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Non-Invasive Treatments


Non Medical Options for Varicose Veins

Hi, Doctor Gan here. Some of the patients that I meet, have noticed varicose veins just pop up in their legs. There other patients that have had these varicose veins for many years. These same group of patients, for personal reasons, may not be ready to get treatment straight away. However, they do want to reduce their symptoms, even prevent the progression of vein disease. If you happen to fall into this category, today I’m going to be discussing some of the conservative options available to reduce symptoms, and even prevent progression.

Now, the first form of treatment is compression stockings. Now, compression stockings, in my opinion, is one of the best forms of treatments because it reduces symptoms such as aching and swelling in your leg, and it also prevents the formation of a clot. The only challenge that patients have is that they find it a little bit cumbersome to put these stockings on and even take off, and they may also find it uncomfortable because it’s probably the tightest stockings they’ve ever worn.

It’s important to note that these stockings are not the same stockings you get in the supermarket or store. They are actually medical grade stockings that you need to measure specifically for your legs, and therefore they can be a lot tighter than you expect. At our clinic, this is a service we offer, so if this is a form of treatment that you plan to pursue, we are happy to help.

Another option available is exercise. Now, the calf muscle pump is one of the best pumps we have in our body, and what it does is every time it basically squeezes together, it pushes blood all the way from your legs back up to your heart, and it improves the blood flow. So, by actually flexing and extending your foot, you’re actually activating this calf muscle pump that is pumping blood back up to your heart, and this can improve symptoms. Now, by exercising, you’re also keeping your weight down, which eventually helps reduce symptoms and even prevent progression of vein disease.

A third option is elevation of your legs. Now, elevation is great because when you’re standing for long periods of time, you’re basically through gravity, you’re getting blood flowing all the way to your legs, and if your valves in your veins are damaged, it’s going to be hard for it to be pumped up. And so, by elevating your legs by putting it up on a table or a chair, a little bit above your heart level, you’re basically allowing gravity to get that blood back into the heart.

Now, another option is lying on your bed and actually putting your legs on the wall, and this can actually help relieve symptoms quite quickly. The next option available is medications. Now, medications can include anti-inflammatories such as Ibuprofen or Voltaren, they are essentially non steroidal anti-inflammatory drugs. I’m not a huge fan personally, because anti-inflammatories can often cause a lot of trouble in your tummy, with your gut flora, which are the bugs in your tummy.

They can cause symptoms such as gastritis, and nausea at times, and even the formation of ulcers. So they cause irritating symptoms that you did not really want to have, but I can understand that for some patients that have reached the end, where compression’s not helping and elevation’s not helping, some anti-inflammatories can help. Now, I would advise that if you reached this level of pain or symptoms that you can’t handle and you need medication, you may have to look at treatment options because you using medication, is really kind of a bandaid effect.

Now, the final option that I have, which I think is actually very important, is essentially food, and we’ve heard the saying, food is medicine, and there are certain types of food, especially fruits and vegetables that are great for your vein health. And flavonoids is a type of chemical that’s actually found in vegetables and fruits. It’s an antioxidant. It basically prevents clot formation, and also improves vein health, reduces blood pressure and reduces cholesterol. This can be found in most berries, it can be found in grapes, it can be found in olives and even apples.

It’s full of vitamin C, which is great for your skin as well as your vein health, and if you’re eating healthy what that tends to mean, is that you tend to have a better weight, so it’s a win, win, any way you look at it. If you need further information regarding the conservative options available, we are always happy to help. Visit our website at, or book yourself in for consultation.

Are the needles used painful?

Dr Param addresses one of the most common questions asked about the treatment of varicose and spider veins: “Are the needles you use painful?” Short answer: No, find out more in this short video:


Hi, Dr. Gan from Doctor Vein Medical Clinic. Some of the patients coming in for treatment of their spider veins or varicose veins often are a little bit concerned about needles, specifically, are they going to be painful? Is it going to cause discomfort? I can understand where this comes from because if you’ve never had this procedure done before, it’s quite normal to actually feel a little bit anxious because you’re not sure what’s going to happen on the day, and if you actually go to a doctor and you actually speak about this, no one really talks about, are you going to feel any discomfort? They just mention, “This is a procedure. We’re gonna do it. We’re gonna do it under local anaesthetic. You shouldn’t feel it, and it’s gonna be fine,” and most of the time, it is fine.

This probably stems from immunisations that people got when they were kids or even as adults, and even dental procedures where they had local anaesthetic, which, really, even with dental procedures these days, they do it so quickly and so finely that most patients do not feel anything at all.

