they produce cause different types of physical discomfort and cosmetic problems in the legs.

Symptoms of Vision

• • Fine Lines and Colour Change: Very fine (usually less than 1 mm) spiderweb-like veins in red, blue or purple colour can be seen just under the skin surface.
• • Cluster Formation: They can present themselves as individual lines, form fan-shaped patterns emanating from a specific point, or cluster together in a web-like structure in a specific area.

Physical Complaints

About half of the patients report aesthetic problems as well as the following physical symptoms:

• • Pain and Ache: Dull pain or ache in the vein area.
• • Heavy and Tired Legs: A sensation of heaviness and tiredness in the legs, especially at the end of the day.
• • Itching and Burning: Itching, burning or tingling around the veins or in the legs.
• • Cramps and Restlessness: Nite cramps or a sensation of restlessness in the legs.
• • Pulsation or tingling: In untreated cases, the legs might experience pulsation or tingling.

Aggravating Factors and Complications

• • Standing: Symptoms tend to get worse after standing or sitting for a long time.
• • Bleeding: Bleeding from superficial capillaries is uncommon but can occur in patients on anticoagulation medication.

Could the presence of capillaries be a sign of some underlying disease?

Yes, spider veins do appear to be more of a cosmetic issue, but they can be a sign or symptom of a more serious underlying vascular disease.

Capillaries may indicate other conditions and diseases, including:

• • Hidden Varicose Veins: Capillaries, particularly on the inner parts of the legs, can be a sign of underlying varicose veins that have yet to be seen on the outside of the skin. They can become visible when the high pressure of the valve insufficiency (venous reflux) pushes them toward the skin, causing reverse blood flow.
• • Chronic Venous Insufficiency (CVI): In medical terminology, capillaries are part of the spectrum of Chronic Venous Insufficiency and are classified as the first stage of the disease (C1) in the CEAP clinical classification. If not treated, the condition can over time develop into swelling of the legs, discolouration of the skin and non-healing venous ulcers.
• • Problems of the feeder vein: The capillaries are generally fed from deeper “feeder veins” (reticular veins). Because of a problem with these feeder veins, the superficial capillaries tend to proliferate. If this deep focus is not treated, the capillaries tend to recur.
• • Raised Intra-Abdominal Pressure: Increased intra-abdominal pressure from more serious medical conditions, such as tumours or masses, that rarely obstruct venous return in the abdomen, can cause enlarged veins in the legs.

Hormonal and systemic factors: Pregnancy, hormonal changes or liver diseases may affect the structure of blood vessels and cause rupture of capillaries (e.g., spider naevi).

For these reasons it is important not to consider capillaries as a "skin blemish" but to understand the condition of the underlying venous system undergoing a venous Doppler ultrasound examination, which is a critical step for diagnosis and proper treatment planning.

Novel Treatment Approaches

It is very important to have a vascular map with venous Doppler ultrasound by a specialist doctor (such as a cardiovascular surgeon such as Prof. Dr Cenk Eray Yıldız) before starting the treatment. The surface capillaries will return in a short time if the underlying “feeding” veins are not treated.

Treatment of vascular diseases depends on the size and location of the vessel, as well as the patient’s preferences.

Microsclerotherapy

This is the most common choice, especially for veins under 4 mm, and is the “gold standard” for the treatment of the fine veins in the legs.

• • Method: This is the direct injection of a liquid or foam medication known as “sclerosant” into the vein with a very fine needle.
• • Mechanism of Action: The drug causes irritation to the vessel wall, leading to constriction and adhesion of the vessel, thereby closing it. The closed vessel is slowly absorbed and disposed of by the body.
• • Advantages: It is more effective than laser for vessels larger than 0.5 mm, it does not require anaesthesia, and patients can return to their daily lives by walking immediately after the procedure.
• • Results: Usually, one session eliminates 50% to 80% of the veins, but several sessions may be necessary for total recovery.

Laser Therapy (Nd:YAG, IPL/I2PL)

It is a non-invasive method preferred especially for the facial area, sensitive areas and small vessels that cannot be reached by sclerotherapy needles.

Nd:YAG Laser: Has a wavelength of 1064 nm and is quite successful in targeting deeper vessels and those up to 2 mm in diameter.

IPL/I2PL (Intense Pulsed Light): The light is absorbed by haemoglobin and converted into heat, destroying the vessel wall; it is especially suitable for common facial redness.

• • Benefits: It is an ideal solution if there is a fear of needles or for fine vascular networks (matting) that can occur after sclerotherapy.
• • Disadvantages: It should be used with caution due to the potential for hyperpigmentation (stains) in dark or tanned skin.

Thermocoagulation (Veinwave/ThermaVein)

The veins are closed by direct heat energy rather than a chemical.

