BACKGROUND. While sclerotherapy has been the standard treatment for spider leg veins for many years, recent advances have allowed lasers to be considered as a treatment option. OBJECTIVE. To study the efficacy of a frequency-doubled Nd:YAG laser at 532 nm with a 50 ms pulse width and chill tip device in the treatment of spider leg veins. METHODS. Forty-six patients with spider leg veins with a diameter of less than 1 mm or 1-2 mm were treated with a frequency-doubled Nd:YAG laser at 532 nm with a pulse width of 50 ms (VersaPulse HELP-G laser) while using a water-cooled chill tip device. RESULTS. Of patients with veins less than 1 mm in diameter, 60% had greater than 50% clearing after one treatment and 80% had greater than 50% clearing after two treatments. Of patients with veins 1-2 mm in diameter, 39% achieved greater than 50% clearing after one treatment and 67% had greater than 50% clearing after two sessions. CONCLUSION. Our results suggest that the frequency-doubled Nd:YAG laser with a pulse width of 50 ms and chill tip device offers an excellent alternative to sclerotherapy in the treatment of small spider leg veins.