Today, I’m going to actually be talking about the needles that I use, and, specifically, I’m going to actually use myself as a demo model and show you the placement of a needle into my skin.

It all comes down to what types of treatments that’s been done. If sclerotherapy or micro-sclerotherapy, whereby we’re injecting a solution to these really fine, baby spider veins, I usually use very, very small needles, and these needles are so fine that you just feel a little bit of a prick as it goes in, and other than that, you don’t really feel it. There’s some parts of our bodies, especially around your feet and ankles that are a little bit more sensitive, and also around the knees into the back of the knee. They’re more sensitive than the rest of your body, but for most places, especially in the legs, you’re not going to really feel much. I’m going to demonstrate with my arm, and I’m going to use my forearm, how it actually feels using one of these needles.

To give you a little bit of a back story, I’m actually terrible with needles. I can give needles, but receiving needles, forget about it. I’m really bad at it. Even though I’ve done thousands and thousands of needles in some form for patients, I’m really bad at receiving it. To be honest, I think about probably four to five years ago, I was getting blood taken, and the young girl was really worried because she thought I was going to pass out, but I’ve actually improved since then. I’m actually quite good. I can watch the procedure being done, and I’m getting better, and before you start judging me and thinking that, come on, it’s just a needle, it’s actually a very common thing for men, and I know I’m defending myself here, but it does happen for some patients, that are a bit worried about needles. I’m one of those people. I’m actually going to be sticking a needle in my forearm right now while I’m actually taking this video. If I can do that, then it can’t be that bad.

This is the needle that we use or I basically I use. Different doctors use different needles. I use a really fine needle here that is … It actually flows really well, and it doesn’t cause much discomfort, so most patients are quite happy.

Placing it on the skin, pierce the skin, in the skin. Didn’t really feel it. It’s actually not to bad. You feel a little bit of prick. I’d be lying if I didn’t say you felt a little bit of a prick. You feel a little bit of a prick, but, other than that, it goes in quite smoothly. Once it’s in, you don’t actually feel anything, and this is a sensitive part of the body, especially around the forearm, around the back of you hand, and take that off, not much of anything, no bleeding, very small needle.

If you’re having sclerotherapy or micro-sclerotherapy, these are the types of needles that I use. For other procedures, such as your ultrasound-guided sclerotherapy, we use a similar needle, but it’s a little bit longer. With this procedure, specifically, I can be completely honest with you, when it happens, patients don’t even realise that it’s happened. Oftentimes, I’ve finished the procedure, and they’re asking me, “Are you finished, or are you done? Did you already do it,” because they’re actually quite surprised that they didn’t actually feel much. Oftentimes, with these procedures, such as your ultrasound-guided procedures, you’re not really going to feel anything.

Moving on to your intravenous laser ablations and even, to that matter, surgical removal of some these varicose veins under local anaesthetic, most patients are quite happy. The ones that actually feel anything or feel a little bit uncomfortable are the ones that are a little bit more sensitive to the local anaesthetic that’s injected rather than the needles themselves. Oftentimes, it’s something that’s very much accepted by patients, and even when they do feel a little bit of the local anaesthetic, it’s very short lived, and they’re often speaking about their families or holidays that they’re going on, so it happens quite quickly and, actually, it doesn’t really concern them that much.

Overall, needles are really well accepted. My hope in this video is that it just removes any worry and concern about these needles, and that for the patient or for person that’s coming in for the first treatment, if you’re watching this, you have nothing to worry about.

To actually end this, I would like to mention a patient that I recently treated. She had a needle phobia. That’s why she came in. She said, “I have a phobia with needles.” The first thing I was thinking at that time was that this is going to be a very interesting case, and I was talking to her about, “Is this something you really wanna do because if you’re scared about needles and I’m gonna have give you a few needles into your legs, is this something that you really wanna do?” She was quite adamant that she wanted to do it. To be honest, after I treated her and we completed treatment, she did really well and she actually told me that she didn’t actually feel uncomfortable at all. She said most of the discomfort was in her head because she had this idea that it’s going to really, really hurt, and she didn’t actually feel any of that, so she did really well, and she said the needles are actually not a big deal.

I hope this gives you some sort of idea about needles. Hopefully, you have no concerns if you come in for your treatment.

Flying and Varicose Veins

We all know, through media or even through the news, that when you fly on a plane, there is always a risk of developing a deep vein thrombosis or DVT. That is why they encourage everyone flying to move around the cabin and do plenty of stretching exercises. Many of my patients are also worried about flying on a plane when they have varicose veins. In this video, I discuss the risk involved and answer the question based on current research, what the dangers are and whether it is acceptable to fly with varicose veins.

