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Usually, sclerotherapy is undertaken - micro injections of medication into veins that destroy the vein lining and veins are subsequently slowly absorbed by the body. Anywhere between 50-80% of injected veins respond and further injections in the same area can be carried out 5-6 weeks later. Treated veins appear worse before they disintegrate and disappear. Sclerotherapy is considered the ‘gold-standard’ treatment for thread and spider veins.
Lasers are also available and can be used in combination with sclerotherapy.
I find long pulsed Nd-Yag particularly useful. Higher energies and deeper penetration are required which means that laser treatment can sometimes be painful. With a careful patient selection, these treatments can provide excellent outcomes.