Spider vein are enlarged tiny veins in the skin (remember, varicose veins are under the skin). They may be hair-thin, or as large as a spaghetti noodle. They may be associated with underlying vein disease. An ultrasound exam may be advised to assess this. Not recognizing underlying vein disease is the most common reason for unsatisfactory results. This is why even spider veins should be treated by a physician with formal expertise in vein disease.