Treating Spider Veins with Sclerotherapy

Sclerotherapy is one of the most effective ways to treat spider veins of all sizes. Often times if patients have clusters of spider veins, this is the only method available to get rid of them. With many patients, they do however also have varicose veins associated with their spider veins and again, sclerotherapy is a great way to treat both. In this video, I break down how it is done, what is to be expected and after care, once they have been treated.

#Sclerotherapy #SpiderVeins #TreatingSpiderVeins #TreatingVaricoseVeins

What Causes Varicose Veins?

What Causes those Unsightly Varicose Veins? Why are you affected more than other people of the same age or even your friends and family. In this video, I break down the commonest causes as to why you develop varicose veins.

Simplifying Varicose Veins – The 3 Levels

Simplifying Varicose Veins into the 3 Levels. Varicose veins and spider veins are a very common condition that many patients have. In this video, I break down the different types of veins and how each one is connected. More importantly, I highlight what type of treatment is required for each level.

What is Sclerotherapy for varicose veins and spider veins?

Sclerotherapy (Pronounced skle-ro-therapy), has been around since the 17th century.  It was not until 1916, when the use of modern sclerotherapy treatment for varicose veins was founded. The word “Skleros” itself comes from the Greek word to make hard. Different solutions and sclerosants have been created since then, that are not only safe but highly effective in removing varicose and spider veins.

What is it?

Sclerotherapy is a medical procedure, whereby a “sclerosant solution” is injected directly into the vein. This then irritates the inner lining of the vein wall causing it to harden and then get absorbed by the body. The absorption by the body is similar to what happens when you develop a bruise after a fall. It eventually disappears.

It is commonly used for varicose veins and spider veins but can also be used for vascular and lymphatic malformations, hemorrhoids (dilated veins in the anal canal) as well as for hydroceles (fluid in a body cavity).

How is it performed?

Sclerosant solution is injected using very small needles either directly into the vein or by using ultrasound guidance for veins that are not visible.

The solutions can be injected directly as a liquid or as a foam. Both are as effective for spider veins, but foam is generally found to be more effective for bigger veins hiding under the skin.

Is it painful?

This is a very common question and the simple answer is no. Some solutions used for sclerotherapy can cause stinging when first injected and others cause some slight itchiness during the procedure. The solution I use has an anaesthetic property as well that further reduces any pain. It is important to note that the needles used are tiny and not ordinary sized needles. Generally, it is very well tolerated by most people. Many who do get treated are often surprised how little discomfort there is.

Recovery time?

Most patients who get sclerotherapy can be treated and go straight to work or any other day to day activities. It is often recommended to not do heavy exercise or weight lifting for the first 5 days after sclerotherapy.

It is also advisable to walk daily for 30 to 45 minutes each day after treatment and wear medical compression stockings during that period.

How many treatments will I need?

This is challenging to answer without examining a patient and doing a duplex ultrasound. Most patients generally need at least 3 treatments of sclerotherapy. Some patients have multiple spider veins scattered everywhere and, in that case, more treatments may be needed. Also, some treatments may need a combination of different procedures with sclerotherapy just being one of them. I advise patients as to what will be required during their initial consultation.

Is it effective?

Treatment of spider and varicose veins using sclerotherapy can be very effective. Even after the first few weeks post treatment considerable changes in the appearance of varicose and spider veins can be seen. The final results will be visible 6 months post treatment.

I personally treat all my patients and at Doctor Vein, our focus is only on veins. We strive for the best outcomes and endeavor to deliver the best results.

If you have any questions about Sclerotherapy, please send me an email to

Busting Varicose Vein Myths

This is an age-old question, often surrounded by myths. The usual adage being, “Oh no, I have my mothers or fathers legs”. We do know that one third of the population suffer from varicose veins in one form or another. Some believe this number is actually higher, especially as many men tend to not seek treatment and therefore often do not contribute to the total. Studies conducted in the UK through the NHS, have highlighted that up to 56% of men and 60% of women have varicose veins.

This article breaks down the common causes and risk factors that increase the chances of developing varicose veins. In order to give you some insight into why it occurs in the first place.

Varicose veins are those bulging veins that are seen on lower limbs, especially the legs and thighs. They can occur because of weakening of the valves, absence of valves in some people, or even damage to the valves of the veins in the limb.

The most common cause for damage of the valves is following a deep vein thrombosis, whereby there is a clot in the deeper veins. This damages the wall of the vein, affecting the valves and impairing blood flow through the veins.

