The decision on how to treat spider veins and varicose veins depends on the size (diameter) of the vein, as well as the personal preference, skill set, and office equipment of the treating physician. For the treatment of spider veins, I prefer to use injections with the FDA approved medicine called polidocanol. This process is called sclerotherapy. In most cases, it is less painful than laser treatment, more time efficient, and a wide range of vein diameters can be treated. I use surface laser therapy for small spider veins (less than .5 mm in diameter), for veins on the face, for patients that are allergic to sclerotherapy medicine, or veins that are resistant to sclerotherapy. I believe a narrow beam, hemoglobin absorbing laser is best, such as the 940 nm wavelength laser. By definition, varicose veins are abnormal, bulging veins greater than 3 mm in diameter. Varicose veins are usually associated with venous insufficiency of deeper, feeder veins. It is important to treat the underlying venous insufficiency with endovenous laser ablation or radiofrequency closure before treating the varicose veins. Then the varicose veins can be treated with ambulatory micro-phlebectomy or sclerotherapy.