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

I had sclerotherapy done last year and I was happy with most of the spider veins that were injected. I noticed however, the appearance of a cluster of new tiny spider veins around the site of a couple injection spots (see pic). Is this normal? My doctor told me that the tiny ones are very hard to treat which is disappointing because that's what I have, a lot of very tiny ones. Is there anything I can do? Thank you.

Doctor Answers 5

Treatment for Spider Veins of the Legs

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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.

Telangiectatic Matting After Sclerotherapy

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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. 

Vein Removal Explained

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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.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

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Tiny spider veins on the leg

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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.  

Possible treatments

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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.

John Landi, MD
Naples General Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.