One way to think about it is to imagine a rubber pipe watering system with valves, that allow water to flow in one direction when opened and stops water from travelling when closed. If this valve stops working, it then allows water to travel in both directions, without any control. Eventually if the pressure is too great, this will cause the rubber pipe to expand or swell up and affect other valves up or down the pipe. When this happens, more valves in various locations along the path of the pipe stop working as well. As the pipe becomes bigger than the original valve, this allows water to leak through in other places, despite having a normal valve.

Similarly, when the valves in veins are abnormal or damaged, the veins can get distended along the length of the vein and not function properly. This then gets carried to other areas of the vein that may have had a well functioning valve in the first place. Almost like a domino effect.

The above is the predominant cause of varicose veins, but the question still remains: Why do some people have varicose veins and others do not?

This comes down to risk factors. Over the years, many studies have been done to show which are the highest risk as compared to those that may only cause a small risk or no risk at all after completing the study.

Busting the Varicose Vein Myths

Below are some of the high risk factors for developing veins in no particular order:

Genetic or family history

  • If you have a family member, mother or father specifically who have a history of having varicose veins, then you are going to be at risk as well.


  • Both progesterone and oestrogen play a major role, affecting the vein wall directly. This will explain why symptoms may be more prominent during the menstrual cycle for women.


  • During pregnancy as a result of hormonal changes as well as increased blood flow, veins tend to expand (dilate), but they do come back to almost normal after pregnancy. For those who have weak valves or who are genetically predisposed, their veins may be worsened by pregnancy. Repeated pregnancies increases the risk whether there is genetic predisposition or not.


  • Being overweight increases the risk of varicose veins, almost as an aggravating factor rather than a cause. Some people, more commonly in women have a condition called “lipoedema”, whereby there is a build of fat tissue and they have a higher risk of developing varicose veins.


  • Standing or sitting for long periods increases the risk, which possibly also explains the higher risk of varicose veins in developed and industrial nations.


  • As you get older, the elasticity of the veins reduces making it more susceptible to expand. This has been shown in multiple studies to date.


Smoking has been postulated to be a risk factor of varicose veins, but the evidence is lacking. We do however know it affects management, but probably does not affect veins directly.

There has not been any conclusive evidence regarding posture and sitting cross- legged as a trigger for varicose veins. However, isolated direct trauma may trigger varicose vein developments in affected regions.

If you are not sure what is causing your varicose veins, but have noticed them and want to find out how to get rid of them, do not hesitate to contact us at Doctor Vein, on 03 91908922. We will be happy to evaluate and manage all your varicose veins concerns.


Help! Why are my Legs Swelling?

Have you ever wondered why your legs swell more towards the end of the day? Or maybe you are unsure as to whether the bulging veins in your leg, could be a cause for the swelling.

This blog will details the various causes of swelling in the limbs and uncover whether varicose veins could be the culprit for your puffy legs at the end of the day.

Swelling also known as oedema, occurs as a result of fluid build up in the tissues of the body. This can occur all over the body, known as generalised oedema, or in certain areas like the legs, known as localised oedema.

The excess fluid comes from blood vessels that become leaky, allowing seepage into the adjacent tissues. As a result of gravity and a pooling effect, this fluid tends to build up in the feet, ankles and legs.

It is generally the job of the lymphatic system, which is almost like a waste disposal system, to run through the body to remove fluid in tissues and return it back in to the blood stream. However, when the lymphatic system becomes overloaded as a result of excess fluid, then its ability to remove this fluid becomes impaired.

When you lay down at night and lift your lower limbs up, this assists in the drainage of fluid back into the blood stream. This is also the reason why your leg swelling improves in the mornings when you wake up, however due to gravity, slowly fills up as the day goes by.

So what causes these fluid leakages in the first place?

  • Heart failure – failure of the heart to pump adequately
  • Acute kidney failure
  • Liver failure specifically following cirrhosis of the liver
  • Certain medications – especially those used for blood pressure, diabetes and some anti-inflammatories
  • Hormonal causes – use of oral contraceptives and hormone replacement therapy as well as during premenstrual periods of the menstrual cycle
  • Lifestyle and occupational causes – standing or sitting for prolonged periods
  • Pregnancy – a common cause of swelling in the legs
  • Problems with the lymphatic system causing blockage and therefore preventing the fluid from returning to the blood stream

Venous or Vein Causes

  • Deep vein thrombosis – a clot in the deep veins of the lower limbs
  • Superficial thrombophlebitis – inflammation of the vein wall causing it to become more leaky (often seen as a red and tender area over the course of a vein)
  • Chronic venous insufficiency – often related to congestion caused from varicose veins, giving rise to the inability of blood to flow back from veins in the leg back to the heart.

