Spider veins and varicose veins are similar in that they’re both annoying, unsightly blemishes that prevent your legs from looking their best. However, spider veins are truly just a cosmetic vein problem, even though they may be symptomatic, whereas varicose veins, one of the most common vein problems, usually signify a more significant underlying medical issue known as Venous Reflux Disease or Venous Insufficiency. Varicose veins should always be evaluated by a vein doctor, especially if they are tender to touch, swollen, or if you have heavy, tired, achy legs at the end of the day.