Taula de Continguts
- Why leg spider veins are not like facial ones
- How the Harmony XL Pro Nd:YAG vascular head works
- Laser or sclerotherapy: what the evidence says
- When a vascular assessment is needed before laser
- What the course of sessions looks like
- Aftercare following a session
- Why it pays to start before summer in Madrid
- How we work at Santé Madrid
- Frequently asked questions
Leg spider veins, or telangiectasias, are small dilated vessels that show through the skin as red or purplish threads, and the 1064 nm Nd:YAG laser is one of the options for treating them when they are fine and there is no underlying venous problem. At Santé Madrid we use the Nd:YAG vascular head of the Harmony XL Pro platform for this, always after a medical assessment. Here we explain why legs are not treated like the face, when the veins should be checked first and how to plan your sessions.
Key points
- Leg vessels tend to be thicker and deeper than facial ones and bear more venous pressure, so they respond differently to laser.
- Studies place the Nd:YAG laser mainly in fine telangiectasias under 1 mm; in thicker vessels sclerotherapy tends to be more effective.
- Varicose veins are not treated with surface laser. If there is heaviness, swelling, skin changes or bulging veins, a vascular assessment comes first.
- Several sessions are usually needed, results vary from skin to skin and treatment is carried out by the medical team after an assessment.
Why leg spider veins are not like facial ones
A capillary on the cheek and a spider vein on the thigh look alike, but they are not. A review of long-pulsed Nd:YAG laser for vascular lesions explains that leg vein abnormalities arise from gravitational dilatation, reflux and venous valves that do not close properly. The same review notes that treating legs with laser is harder because these vessels vary widely in size, depth and flow, and that increased hydrostatic pressure in the lower limbs can make heat coagulation less effective.
Put another way: on the face vessels tend to be fine and superficial, while on the legs very fine threads sit alongside somewhat thicker, deeper vessels, often fed by small veins you cannot see from the outside. On top of that, blood in the legs has to rise against gravity, and that pressure helps explain why spider veins appear and come back.
That is why results on the legs tend to be slower and more variable than on the face. For a general overview of the options, see our guide to laser for spider veins on the legs; here we focus on the head we use in Madrid.
How the Harmony XL Pro Nd:YAG vascular head works
Harmony XL Pro is an Alma Lasers platform with several interchangeable heads. According to the manufacturer's official product page, its long-pulse Nd:YAG head works at 1064 nm, a wavelength with high absorption by haemoglobin and deep penetration, and it is indicated for vascular lesions on the face and body. Haemoglobin absorbs the energy and heats up, and that heat damages the vessel wall, which the body then gradually reabsorbs.
Deep penetration is what makes this wavelength useful on the legs, where vessels are not as close to the surface as on the face. In return, the energy has to pass through the skin, which is why controlling the surface temperature matters. A randomised study in 285 women with leg telangiectasias notes that skin cooling systems allow safer treatment and reduce pain, and that lighter skin tends to need longer cooling than darker skin.
In practice, the medical team adjusts the spot size, energy and pulse duration to the calibre and colour of each vessel and to your skin type. Two legs with similar-looking spider veins may need different settings.
Laser or sclerotherapy: what the evidence says
Sclerotherapy, which injects a substance into the vessel to close it, is the reference technique in vascular guidelines. The 2023 clinical practice guidelines of the US vascular societies recommend sclerotherapy for symptomatic telangiectasias and reticular veins, and suggest transcutaneous laser when there is sclerosant allergy, needle phobia, sclerotherapy failure or very fine vessels under 1 mm. A 2021 Cochrane review found no clear difference in effectiveness between laser and sclerotherapy, and laser may cause less hyperpigmentation, although the evidence is still limited.
Vessel size makes the difference. Both the study in 285 women and a randomised trial in 132 patients concluded that Nd:YAG is a good option for telangiectasias under 1 mm, while in thicker vessels sclerotherapy with polidocanol gave better results.
| Vessel type | What it looks like | Option usually considered | Role of surface laser |
|---|---|---|---|
| Fine telangiectasias, under 1 mm | Flat red or purplish threads | Nd:YAG laser or sclerotherapy | Where studies place it most clearly |
| Thicker telangiectasias and reticular veins, from 1 to under 3 mm | Bluish or greenish small veins under the skin | Sclerotherapy as first option | Complementary depending on the case |
| Varicose veins | Bulging, raised veins, often with heaviness | Vascular study and treatment by a specialist | Not treated with surface laser |
If another option suits your vessels better, the medical team will tell you clearly.
When a vascular assessment is needed before laser
Many spider veins are purely a cosmetic concern. The 2023 vascular guidelines state that, if they cause no symptoms, a Doppler ultrasound of the veins is not routinely needed, but that when there is bleeding or severe pain and burning it may be indicated to rule out associated venous insufficiency. Chronic venous insufficiency can cause swelling, skin changes and ulcers, and in those cases treating only the surface does not address the source.
