Thank you for your question and the photograph.
For the veins that you have shown, either injection by sclerotherapy or laser treatment should work.
To be sure, see two or more board
certified and experienced plastic surgeons who work commonly with lasers in your area for a full and complete
I hope this helps.
These are the tiniest of the spider veins, < 1mm in size and are known to develop after any type of intervention and the literature shows that they involute (go away) spontaneously after a year. If not, they are amenable to topical laser therapy. Of note, they are quite stubborn to treat as your doctor has suggested and may require multiple sessions of laser therapy. These are called telangiectatic matting.
Treatment options for leg veins are determined by the width
or thickness of the vein. Sclerotherapy (injections) typically work best for
treating larger spider veins and varicosr. The sclerosants damage the inner
endothelium tissue that lines the blood vessels. This results in a clearing of
the blood vessels from the skin’s surface.
If the vein is less than 3 millimeters, laser treatments
typically work better for vein removal. This treatment option for leg veins
targets the blood vessels underneath and singes them, which basically kills the
vein. I prefer the Nd:YAG laser (1064 nanometer) for smaller vein removal. Ask
your doctor if laser treatment is available and suitable for your cluster of
It is very normal to develop new spider veins over time. This tends to occur whether or not people undergo any types of treatment for their veins. The smaller spider veins on the legs are just as readily treated with injections as the slightly larger ones. If you have already had good results after sclerotherapy I'd suggest to do another session on all of the veins that are bothering you at this point.
Your doctor is right in that the smallest veins are the hardest to treat and cluster of veins can form after sclerotherapy. This is called neovascularization.. However, there are very small sclerotherapy needles #33 gauge which can often get into very small veins (but not always). Also micro needle radio frequency will sometimes help to treat these very small veins.