The truth about bulging hand veins

Some people are not bothered if the veins on their hands are visible. For others, prominent bulging hand veins can feel like a nightmare – unsightly or even a sign of their age. What causes hand veins to bulge and what can be done? Leading vascular surgeon and pioneer in endothermal laser ablation Mr David Greenstein explains.

What are bulging hand veins?

Bulging hand veins are not pathological – in fact, everyone has bulging hand veins. These veins are not like varicose veins in the legs; they are quite normal. However, for some people, they can be very unsightly. They are not a medical problem, but are purely cosmetic; patients who want treatment purely want it for aesthetic reasons. However, when even celebrities like Madonna and Sarah Jessica Parker have been unfairly treated by the press for having such visible veins on their hands, who can blame them?

Patients may be young, fit athletes, who may be slim, who are very conscious of these big veins on their hands, forearms, or upper arms. There tend to be more female patients than male, although men do ask for it.

You sometimes see it in patients as they get older. They lose skin tone and fat, so the skin starts to sag and the veins become more prominent. As women get older they may complain about having “old ladies’ hands”. This phenomenon is common in women in their 40s and 50s, as they become more self-conscious about their age. They can put make-up on their faces, but not their hands, which some patients feel gives away their age. Some men also feel that the veins on their hands and arms are unsightly as they age.

In general, men have more prominent hand veins than women, but seek help less often. This may be because they are not as self-conscious of their veins – indeed, some may consider it part of having a muscular male physique. On the other hand, some men don’t like the appearance of their veins.

What causes hand veins to bulge?

They can occur in very fit, healthy people. They can occur in people who exercise a lot, and have no fat on them. The veins then stand out – they may be thought of as athletic-type veins.

In the elderly, it tends to be a phenomenon that occurs with age, which we have no control over. It occurs more in the women than in men. Interestingly, if you are overweight, you tend not to notice it too much – the fat buries the veins. The elderly people who want treatment tend to be healthy and look after themselves.

Can bulging hand veins have a serious underlying cause?

Only on extremely rare occasions. No one has ever come to me with bulging hand veins that have had a serious cause. Unusual but serious causes of bulging hand veins include abnormalities in the thorax (chest) and extra ribs (known as “cervical ribs”). In extremely rare cases, these unusual conditions can cause an obstruction to the blood flow. As the blood flowing through the hand veins will go back to the heart, an extra rib or a tumour pressing on the vein obstructs the blood flow, and it causes veins to bulge.

How can bulging hand veins be treated?

No two patients are the same. We discuss the options with each patient and decide on a treatment plan, and each plan is bespoke to the individual patient. The treatment plan is usually a combination of three therapies.

• Endothermal laser ablation – a treatment I helped pioneer. A laser fibre as thick as a hair is passed into the vein, where it emits energy to destroy it.
• Micro-phlebectomy
• Sclerotherapy

Some treatment plans only involve one or two of the above options. All can be performed with a local anaesthetic, and all achieve good results, with very high patient satisfaction.