Sclerotherapy generally works when done properly. Obviously, you have had a lot of treatments with very little improvement. Has your physician ever ultrasounded your legs to make sure that there is nothing going on deeper in your legs? If there is, you really need to have that treated first before ever undergoing surface vein treatment. If your physician does not look inside your leg with ultrasound before ever treating you, you need to find a doctor who will treat your entire leg and not just this spot or that spot. If you know that you do not have any abnormal veins deep inside you legs, then another possibility is that the person performing your sclerotherapy just is not hitting the reticular veins feeding your spider veins. If that is the case, you need to find someone else who can.

Published on Jul 11, 2012

First of all may I assume you have had a consultation with a dedicated vein specialist and have undergone a thorough ultrasound investigation for insufficiency? If not , this should be your next step. Find a reputable
vein specialist in your area and seek them out for an evaluation. If your veins are largely below the knees, this is most likely due to veins underneath the skin leaking and causing the proliferation of more superficial spider veins.

Published on Jul 11, 2012

If sclerotherapy has not been effective for you, you may want to see a dermatologist and discuss with them the possible efficacy of laser treatment.

Published on Jul 11, 2012

The answer depends on if you've had other treatments, such as the laser ablation, done. If you have just treated spider veins and you've noticed they've come back, then that would mean you have a deeper source of the problem and possibly reflux in the saphenous veins. An ultrasound on the legs would determine this.

Published on Jul 11, 2012

I recommend a second opinion with a qualified phlebologist to determine why you didn't respond. There may be a deeper source feeding some of your surface veins.

Published on Jul 11, 2012

You probably need another doctor's opinion with an in-person consult.

Published on Jul 11, 2012

The first thing that we would recommend would be a consultation visit which insurance would provide benefits for if you are having any symptoms such as pain, swelling, aching, burning and varicose veins. You may have an underlying reason causing the spider veins.

Published on Jul 11, 2012

In the interest of good care you could have a Vascular Study of your legs in a qualified lab. An ultrasound is not invasive and provides your physician with valuable information about your problem. If the small veins continue to reappear after treatment it may indicate another deeper issue that should be resolved.

Published on Jul 11, 2012

I would recommend a thorough evaluation including ultrasound by an experienced vein treatment vascular surgeon. If there is underlying vein reflux (back flow) it can make clearing of spider veins difficult. If present, these veins should be sealed using laser ablation. In our practice we also screen for underlying reticular "feeder" veins using a fiber optic light. If these are present, the surface veins may not seal or return soon after surface treatment. These are treated in our sclerotherapy sessions by injection with a slightly stronger solution and sometimes foam. We often combine topical laser with sclerotherapy. If you have a lot of spider veins, it is often better to focus on certain areas until you get adequate clearing (such as starting at the lower legs and then moving up). 70-80 percent clearing is considered good and realistic. An average areas of veins can take 3-5 treatments to clear.

Published on Jul 11, 2012

You need to find another doctor.

Published on Jul 11, 2012

First, get your legs to a vein specialist who can perform an ultrasound of their own, to actually see
possible reasons for "scleroresistance". There may be saphenous vein insufficiency, refluxing reticular or tributary veins responsible. These must be controlled first, to neutralize elevated pressure in superficial
veins. It is also possible that only spider veins were injected neglecting the attached feeder veins in the reticular dermis that are part of a unit. Again, there are individuals that have thousands of spider veins, usually red and very small (0.1 - 0.2mm) that I call "vasculopaths." There might be some problem with vascular growth factors, hypertension, etc.

Published on Jul 11, 2012

Have you had a Venous Doppler done by a physician vein specialist (not by a technologist) to determine if you have venous reflux?

Published on Jul 11, 2012

Sclerotherapy may not work in about 10 percent of people. However, the success of sclerotherapy depends on many factors including type of sclerosing solution used, the concentration to the solution, the types of veins being treated and, most importantly, the experience of the person doing the sclerotherapy. Another very important factor is to ensure that you do not have valvular reflux which may be the underlying cause of your spider veins. Consider seeing a vein specialist and obtaining a venous reflux ultrasound.

Published on Jul 11, 2012

Go see another doctor. Maybe you need an ultrasound. Maybe you have a problem with the veins not visible. Maybe you need to change providers. You should have seen some benefit by now.

Published on Jul 11, 2012