Why Spider Veins Return After Treatment
Most spider veins that seem to return are not a fully treated vessel reopening. They are vessels a session did not completely close, veins kept filled by a feeder or a leaking vein that was never treated, or new vessels from the same tendency that caused the first ones. A vessel fully sealed and absorbed does not come back.
Each cause has its own fix. For the condition itself, see spider veins; for how the treatments compare, see spider vein treatments compared.
Same Vessel or a New One?
Sclerotherapy aims to damage the lining of a vessel enough to turn it into a fibrous cord that cannot reopen, as published standards of care describe it. Cleveland Clinic puts it plainly: when treatment works, the problem does not happen again. It also estimates that one session clears 50 to 80 per cent of the injected veins. A vessel still visible after the first session has not returned. It is unfinished.
Where the new lines sit is a useful clue. A line that returns in exactly the same place means a vessel that was only partly closed has reopened. A fresh cluster over the inner thigh or knee, along the main surface vein, raises the question of a leaking vein beneath. A haze of tiny red vessels around an injection site is matting. New lines in skin never treated are simply new veins.
Five Reasons Spider Veins Reappear
A vessel that was only partly closed
If the solution or the light did not damage the whole length of the lining, blood can find its way back through the channel, and the line reappears where it was. This is why the strength and volume of solution are matched to the size of each vessel, and why a review after treatment matters.
A feeder vein left open
Most leg spider veins are fed. In a 1993 duplex study of 37 legs with thigh spider veins, a leaking reticular vein lay close to the spider veins at 89 per cent of the sites examined, and the authors recommended treating those feeders with the visible vessels. Treat the red lines alone, and the blue vein supplying them keeps pushing blood into the same patch of skin.
A leaking vein deeper down
In a study of 269 legs of women whose visible problem was spider veins, ultrasound found saphenous reflux in 46 per cent, usually in a segment below the groin rather than at the junction. Not everyone needs a scan: the 2023 guidelines discussed below advise against routine scanning when spider veins cause no symptoms. A duplex ultrasound is worth discussing when veins come back quickly to the same area, or arrive with aching, heaviness or swelling.
Matting around the treated area
Matting is a network of very fine red vessels that can appear around an injected area in the weeks after treatment. It is a reaction to treatment, not the original vein returning, and a review in Dermatologic Surgery notes that it usually fades on its own within 3 to 12 months. Its causes and treatment are covered in pigmentation and matting after sclerotherapy.
The tendency that caused the first veins
No treatment changes the reasons the first veins formed. Cleveland Clinic lists family history, pregnancy, hormonal contraception or hormone therapy, obesity, long periods of standing or sitting, sun exposure and smoking among the risk factors, and notes that treatment may be needed again if new spider veins form.
What the Evidence Can and Cannot Tell You
How often do spider veins come back? Nobody can give a reliable figure. A 2021 Cochrane review pooled 35 randomised trials with 3,632 participants and found that none had measured recurrence; the reviewers named it among the outcomes future trials need to cover. Any recurrence figure rests on clinical experience and small case series, not controlled trials.
What Lowers the Chance of Return
Treat in the right order. A leaking vein or feeder is treated before, or together with, the visible vessels. The 2023 guidelines of the Society for Vascular Surgery, the American Venous Forum and the American Vein and Lymphatic Society recommend liquid or foam sclerotherapy for symptomatic spider and reticular veins, and suggest surface laser where injections have failed, where a sclerosant allergy or fear of needles rules them out, or where very fine vessels have matted; laser or sclerotherapy for spider veins sets out how the two compare. Dr. Sohrabi treats spider and reticular veins with sclerotherapy, in line with that guidance.
Wear the compression. After spider vein sclerotherapy, Dr. Sohrabi advises compression stockings for one to two weeks; in a 2007 randomised trial, stockings after treatment gave clearer legs than none. In a Dubai summer that is a real ask, which is one reason to consider the cooler months. Stockings are not for everyone: the NHS notes they are not suitable if you have problems with blood flow in your arteries.
