varicose veins

Factors causing Varicose and Spider Veins

Unsightly leg veins are more common as we age. Heredity is the major contributing cause of varicose veins, affecting 30% of men and women. Genetic factors are a major cause – being born with “weak” veins or valves or insufficient valves are a major cause.

Pregnancy is the other major cause. Pregnancy induced hormones and the pressure caused by the enlarging uterus increases the back pressure on valves. In general, the distension of the veins settles following the first pregnancy. With each subsequent pregnancy, the distension and back pressure becomes accumulative, causing non-reversible distension, thus valve failure or “incompetence” leading to varicose veins.

Other factors contributing to venous disease are trauma, occupations that require prolonged periods of standing, obesity and past history of thrombosis. Excessive sun exposure in fair skinned individuals increases the chance of getting veins on the nose, cheeks and chin.

Unsightly veins in legs are usually of three different types. Tortuous, lumpy, thick knotted veins are called varicose veins while tiny purplish network of veins which often look like a spider web are called Telangiectasia or spider veins. In between these two types are bluish/green veins lying deeper in the skin called reticular or feeder veins. These are often responsible for spider veins.

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The face, neck, chest and back are the most commonly affected areas.

Normal Circulation

Blood is circulated throughout the human body via arteries and veins. In general, arteries conduct oxygen rich blood to our tissues and extremities and this is enabled by the rhythmic pulsation of the heart. Once oxygen and nutrients are used by tissues, they are returned to the lungs and heart via veins. This return of blood is achieved by the contraction of leg muscles and the action of valves in our veins. Leg muscles function like a pump and the valves are “one-way” valves preventing back flow. When these valves malfunction, backflow occurs, increasing pressure in the venous system heralding the beginning of varicose or spider veins.

There are two vein systems in our legs a deep and a superficial system. The deep system lies deep to the skin and is the main channel for returning blood to the heart.

The superficial system lies beneath the skin and while also transporting blood towards the heart, most of the blood is conducted to the deep system via connecting channels known as perforators as well as branches or tributaries. These perforators and branches also have valves preventing backflow therefore flow of blood is generally from the superficial to the deep system when the leg muscle pump is activated.

The main superficial vein is the Great Saphenous Vein, which originates on the inside of the ankle and stretches to the groin where it meets the deep vein, while on the back of the leg is the short saphenous vein which starts on the outside of the ankle and extends along the calf to drain into the deep vein at the back of the knee.

These veins are the ones that are commonly varicosed and subject to treatment. Branch and subsidiary veins can also become varicosed and may also require treatment.

When the muscles contract (e.g. when walking) they become tense and thicken, thus producing pressure on adjacent veins, so that blood is forced out of those vessels. Venous valves then act like a check valve: the blood can only flow towards the heart. The way back down is impeded by closed venous valves. When the muscles relax, blood can flow from below because the venous valves will have reopened at that point in time.


Varicose and spider veins are in most cases visible. Sometimes there is back pressure and development of varicose veins or significant spider veins, where the underlying causative varicose vein is not visible. Often there are no visible signs of venous disease, but only significant symptoms such as pain, tired legs, aching legs, restless legs or night cramps.

A Venous Duplex Ultrasound examination can accurately rule out or rule in these symptoms as being caused by varicose veins.

A Venous Duplex Ultrasound attracts a fee of $156.00. However, if a patient presents with a GP referral requesting assessment of leg veins with an ultrasound, this practice will bulk bill for the ultrasound study.
Duplex ultrasonographyThis state of the art instrument has become the “golden standard” in the diagnosis of venous disease. Modern ultrasonography provides accurate and direct visualisation of the veins as well as velocity and direction of blood flow. By combining accurate assessment of the size and shape of blood vessels with functional evaluation of blood flow, this modality is ideal for assuring correct diagnosis and planning the most appropriate treatments.

Do you need to treat Varicose or Spider Veins?

Varicose or spider veins are not a cosmetic problem they are a medical problem.

The pooling of old blood (from back flow) causes not only symptoms in the legs but damage to the skin and underlying tissues such as discolouration of the skin, itching, venous eczema, ankle swelling and leg ulcers.

Varicose veins and spider veins respond better to treatment the earlier it is done. Long standing vein problems tend to require more treatments and respond much slower to treatment.

Spider veins should not be treated until associated varicose veins are treated.

In general, surgery (stripping) is not required to treat varicose veins; they can be treated by an injection technique as an outpatient, called sclerotherapy. Ultrasound guided sclerotherapy is used for varicose vein treatment while microsclerotherapy is used for spider veins.


At Shire Cosmetic Medicine, we specialise in Ultrasound Guided Sclerotherapy (UGS). UGS involves the injection of a sclerosant substance into the vein under ultrasound guidance.

The two sclerosants or solutions used in this clinic are Sodiumtetradecylsulphate and Aethoxysclerol. These solutions come in a concentration of 3% and can be reduced in concentration by the doctor as required.

Our treatment protocol is to treat any one leg at a session (a session may take between 1/2 hour and one hour) with reviews done at 1 week, 2 weeks, 6 weeks and 12 weeks post treatment. If two limbs need to be treated, the second limb can be treated after two weeks. A compression stocking following treatment is mandatory and worn for a minimum of two weeks.

The treatment is relatively pain free and no anaesthetic is used. Return to normal duties immediately after treatment is encouraged. As with all treatments, there is a healing period and this time depends largely on the state of the veins to start with – the bigger the varicose vein, the longer the healing period.

Treating varicose veins is not a cure and recurrence is possible no matter what method is used to treat them. Left untreated, varicose veins may lead to itching, eczema, discolouration of the skin, swelling of the legs, deep venous thrombosis, bleeding and ulceration.

Our treatment of spider veins and reticular veins

These may be treated by micro sclerotherapy or laser ablation.

Our preference in our clinic is for micro sclerotherapy. This is done by direct vision and the same sclerosants, Sodiumtetradecylsulphate and Aethoxysclerol, in reduced concentration, are used.

Multiple injections are done into the offending veins and most patients require 2 to 3 treatment sessions per leg to obtain a good cosmetic outcome. Again one leg is treated at any one session with each session being of 30 minutes duration. A compression stocking is again generally required and worn for one week.

The second leg is treated one week after the first treatment and repeat treatments to the same leg are spaced one month apart. No anaesthetic agent is used in the treatment and most patients cope with the pain quite well for the duration of the treatment.

With the introduction of foam sclerotherapy for UGS and micro sclerotherapy the outcomes are far better and achieved with fewer injections and treatment sessions.

Before & Afters

Patients of Dr Alan Evans.

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