Why haven't certain patches of my spider veins responded to Sclerotherapy?

In almost all cases, spider veins can be treated with either sclerotherapy or lasers. As a pioneer of sclerotherapy treatment, I would suggest visiting a board certified dermatologist who is highly specialized in the treatment of leg veins, as they will have the highest level of knowledge for bringing you a successful and effective treatment. When treating spider veins with sclerotherapy injections, many doctors simply treat the visible veins instead of locating the root problem. When I perform the treatment for my patients, I carefully locate the cause of the spider veins, which brings the best results as the root source is being treated instead of the after effect veins.

Thank you for your question.

Persistent pooled venules (bluish spider veins) are normally due to back flow in the 'feeding '  larger vein which sometimes itself is not visible.

Doppler ultrasonography is required to establish that. Solution might be to strip out that vessel surgically or use a foam sclerosant. Look for a doctor experienced in vascular treatments.

When spider veins persist in spite of treatments, there is usually an underlying cause, leaky valves, that has not yet been treated.  Ultrasound by an experienced technologist or physician is important to look for that.  Heredity can be a major factor as well.  Switching sclerosing solutions, the concentration of the solution, making sure that compression stockings are worn, consideration of laser, are all important.  Whether the spiders are pink, red, or bluish-purple makes a difference as well.  If your physician isn't able to address these questions, I would consider another physician.  There are a lot of technique aspects in this type of treatment.