Thread veins — also called spider veins, broken capillaries or telangiectasia — are tiny blood vessels sitting close to the surface of the skin. They show as fine red, purple or blue lines, most often across the nose and cheeks, or in clusters on the thighs and calves. They are harmless. They are also, for a lot of people, the thing they notice first in the mirror.
Why they appear
Genetics come first. If a parent has visible facial veins, you are more likely to develop them, and often at a similar age. Beyond that, the usual contributors are cumulative sun exposure, which weakens the vessel wall and the collagen supporting it; hormonal change, which is why pregnancy and menopause are common trigger points; and anything that repeatedly dilates surface vessels — alcohol, very hot showers, spicy food, extremes of temperature.
Rosacea deserves a separate mention. Persistent facial flushing over years frequently leaves permanent visible vessels behind, and treating the veins without addressing the underlying rosacea means you will be back.
On the legs, standing occupations, pregnancy and body weight all play a role. Leg thread veins also occasionally sit above a deeper venous problem, which is why they need assessing rather than simply treating.
What does not work
No cream removes a thread vein. Products marketed for the purpose may reduce redness or improve the skin around the vessel, but nothing applied topically closes a vein. Pigment-targeting treatments and most general 'redness' devices are similarly hit and miss on discrete vessels.
Concealer works, of course — but it is a daily tax rather than a solution.
What does work
Treatment that closes the vessel itself. At The Armstrong Clinic we use ThermaVein®, which delivers a very low microwave current through a fine insulated probe placed directly onto the vein. The vessel wall collapses and seals, and the body clears it. There are no chemicals and no laser, which is why it suits a wide range of skin types and tones.
The visible change is immediate for most vessels — you can watch them disappear during the session. Some redness, mild swelling or small scabs for a few days afterwards is normal and settles quickly.
For larger leg veins, sclerotherapy or a vascular referral may be more appropriate. Part of a proper assessment is being told when a different route is the better one.
Will they come back?
The treated vessel is gone permanently. What treatment cannot do is change the tendency to form new ones. If sun, rosacea or hormones caused the first set, they can produce more over time. Daily SPF and managing any underlying flushing are what make results last, and most people who maintain both find a single top-up session every couple of years is plenty.