Superficial telangiectases associated with systemic sclerosis may be more responsive to treatment than those deeper in the dermis. We investigated whether dual-wavelength laser Doppler imaging (LDI) is sufficiently sensitive to ascertain the distribution of blood flow within telangiectases and whether blood flow relates to telangiectatic diameter. The perfusion and diameter of 20 telangiectases were measured in superficial and deeper layers of the skin using dual-wavelength LDI. Of 20 telangiectases, 18 had higher blood flow in the red (representing deeper blood flow), rather than the green (representing superficial blood flow) wavelength images. Clinically apparent diameters correlated with those of the superficial (r = 0.61, P = 0.01), but not with the deeper blood flow images. Hence, the apparent size of telangiectases at the skin surface does not predict blood flow through the microvessel(s) at deeper levels, and thus clinically apparent size is unlikely to predict treatment response. Dual-wavelength LDI may help predict treatment response. © 2009 British Association of Dermatologists.