Steven Mehta, MD

I would suspect that you are lean, based upon the relative amount of fat on the back of your hands? This would also contribute to the prominence if the veins. Yes, sclerotherapy of the prominent veins would likely be the first step, but I would pause for a few months after that to see what change you might see in the skin turgor.
If you were still dissatisfied with the appearance, at that point you could consider treatment to increase tissue volume - either fat transfer or filler (pros/cons to both). Again, like any medical procedures, be sure to be evaluated by an experienced physician who can determine the best types and sequence of treatments to achieve your goals.

While overlying tissue may "hide" muscular definition, the first steps should still generally be optimizing muscles and tissues, before "tightening" anything.
At your age, hormone status may be of interest - particularly testosterone levels. Additionaly, there may be other nonprocedural options to help increase lean muscle mass and decrease fat percentage, depending upon your goals.
It would be important to undergo a detailed evaluation by a physician aligned with your goals and medical condition to determine the options.

Don't mean to sound elusive, but it depends.
Once "normal" anatomy has been altered, treatment options can change as well. Depends on what veins are still open and malfunctioning, or whether new ones are forming each time. It can be a frustrating situation but a detailed ultrasound is the first step. There may be other "options" besides Varithena, but your experience suggests that there is a more complicated issue due to your anatomy and underlying vein abnormalities (possibly even involving the "deep" system?).
You do need to see a highly experienced vein specialist who can assess your history and current anatomy to come up with an appropriate treatment plan.

In our practice in Arizona, we regularly treat superficial veins on the backs of hands, with patients of all ages - from their 30s to 70s and 80s. With the newer foam techniques (sclerotherapy), it is less common to have to remove veins (phlebectomy) as opposed to just closing the dilated ones with foam.
On initial consultation, we would identify the specific veins that your are dissatisfied with and formulate a treatment plan, as well as further discuss possible risks.
With sclerotherapy alone, there are minimal side effects/complications. We occasionally will need to "drain" a treated vein a few weeks postop, to resolve tenderness that may occur from trapped blood in the vein, This is a very minor office procedure and provides prompt relief.
The most common/serious complication of any type of vein procedure is blood clot. In the hands, this is typically more of a nuisance (painful) than dangerous. Deep vein thrombosis in the upper extremity is a theoretically possible risk, but I personally have not seen it. Decreased venous return in the arm resulting in swelling is also possible, but very unlikely if just a limited number of veins treated. Again, not a complication that we have seen at this point.
Overall, treatment of dorsal hand veins can be a very gratifying procedure with minimal discomfort and risk.

Based upon your pictures, you appear to have developed prominent superficial breast veins that may become noticeably worse during pregnancies and/or lactation. If you are past the breast feeding phase, these veins can often be treated with a simple injection of a sclerosing agent such as sotradecol or polidocanol. The treatment itself may involve the injection of liquid or foam, as determined by your treating physician. These procedures are typically performed by vein specialists with particular experience treating prominent veins in various body areas such as breasts, face, hands, etc.
Of course with any abnormalities of the breast, a thorough evaluation of the breasts by your gynecologist or PCP to exclude any serious medical conditions is advised prior to proceeding with cosmetic treatments.

Unfortunately, hemosiderin staining can be a very frustrating result of chronic venous insufficiency. As you may know by now, it results from the deposition of iron from the blood in the interstitium of the skin (between skin cells). While certain lasers may improve hyperpigmentation in some circumstances, yours may be a condition where the light stimulation actually increases the hyperpigmentation and staining.
Because it is such a frustrating and persistent condition, we are exploring novel approaches as part of a research protocol. However, if you haven't had a recent detailed venous reflux ultrasound, I would recommend that first, as recurrent or new reflux can also cause worsening skin appearance and if present, should be addressed prior to additional skin treatments.

RF skin treatment will not affect your heart valves. If you have a pacemaker there may be issues requiring further evaluation but just a heart murmur and mitral valve prolapse should not be an issue.

Yes, surface veins of the feet (and hands) can be treated - we do so regularly. Your situation is interesting in that the veins seem to have increased following your perforator ablation and phlebectomy. It would be very helpful to see a detailed ultrasound of the current venous drainage of your lower legs.
Before attempting to treat the foot veins, I would want to make certain that there was not any additional reflux or increased venous pressure that needed to be addressed first. Ongoing reflux "upstream" could make the foot treatment less successful, or even make the veins worse.
In the meantime, please use good (20-30mmHg) closed toe compression stockings to try and relieve your symptoms.