If any of these signs come up during the assessment, the Santé Madrid medical team will recommend a vascular study with a specialist before considering laser. Treating what feeds the vessels first and what you can see afterwards is usually the most logical order.
What the course of sessions looks like
A session starts with cleansing the area. We protect your eyes and the doctor traces each vessel with the handpiece while the skin is kept cool. According to the studies cited, the laser feels like a brief burning sensation at the moment of each pulse, which cooling helps you tolerate. Right afterwards, the vessel may look darker and the area slightly red for a few hours.
The vessel does not disappear on the spot: the body reabsorbs it over the following weeks. That is why more than one session is usually needed. In the two randomised trials cited, patients received two sessions about eight weeks apart and the result was assessed two months after each one. In clinic, the number of sessions and the interval are decided according to the size and number of vessels and how your skin responds.
Spider veins can come back over time, because the underlying tendency is still there. Results vary from skin to skin and we do not promise a specific outcome. Side effects described in the studies include small burns and pigmentation changes, lighter or darker, and the doctor explains the risks before you start.
Aftercare following a session
Aftercare is simple, but it affects the risk of dark marks. The study in 285 women stresses that sun protection is key to a good cosmetic outcome, and notes that, unlike after sclerotherapy, compression stockings are not routinely recommended after Nd:YAG. Even so, the doctor may advise them in your particular case.
- Protect the treated area from the sun: clothing that covers it and broad-spectrum sunscreen if it will be exposed.
- For a few days avoid intense heat, such as sauna, very hot baths or waxing in the area, for as long as we advise.
- You can walk normally; very demanding exercise should be resumed when your doctor advises.
- Do not scratch or rub if a small scab appears; let it come off on its own.
- If you notice a blister, increasing pain, a warm or swollen area or any sign of infection, message us so we can check it.
The exact instructions depend on the settings used and on your skin, and we explain them at the end of the session.
Why it pays to start before summer in Madrid
Madrid has a continental climate with very sunny summers, and that is when legs are most on show: skirts, shorts, the pool. That is why summer is a poor time to start. Tanned skin absorbs more laser energy at the surface, which can increase the risk of burns and dark marks, and after the session the treated skin can pigment more easily if it gets sun.
Results also need time. Given that the vessel takes weeks to be reabsorbed and that more than one session is usually needed, several weeks apart, the sensible approach is to start in autumn or winter, when legs are covered and it is easier to keep them untanned. That way you reach spring with the plan well under way.
This does not mean it can never be done in summer: with untanned skin and strict protection, the doctor can assess it for your case.
How we work at Santé Madrid
Our clinic is at C. de Amador de los Ríos, 1, Chamberí, 28010 Madrid, close to Almagro and Colón. This is the usual pathway:
- First consultation. You can start with an aesthetic assessment with a Beauty Coach, which is free, or go straight to a body medical consultation at 50 € (the price of the consultation, not the treatment).
- Leg assessment. The Santé Madrid medical team examines your vessels, asks about symptoms and history, and checks for signs that call for a vascular study first.
- Decision. If the vessels are suitable for laser, we explain the plan. If they are not, we tell you.
- Sessions. The doctor adjusts the settings of the Nd:YAG vascular head to your vessels and skin type at each session.
- Follow-up. We review progress after a few weeks and decide whether another session is needed.
If you would like to learn about the platform's other heads, we cover them in our article on the Harmony XL Pro laser in Madrid, and here is more information about the body medical consultation. Results vary from skin to skin: the aim is a realistic, safe plan for you.
Frequently asked questions
Does Nd:YAG laser on the legs hurt?
It feels like a brief burning sensation with each pulse. Skin cooling helps you tolerate it, and the sensation depends on the area and on each person.
How many sessions will I need?
There is no fixed number. It depends on the size and number of vessels and how your skin responds. More than one session is usually needed, several weeks apart.
Does laser work for varicose veins?
No. Varicose veins are thicker, raised veins and are not treated with surface laser. They need a vascular study and treatment by a specialist.
Do I need a vein ultrasound before laser?
If the spider veins cause no symptoms, it is not usually needed. If there is heaviness, swelling, skin changes, bulging veins, bleeding or severe pain, the medical team will recommend a vascular study before considering laser.
Can spider veins come back?
Yes. Laser treats the vessels you can see, but the tendency to form new ones may remain, and some people need maintenance sessions.
Can I have the laser in summer?
It is possible if your skin is not tanned and you keep strict sun protection, but the usual approach is to start in autumn or winter to reduce the risk of dark marks and reach summer with the plan well under way.
Can I be treated if I am pregnant?
As a precaution, cosmetic laser treatments are usually postponed during pregnancy and breastfeeding. Tell the medical team at your assessment and we will plan it for later.
Not all leg spider veins are treated the same way. What matters is knowing which vessels you have, ruling out an underlying venous problem and choosing the right time of year. The first step is an assessment with the Santé Madrid medical team.
