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From a cosmetic standpoint, what is the best treatment option for varicose veins?

I have very prominent varicose veins on my legs. I just want them to go away. From a cosmetic standpoint, what is the best treatment to make them go away?

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Doctors Answers (5)

Sclerotherapy (injections) is still the most cost-effective treatment method with the best outcome for most leg spider veins. Afterward, radiofrequency with either VeinWave or VeinGogh can clear up many of the smallest veins if you are picky. Do not waste your time or money with surface laser; it is ok for spider veins in other locations, but not very effective on the legs. For varicose veins, there are several good methods to choose from including ultrasound-guided injections, thermal ablation, and starting this June, Varithena foam. Consult with a vein specialist to review the pros and cons of each method to see what appeals to you the most. Happily, vein stripping surgery is no longer necessary. The treatment is the same regardless of whether it is done for cosmetic or medical reasons.

The answer is probably sclerotherapy because it will not leave incision marks. However there is a slightly greater risk of hyper-pigmentation especially if the vein is very large and very close to the surface. Phlebectomy can also be done, which has less risk of pigmentation but does leave a scar from the incision. If sclerotherapy is done by a skilled physician, who has experience in draining any residual trapped blood the pigmentation can minimized even on very large veins. Also very skilled physicians can leave very small scars with phlebectomy. There is no totally perfect procedure.

The first step is for an ultrasound evaluation and closing the saphenous trunk if it is refluxing. Assuming the saphenous is not refluxing or has already been treated, then visible branch varicose veins can be treated by foam sclerotherapy if they are smaller and for the larger veins a micro-phlebectomy has the best cosmetic result. The superficial varicose veins are anesthetized with a tumescent fluid and physically removed in segments through 1mm incisions spaced out along the margin of the vein in an office procedure. The incisions are covered with steri-strips and do not need to have sutures. In all of these treatments you can resume normal activities. Typically, the location of the veins and the incisions are not visible at a one month follow-up.

Whether your veins are symptomatic or just unsightly, you should be evaluated for underlying saphenous incompetence (refluxing valves). This is typically an inherited condition and the usual cause of varicose veins. If this is present and varicose veins are removed using tiny punctures (microphlebectomy), you will most likely develop new varicose veins because of the back pressure. If saphenous reflux is not present then microphlebectomy is a great option, one treatment and they are gone. Injecting larger veins involves many treatments, extra visits if there is trapped blood to be removed and increased chance of pigmentation over the veins. If saphenous incompetence is present, the vein can be sealed using laser treatment from the inside of the vein through a tiny IV like puncture in the lower leg. This is a much more expensive procedure, but we often do this for more effective long term cosmetic results.

You need to find a local expert to evaluate your condition and help develop a plan of treatment. You must have a long term plan.

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