Come back for review. Dr. Sohrabi reviews patients a few weeks after each session, so a segment that has not fully closed can be found and treated before it reopens.
Plan for maintenance. An occasional top-up session is part of long-term care, not a sign that treatment failed. Cleveland Clinic suggests breaking up long spells of sitting or standing, keeping to a healthy weight and raising the legs at rest to help prevent new veins.
Dr. Soroush Sohrabi is a UK-trained Consultant Vascular and Endovascular Surgeon (FRCS, CCT) practising in Dubai, with a Cleveland Clinic Advanced Endovascular Fellowship and 77 peer-reviewed publications.
Choosing a Surgeon When Spider Veins Return
Look for someone who checks what feeds the veins before treating them, can scan for a leaking vein when the pattern suggests one, and can treat every layer, from a main vein to the fine surface vessels. Dr. Sohrabi holds the FRCS in Vascular Surgery and a CCT, performs and interprets his own duplex scans, closes leaking main veins by ablation and treats spider and reticular veins with sclerotherapy. Book a consultation to find out why your spider veins came back.
About the Author
Dr. Soroush Sohrabi MD, PhD, FRCS, CCT (UK), PGCert, MCPhleb is a Consultant Vascular and Endovascular Surgeon practising in Dubai. He trained in the United Kingdom and holds a Fellowship of the Royal College of Surgeons (FRCS) in Vascular Surgery and a Certificate of Completion of Training (CCT). He has published 77 peer-reviewed papers with over 1,183 academic citations and is a member of the European Society for Vascular Surgery (ESVS) and the Vascular Society of Great Britain and Ireland (VSGBI). He is licensed by the UK General Medical Council (GMC No. 5207627) and the Dubai Health Authority (DHA No. 48905551).
Medically reviewed by Dr. Soroush Sohrabi MD, PhD, FRCS, CCT, Consultant Vascular and Endovascular Surgeon, October 2026.
References
Khunger N, Sacchidanand S. Standard guidelines for care: sclerotherapy in dermatology. Indian J Dermatol Venereol Leprol. 2011;77(2):222-231. https://doi.org/10.4103/0378-6323.77478
Cleveland Clinic. Sclerotherapy: Treatment and Recovery. https://my.clevelandclinic.org/health/treatments/6763-sclerotherapy
Somjen GM, Ziegenbein R, Johnston AH, Royle JP. Anatomical examination of leg telangiectases with duplex scanning. J Dermatol Surg Oncol. 1993;19(10):940-945. https://doi.org/10.1111/j.1524-4725.1993.tb00982.x
Engelhorn CA, Engelhorn AL, Cassou MF, Salles-Cunha S. Patterns of saphenous venous reflux in women presenting with lower extremity telangiectasias. Dermatol Surg. 2007;33(3):282-288. https://doi.org/10.1111/j.1524-4725.2007.33063.x
Gloviczki P, Lawrence PF, Wasan SM, et al. The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101670. https://doi.org/10.1016/j.jvsv.2023.08.011
Goldman MP, Sadick NS, Weiss RA. Cutaneous necrosis, telangiectatic matting, and hyperpigmentation following sclerotherapy: etiology, prevention, and treatment. Dermatol Surg. 1995;21(1):19-29. https://doi.org/10.1111/j.1524-4725.1995.tb00107.x
Cleveland Clinic. Spider Veins. https://my.clevelandclinic.org/health/diseases/24567-spider-veins
Nakano LC, Cacione DG, Baptista-Silva JC, Flumignan RL. Treatment for telangiectasias and reticular veins. Cochrane Database Syst Rev. 2021;10(10):CD012723. https://doi.org/10.1002/14651858.CD012723.pub2
Kern P, Ramelet AA, Wütschert R, Hayoz D. Compression after sclerotherapy for telangiectasias and reticular leg veins: a randomized controlled study. J Vasc Surg. 2007;45(6):1212-1216. https://doi.org/10.1016/j.jvs.2007.02.039
NHS. Varicose veins. https://www.nhs.uk/conditions/varicose-veins/
