Raymond Shaheen, MD, FACS

You are asking the right question because we always want to ideally start with the correct diagnosis THEN consider the correct treatment. But regardless of the academic name of the vein used (I.e. spider, telangectasia, reticular, or varicose vein) what matters more is where is those veins are starting from or draining into. I recommend a good quality ultrasound to see if these are tributaries to an anterior accessory saphenous vein, lateral incompetent venous perforator vein, or even associated with a posterior thigh extension vein.

Once any underlying source vein(s) are identified and treated, the visible veins may appear less obvious. Since the visible thigh veins are not bulging surface veins, to directly perform sclerotherapy on them, I find the assistance of a Vein Light to get the best technical result because while they are beneath the skin, they also are generally too close to the skin for standard ultrasound guided sclerotherapy.

Most commonly patients get recommendations for thermal ablation with either RF or laser (EVLT). I find laser may require a little more NSAIDS after the procedure but if the physician modifies the intensity of the laser to match your vein size
And pullback speed that will minimize the difference between the two in terms of pain. Laser needs priocedural glasses and the sound can be more alarming for apprehensive patients. Ear buds and music can help. Laser is better for a really large saphenous vein but both of these are older technologies. Heat has a larger zone of injury than the inflammation from non-thermal ablation (1. Venaseal/glue, 2.MOCA/mechanical obliteration and chemical ablation, or 3. Varithena/microfoam).
Every technique has slightly different advantages (Glue- less dependent upon perfect compression and closes veins definitively, MOCA- least inflammatory provoking of the catheter options, Varithena- does not use a catheter and is the most versatile particularly in large, tortuous, or very superficial veins) or disadvantages (Glue - avoid if you have multiple allergies particularly to adhesives & uses a larger sheath and stiff catheter, MOCA - may have a fewer insurance coverage & possibly slightly higher partial closure rates due to it being so gentle and well tolerated, Varithena - harder to seal the vein exactly on a dime as you can with catheter-bases techniques and not approved for the small saphenous vein ablation.

If you have severe disease (may need to rule out iliac vein obstruction) and there is a higher-risk of ablation partial failure or anticipated multiple procedures, then Venaseal in my experience is what I use particularly for the thigh GSV/AASV(anterior accessory saphenous vein) or SSV because it has the most definitive closure out there. Also it is best if the pt has very large thighs or has challenges with compression in the thighs.
Varithena is so versatile it is great for tortuous AASV, large bulky varicose veins, and can be used for GSV. Also, if you are apprehensive about needles or procedures, Varithena does not require insertion of a catheter and therefore no cut in the skin (just uses numbing skin injection followed by foam injection. If the patient wants the least amount of chemical exposure and doesn’t want all the extra needle sticks from heat-based procedures, MOCA will generally very well via only a micro puncture access even below the knee. MOCA is safe if there are connection veins that drain directly into the deep system (“perforator veins”) and you possibly want to avoid glue or foam in those areas.

Hope all these details help you determine with your doctor which approach is best for your vein anatomy and overall situation. At 6’1” and 159 Lbs being careful to minimize heat and inflammation to the skin will be major determining factor in the decision making process.

No. Varithena is a form of foam sclerotherapy and should not be used around the eyes or face for a variety of potentially serious reasons for which i recommend Veingogh for facial veins (see below).

While it is a 1% polidocanol solution and is highly effective for treating difficult and much larger varicosities in the legs, it is excessively potent for the face and could even skin necrosis if injected outside the vein. Much lower concentration of physician prepared foam sclerotherapy can be used for spider veins on the legs, but the foam can cause vasospasm or even thrombosis of the retinal artery which has a very rare but permanent risk of blindness. Do not do foam sclerotherapy in these very delicate areas please.

Tiny doses of liquid (non-foam) sclerotherapy have been considered, but why assume the risks? Instead, I recommend Veingogh which used a tiny needle to deliver variable brief pulses of heat and no permanent scarring, despite some minimal social downtime.

Before I started doing body contouring, I had a choice and I chose SculpSure over Coolsculpting and favored SculpSure due to the feathering effect outside of the treated area and no painful post treatment massage. Coosculpting was first to market so I assume they have a lot of machines out there and providers are reluctant to get anther expensive machine to treat similar things.
You need to grab or be able to pinch fat not just SculpSure will kill about 20% of the fat cells in the treated area but you are right to ask these questions. Generally 2 sessions of SculpSure in the same treated area would be recommended with the second treatment 4-6 weeks after the first. You could consider a single treatment with SculpSure and follow this up with Emsculpting, which will get the small fat near the abdominal muscles, and thus help with the definition your looking to achieve in the most cost effective manner.

I would not lead with filler. You can always do that later after your have obtained a mid-face lifting and tightening with Ultherapy or Thermage. I wish I could see your cheek bones as you will get a softening of your nasolabial folds with some cheek filler (again after Ultherapy if you like). The nasolabial folds are the end result and it is helpful to have a more comprehensive look at your face before rushing in for filler just there.