you're so vein

In the quest to stay eternally ageless, it helps to pay attention to your veins. Tens of millions of women and men in the U.S. experience varicose and spider veins in their legs—and face an often confusing variety of remedies to choose from: Laser treatment? Injections? Surgery? To find out what works best, The Sheet headed to Cornell Vascular and spoke with renowned venous expert Dr. Robert Min.

Q: What are varicose and spider veins?
A: Spider veins are small red or blue veins located just below the surface of the skin. They can have a linear or web-like appearance—hence the term spider vein. Varicose veins are larger, located deeper underneath the skin. They can protrude from the skin surface in a rope-like appearance.

Q: What determines if you get varicose and spider veins?
A: Hereditary factors play the most important role. Women are more likely to have varicose or spider veins due to hormonal factors, including pregnancy, birth control pills, or hormone replacement therapy.

Q: Do these veins cause other health symptoms?
A: Most spider veins are nothing more than a cosmetic nuisance. Although varicose veins can also be unattractive, they're often associated with symptoms such as leg pain, cramps, fatigue, heaviness, or swelling.

Q: What treatments are available?
A: The treatment of choice for the majority of varicose veins and nearly all spider veins on your legs is compression sclerotherapy. In some cases, additional intervention such as surgery, ultrasound-guided sclerotherapy, or endovenous laser treatment is necessary.

Q: What's compression sclerotherapy?
A: Sclerotherapy is an in-office procedure involving a series of injections. A tiny needle is used to administer small amounts of a sclerosing solution into the vein. This irritates the vein's inner lining, causing it to collapse and ultimately disappear.

Q: Does sclerotherapy hurt?
A: Most people report little if any discomfort. Occasionally you may feel mild burning at the injection site for a few minutes.

Q: How many treatments will I need?
A: This varies according to the severity and number of veins that need to be treated. Although most people notice some improvement after the first treatment, most areas need to be treated approximately three times for optimal results.

Q: Is surgery needed to treat severe cases of varicose veins? A: Occasionally, patients with varicose veins need more than just sclerotherapy. In the past, surgical ligation and stripping was the only treatment available for these cases. Today, minimally invasive in-office methods are available and may offer good alternatives to surgery.

Q: What are some of the latest advances in varicose vein treatment?
A: In recent years, some exciting advances in the treatment of veins have been made. These newer, less invasive treatments include: ultrasound-guided sclerotherapy, radiofrequency heat closure, and most recently, endovenous laser treatment. Endovenous laser treatment is a minimally invasive technique performed in the doctor's office. It doesn't require general anesthesia, doesn't cause scarring, has fewer risks, lower costs, and a shortened recovery period compared to surgery.

Q: How do I know which is the best treatment for me?
A: The first step is to find a physician with experience and expertise in phlebology, the field of medicine dealing with disorders of the venous system. A focused medical history, physical exam, and diagnostic testing will determine the cause, severity, and best treatment options available for your particular problem.

Robert J. Min, M.D., is director of Cornell Vascular, Assistant Professor and Attending Physician in Vascular Interventional Radiology at New York-Weill Cornell Medical Center. He's specialized in the treatment of varicose and spider veins for the past decade and serves on the board of directors of the American College of Phlebology. Dr. Min and his staff at Cornell Vascular will be happy to answer any of your questions at (212) 752-7999.