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The "correct" thing to do is to treat the underlying venous reflux before performing sclerotherapy for spider veins. These treatments include endovenous laser ablation (EVLT), radiofrequency ablation, mechanical and chemical closure. I do treat spider veins in the beginning if the patient insists on treating them as long as I stay away from larger reticular veins and varicose veins. The reflux must be taken care of!Hope this helps and take care,Dr Chang
Think of your veins like a tree with with saphenous vein with the refluxing valves being the trunk and the spider and varicose veins being the branches. If you have reflux and only a small amount of spider veins then treating the spider veins alone is all that is necessary realizing that the underlying reflux problem still will be there. If you have extensive spider veins and significant reflux then you may want to consider a closure procedure first. If you have varicose veins then you should definitely treat the reflux before the varicose veins.
Thank you for your question.Unless you are in a rush to treat the spider veins, I would recommend that you have the venous insufficiency treated before your get the spider veins treated by sclerotherapy and/or topical lasers. Read the book about this subject for further education. See the link below.
First is to treat the varicose veins and venous insufficiency. After that sclerotherapy for the tributaries and spider veins