• • Method: It is the thermal sealing of the vessel using high-frequency microwave or heat energy applied from the skin surface.
• • Target Audience: It is effective in very small capillaries where sclerotherapy cannot be performed or laser is insufficient.
• • User Experience: It provides a safe alternative for patients with needle phobia because it does not involve the risk of needle injection and drug allergy.

Comparison of Treatments Table

What to Expect After Thread Vein Treatment

Treatment of thread veins (capillary veins) with a needle (microsclerotherapy) or laser method, as a rule, passes quickly and comfortably. According to the sources, here are the stages you should expect from the post-procedure process:

After the Procedure: Movement and Walking

• • Immediate Movement: You will be asked to move your legs as soon as you get off the table after the treatment.
• • Mandatory Walk: Be sure to take at least a 30-minute walk before leaving the clinic. This gets blood flow moving again, making it less likely that clots will form and helping the treatment to work better.
• • Return to Work: This is a “lunch break” procedure; most patients are able to return to work and normal activities the same day.

Compression (Varicose Vein Stockings) Procedure

• • Important: The most important thing for success is to wear varicose vein stockings or bandages for the period recommended by the doctor.
• • Duration of Use: In principle, the bandage should be worn continuously, day and night, for the first 3 to 5 days. Varicose vein stockings, however, are generally continued during the day for at least 1-2 weeks.
• • Benefit: Compression application decreases the risk of bruising, swelling and permanent skin discolouration (pigmentation).

Activity Restrictions and Care

• • Heavy Exercise: No heavy lifting; do not strain your legs too much, and no vigorous sports for the first 3 days.
• • Sun Protection: if you've had laser treatment, you should protect the treated area from direct sunlight for 30 days and use a high-factor sunscreen.
• • Bathing and swimming: After one week swimming is generally permitted. In the first days, bathing should be taken care of so as not to wet the socks.

Anticipated Temporary Side Effects

The following conditions are normal in the course of recovery and usually disappear with time:

• • Bruising and Changes in Colour: Swellings, redness or bruising similar to insect bites may develop at the injection sites. Bruises usually clear up within 2-3 weeks.
• • Dark Lines: The treated veins may appear darker or more prominent at first, which means the medication is working.
• • Hardness and 'Trapped Blood': You may feel hard, small lumps along the line of the vein. These are usually relieved by your doctor draining them with a small needle intervention at the check-up 4 weeks later.
• • Pigmentation: Some patients may have brown discolouration along the vein; these usually fade within 6-12 months and are rarely permanent.

Results and Follow-Up

• • Follow-Up: A follow-up appointment is normally scheduled 4 weeks after the procedure.
• • Number of Sessions: 1-4 sessions to achieve a complete aesthetic result in the capillaries. 4-8 week recovery period between the sessions.
• • Anticipated: The treatment improves the appearance of the existing vessels by 70-80% or so. But as your genetic predisposition goes on, it must be remembered that in the future new areas may form other vessels.

F.A.Q:

Will it hurt a lot during the procedure?

Most patients describe the procedure as a “rubber band snap” or “slight needle prick” and it is usually performed without anaesthesia.

Is the treatment of capillary vessels permanent?

Yes, a successfully closed vessel will not open again. However, you may develop new vessels over time in different locations due to your genetic predisposition.

Can all veins be treated in one session?

Usually between 1 and 4 sessions can be needed depending on the density of the veins. Recovery between sessions is expected to take 4-8 weeks.

Which is the best season for treatment?

The best time to do it is winter and spring, because after the treatment you need to protect yourself from the sun and put on compression stockings.

How long will bruises last after the treatment?

Bruising and redness usually go away completely in 2-3 weeks.

Is sclerotherapy done for facial capillaries?

For very fine vessels on the face, laser is usually preferred, but for more prominent vessels a specialist doctor may also apply sclerotherapy.

Is it treatable during pregnancy?

These treatments are not recommended in pregnancy and lactation and are postponed until after delivery.

Do capillaries disappear on their own?

Unfortunately, no, they don’t just go away on their own once they are formed. They spread, in fact.

Laser treatment or needle treatment, which is better?

It is determined by the size of the vein. Injection (sclerotherapy) is more effective for thicker “feeding” veins, and laser treatment for very thin superficial veins.

Are capillaries blocked by sunscreen?

Sunscreen, particularly on the face, can prevent skin damage and reduce the risk of neovascularisation.

Can I go back to work right away after I’ve been treated?

Yes, this is a “lunchtime” procedure. You may leave the clinic and return to work.

How costly is the treatment?

The cost depends on the extent of the veins and the number of sessions. On the first visit the doctor will give you a plan.

Who is not a candidate for treatment of capillaries?

Patients with active infection, serious systemic disease or bedridden patients may not be suitable for treatment.