As you can see from above there are many causes for swelling in the lower limbs. One often missed cause is chronic venous insufficiency, seen as varicose veins in the region of the lower limb. In some instances, the varicose veins may not be very prominent, yet there could still be venous disease causing all the swelling symptoms.

How do chronic (long term) venous problems, including varicose veins, cause swelling?

The largest superficial vein in the lower limb is the great saphenous vein. It has valves that close during relaxation of the calf muscles and contract during contraction of calf muscles, therefore pumping blood back to the heart.

When these valves are damaged, blood then flows in both directions not being able to be pumped back to the heart efficiently. This gives rise to a buildup of blood in the great saphenous vein, which then overflows to other channels or tributaries giving rise to varicose veins that are prominent in the lower limb.

As the symptoms gradually worsen with time, many people only seek medical attention when complications set in, such as skin discolouration, scarring, itching, rashes and ulcer formation.

If you experience swelling in the limbs it is important to have this investigated early. A simple duplex ultrasound, can rule out chronic venous insufficiency as a cause of your swelling. If you are not sure what is causing your swelling, or have varicose veins and are wondering if they could be the cause of your symptoms, feel free to contact us at Doctor Vein. Our trained medical staff will be happy to evaluate you and rule out venous causes of your swelling.

Varicose Vein Treatments are NOT just for “Vain” people

Time and time again, I consult with a patient who tells me that they have put off treatment of their varicose veins as they thought it was merely a cosmetic problem and did not want to come across as just being a “vain” individual.

In that token, after taking a complete and detailed history, examining them and completing a duplex ultrasound, I often find that their varicosities have become quite complex, profound and show signs of early complications like permanent skin changes setting in.

If they had come in earlier, they would likely require less treatment and have no permanent skin changes often seen with chronic venous insufficiency.

For this very reason, I feel it is extremely important to look at the symptoms of varicose veins and discuss what happens as they progress. I have already covered the difference between varicose veins and spider veins in a previous blog here.

Symptoms of varicose veins in the limbs, listed from most common to non specific (non- specific meaning they could be as a result of other conditions and not just due to a venous or vein disorder):

  • Heaviness and tiredness
  • Pain and aching
  • Swelling
  • Itching
  • Rash
  • Cramps (Non specific)
  • Restless legs (Non specific)

Individuals who are at risk of developing veins:

  • Have a strong family history of varicose veins, ulcers, clots or blood disorders. Often a parent or sibling will also have varicose veins. This implies that from birth, the valves within the veins are weakened and have a tendency to impair blood return through the veins.
  • Have had children. During pregnancy, veins tend to distend, but after delivery, they tend to go back to their original state. Often with multiple births, the veins tend to distend and blood flow gets impaired giving rise to varicose veins.
  • Lifestyle risks, such as occupations involving standing for long periods. This includes those who work in restaurants, cafes, teachers, nurses, police officers, factory or mining workers and essentially any occupation where you are on your feet for extended periods of time. Those who sit for long periods in the same position are also at risk, as well as very tall individuals. Professional sports players also have a tendency to develop varicose veins due to their intense exercise routines.
  • Hormones, especially in women. Symptoms of varicose veins are often worse just before women get their period because of the hormonal influence on veins. The progesterone hormone tends to decrease the venous tone of veins making them more likely to bulge and distend. Women taking the oral contraceptive pill or hormone replacement therapy are also at risk for similar reasons.
  • Obesity has a very strong correlation with developing varicose veins.
  • Smoking is a strong predisposing factor for varicose veins.

If varicose veins are treated early, then this prevents them from progressing to more chronic disease forms.

Some of the features and complications that arise as varicose veins progress include:

  1. Spider veins that are visible on the skin in a variety of patterns
  2. Green veins visible through the skin known as reticular veins
  3. Larger bulging varicose veins
  4. Swelling that settles initially by lying down or wearing stockings, but later fails to settle
  5. Pigmentation or discolouration
  6. Eczema over a region, commonly the lower leg (itchiness of the skin)
  7. Scarring of the skin with thickening (often darker but can be white)
  8. Ulcer formation (wound formation – Either in one region or spreading)

As you can see from above varicose veins are not merely a cosmetic concern for “vain” people, but can progress into a more chronic state when left untreated. Considering that more than one third of the population have varicose veins, it is important to identify it early and seek treatment before symptoms get worse and complications set in.

I hope this has shed some light on what to expect with varicose veins from a symptom point of view, as well as the risk and complications associated with it.

If you need any clarification or are unsure if you may have progressive venous disease, feel free to contact us at Doctor Vein and make an appointment with our medical team today.