Would a second sclerotherapy session banish my remaining spider veins? I can see them 6 weeks after the first session. (Photo)

Despite the introduction of lasers, sclerotherapy remains the gold standard for treating spider veins on the legs. In general, it takes two to four treatment sessions per area, spaced at monthly intervals to achieve an 80 percent overall improvement in appearance in about 80 percent of individuals. Some people do not respond at all and some respond dramatically after just one treatment. However, to avoid disappointment, it is best to think in terms of a series of treatments. It is also important to note that treating those spider veins that are currently present does nothing for preventing new ones and typically new ones of sufficient size to warrant treatment will appear every two to five years. 

Sclerotherapy, unfortunately, is a process and usually requires several sessions (1-3) to eradicate the veins.  The gold standard for spider vein treatment is sclerotherapy but on those veins that are too small for the injecting needle, other treatments such as ohmic theromlysis, laser or mironeedle radio frequency can be alternatives but these treatments also can require multiple sessions.  Also, in addition to treating the spider veins, any feeding veins (blue or reticular) should also be treated. As a rule of thumb and rough estimate, about 1/3 of veins will resolve within 2 weeks, another 1/3 over 6 weeks and another third will need further treatment.

There are two main methods to treat spider veins of the legs and thighs. Laser vein treatment and sclerotherapy. Both are equally effective. Both need more than one session of treatmnent. May require 3-6 sessions to see an 80% improvement. You have to weigh the cost benifit ratio and decide if it is worth it for you.

Although you can elect to have more sclerotherapy, the small size of those veins (telangiectasias < 1 mm) would be better served with topical lasers - and certainly less expensive and more durable. 

By just looking at your photo I would probably opt for a laser treatment using a 1064 nd yag.  However the success or failure of a single treatment has many variables that should be assessed and discussed on your first visit/consultation. Since we can only see a small portion of the leg it is impossible to know the entire situation.  First is location and relative size of the vessels. Are there any deep feeder veins that are refluxing  creating pressure on the smaller veins. What is your level of activity? Do you run, jog or exercise where you place extreme pressure on your legs?  Does your job require you to stand or sit for longs periods of time?  Is there an activity or clothing that might be creating these vessels? How are your hormones?  Are you taking any medications that might be contraindicated for a procedure?After we determine the answers to these questions then we decide what is the best treatment for you.  Are you a candidate for a quick laser treatment or do you really need sclerotherapy?  If you need sclerotherapy what solution is best for this size of vessel that will give the optimal result with the least amount of possible complications? (Sotradecol, Polidocanol, Glycerin, Hypertonic Saline, Foam)  Do you need to wear compression stockings after treatment and avoid high impact aerobic exercises or abdominal workouts or can we just use a temporary Co-Ban wrap?  Is one treatment going to do the trick or do you need multiple treatments?  The next step is treatment.  Are we seeing either complete collapse of the vessels or a positive sign that the solution/heat used is creating inflammation in the internal walls of the treated vessels.  If no, is a stronger strength solution or laser setting needed? Do we need compression to keep the vessel closed, etc?  If all of this is done then you should see an effective treatment and realize outstanding results.