What is the best treatment for tiny spider veins on the legs? (Photo)

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
evaluation.



I hope this helps.

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
spider veins.

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.  

Thank you for the question! In my practice, I offer sclerotherapy, endovenous laser ablation, Clariven treatment, and microphlebectomy to treat varicose and spider veins. It's not a matter of one treatment being better than the other. Rather, the choice of treatment will depend on a size and location of your veins.  
In recent years, endovenous laser ablation (EVLA) has replaced traditional surgical method of treating varicose veins. This procedure uses laser to heat the veins instead of surgically removing them. The heat produces a steam bubble inside the vein, which destroys the vein walls, causing the affected vein to collapse. The body, in turn, naturally absorbs the dead tissue. 
Sclerotherapy tends to be one of the most popular and widely-used treatments these days. It uses a sclerosing solution that causes the vein to shrink. Usually, sclerotherapy takes only 1 to 2 sessions to achieve fading of the undesirable veins.  
Microphlebectomy is ideally suited to treat superficial bulging veins that are too large for sclerotherapy.  In the course of this treatment, I will make tiny incisions as small as 1mm to remove an undesirable vein.  He will then insert a small phlebectomy hook to extract the vein through the puncture.  Only a small section of the vein needs to be eliminated because the remaining portion of the vein will clot off and gradually fade from view. 
Clarivein is a minimally-invasive procedure that utilizes a thin infusion catheter clinically proven to deliver faster results and guarantee up to 74% less pain than most other peripheral vascular treatments. 
An in-person exam with a board-certified plastic surgeon would be the best way to assess your needs and obtain expert medical advice. Best of luck!

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. 

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.