Andres Zavala, DO

Your doctor is correct in that underlying saphenous reflux is best treated before doing sclerotherapy of spider veins once reflux has been confirmed by ultrasound. Doing so will result in the best long-term results. In the absence of treating the source of high pressure that has resulted in the formation of spider veins around the ankles, sclerotherapy results are likely to be short lived and in some cases no improvement will be made at all if the underlying pressure is too high. That is not to say, that you don't have the option of doing just sclerotherapy.  More likely than not, you will see some improvement, just keep in mind that it may not last very long.  Also, in the long run unless you start wearing compression stockings daily, the underlying saphenous reflux will continue to progress and you are likely to develop more veins and more symptoms.

Some bruising and slight discoloration is normal after sclerotherapy. Darker discoloration is usually the result of larger volumes of trapped blood within the vein and in these cases it is best to do a micro-thrombectomy which is removal of the trapped blood via a tiny incision.  This will allow the area to heal quicker and lessen risk of longer lasting or even permanent discoloration. Matting or the formation of tiny little red veins around the treated site will often go away on its own but may take a year or more and in some cases it can be permanent. Treating this areas with a different sclerosing agent like Glycerin can often help speed up recovery of the matting.

It is difficult to see the veins discretely on the picture you posted. If the telangiectasias are big enough to inject with a tiny 32 gauge needle, sclerotherapy may help.  I find that 72% Glycerin in a  2 to 1 ratio with 1% lidocaine and epinephrine works well.  Again; however, the veins have to be big enough to place the bevel of the needle inside the vein. In some cases telangiectasias are so tiny that injecting them is impossible, injecting around them would not work. If you haven't had success with laser, consider asking your treating physician or get another opinion from a vein specialist. Best of luck.

Some bruising and or discoloration of the skin after sclerotherapy is normal and resolves on its own with time. The picture however also appears to show what looks like telangiectatic matting which is a dilation of smaller surrounding veins due to inflammation after treatment. While these often heal on their own, they can take a long time to do so. If it has not resolved after a couple of months you may need additional treatment for these little red veins that cluster to look like a bruise.  For this, either laser or sclerotherapy with 72% glycerin can yield good results. I find that glycerin works best.

The picture shows not only small spider veins but also lots of bluish veins called reticular veins.  In order to successfuly treat spider veins, you often have to treat any feeding reticular veins first with sclerotherapy. After that, the small spider veins can be treated by either sclerotherapy (72% glycerin works best for small reddish veins), laser or micro-needle radiofrequency.  If you recently had treatment, give it at least 4 weeks to see your true results, then follow up with your doctor or another vein specialist.