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Do Varicose Vein Treatments Work?

Understanding the Playing field

Hi, Dr Gan from Doctor Vein Medical and Cosmetic. Today I’m going to be addressing a very common question that comes up. It is probably a comment that pops up a lot when you’re at dinner tables and when you talk about any treatment for varicose veins. That is, “Will my varicose veins come back after I’ve had treatment.” Now the reason this pops up a lot is because in the past, the passing statement that usually follows is, “Why bother having treatment because it all comes back anyways.” Now today, I’m going to address this because there might be some truth to that comment, but more importantly I think it’s important to address that comment by itself because there are multiple factors here.

Different Treatments for Varicose Veins

And so the first and most important question you need to ask when you hear such a comment is, “What type of treatment did you have?” Now in the past, the only way of treating varicose veins was by surgery and specifically a type of surgery known as stripping. Here the vein was basically pulled out after you’ve had general anesthetic and it was pulled out from the inside out and the chances of a new vein developing in that area where it was treated was very high. And what I mean by that is that in a year, in two years, in five years, there could be a high possibility that you develop more abnormal veins in that region, which was treated. Now in comparison with the newer treatments, and I’m specifically talking about endovenous laser ablations, and to a certain degree radiofrequency ablations, the chances of any new vein development after it has been treated is close to 0%. That means that when you’ve had that vein treated, the chances of it coming back is almost nil.

Endovenous Laser Ablation for Varicose Veins

So we sort of guarantee that we are up to 99.8% which is almost a hundred percent sure that that treated vein will be gone once it has been treated. Now an important point to remember is that sometimes you can get abnormal veins, or maybe I should put it this way. Sometimes you can get veins that are normal currently, so if you’ve come in for an assessment and I’ve had a look at your veins on the ultrasound, I usually mention to most of my patients that these are veins in this location, this area, are completely normal now. Now in three years, in five years, in 10 years, if that vein becomes abnormal, then sometimes it can pop out on the skin and come across the area where you used to have a vein and it can almost feel like that vein has reappeared.

But if you’ve had the newer treatment, I can often guarantee that that vein that we’re seeing pop up is a new vein. And with most of my patients, I usually show them their normal veins and I usually tell them, “This vein is completely normal.” And I show them the abnormal veins as well so that they know exactly which veins I’m actually treating. So in that way, they’re crystal clear that the vein that is affected them causing them the symptoms, causing them the signs that they see on their leg are treated. Now another important factor too to note is that if you produce veins often (and you usually know which patients these are, because you often get veins at a very early age), there could be a high chance that you can develop more veins as you get older. We tend to call them the vein makers because they keep making veins.

Following Up Treatments

We can always treat the veins and we can guarantee those veins are gone, but then there’s a high likelihood you’re going to create new veins. So coming back to the first comment about, “It’s going to come back anyways.” It’s not completely true, especially for the new treatments because when we treat these veins, we can guarantee they’re gone. The last point I want to make is if you’ve had a vein treated, for example, there’s a vein on your leg that has annoyed you for longest time and you’ve had it treated and you’ve gone through the entire procedure and you find that vein hasn’t disappeared or it has kind of gone down, but it has popped up again in the same location, then there’s a high likelihood that that vein wasn’t treated in the first place. There could be multiple reasons why that’s happened, and I’ve always told patients that if this happens to you or if it’s happened with me, I often want to be the first person to know about it so I can have a look at it.


But more importantly, I think if you’ve had treated with someone and it’s come back, you may want to get a second opinion and here at Doctor Vein, we’re quite happy to have a look and let you know whether or not that vein has been treated. Part of my practice, is that I actually make sure that I follow up every patient to ensure that vein that we’ve treated is gone. Because if I haven’t done my job, I’m completely transparent in patients that it hasn’t closed, and we may have to do a different form of treatment to close it because it may be a little bit resistant. But oftentimes the most important thing to ensure is to make sure that the vein that would be where we’re actually targeting and treating is treated. Hope this gives you an idea about veins coming back after treatment. And more importantly, if you’re having a dinner meeting with a whole bunch of friends, you can kind of tell them that it’s not true. Varicose veins can get treated and they can be gone forever.

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

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.