Get Rid of Varicose Veins

what's the best varicose vein removal procedure?

Doctor Answers 14

Best Treatment for Removal of Varicose Veins of Legs, Bulging Blue Veins

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Varicose veins of the legs are best treated by a board certified vascular surgeon, who is the recognized expert in treatment of blood vessel diseases of the veins.  There are many treatments for varicose veins, and the most appropriate or "best" treatment will depend on the anatomy of your leg veins.  Almost everyone with varicose veins has a defective "feeder" or "trunk" vein beneath the visible varicose veins that can be seen at the surface.  Imaging the veins in your legs like trees . . . they have trunks and branches.  Varicose veins that you see at the surface are the branches.  But there is also a defective "trunk" beneath the surface that also needs to be treated in order to get a good result and cure your problem. 

In the past, surgical stripping and phlebectomy (vein removal through incisions in the skin) were the main treatments offered.  With new technology, such as laser fibers and radiofrequency fibers, now most patients with varicose veins can be treated and cured with these less invasive options that do not require surgical incisions.  The most common procedures used to treat varicose vein problems are listed below:

1) EVLT, which stands for EndoVenous Laser Ablation.  This is a laser procedure that utilizes ultrasound guidance . . . no incisions are required.

2)VNUS, which is also known as the Venefit Procedure.  This is a procedure that utilizes a special radiofrequency cather to close the abnormal veins, and it is done under ultrasound guidance.  No incisions are required.

3)Ultrasound-guided foam sclerotherapy, which utilizes a chemical foam (shaving cream consistency) that is injected into the abnormal veins under ultrasound guidance, destroying the varicose veins from the inside

4)Ambulatory phlebectomy.  This is a outpatient surgical procedure in which small incisions are made on the skin overlying the veins, and the veins are removed through the incisions.  This is a more invasive procedure that is reserved for larger varicose veins

5)Vein stripping.  This is an old-school procedure that is rarely done anymore, as there are bettter less invasive options for most patients.  There are certain unusual circumstances, such as unusual venous anatomy or extremely large veins, where this procedure is still the best option.


It is not unusual to need a combination of the above treatments  in order to get rid of all the abnormal varicose veins.


Since many doctors, such as most dermatologists and plastic surgeons, do not have formal university training to do many of the above procedures, the most qualified physician to do varicose vein treatment is a board-certified vascular / vein surgeon.  Vascular surgeons are trained to perform all of these procedures and are best qualified to offer you appropriate workup and treatment.  Remember, you never want to just treat the surface veins that you see . . . you always want to treat the underlying causative vein as well or else you will get poor results and quick recurrence of your vein disease.

Microphlebectomy for varicose veins

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Sclerotherapy can be used for varicose veins but it typically causes a chemical phlebitis which may be a problem with matting and adherence to the skin with resultant pigmentation and brown discoloration which may be irreversible. it should be used very selectively and by an experienced technician. A better technique to address symptomatic and large sized varicose veins is to perform stab phlebectomy, also known as microphlebectomy. It is done using local anesthesia and you can resume all activites within 30 minutes of the procedure.

Hratch L Karamanoukian, MD

Surgery is best for quickest varicose vein results, quicker than sclerotherapy

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If the problem is an isolated varicose vein without underlying greater saphenous or lesser saphenous vein reflux (as diagnosed by ultrasound), we believe that varicose vein removal (surgery) via micorphlebectomy the quickest option. For many patients, quickest is best (meaning quickest to show-off-able results)

Microphlebectomy surgery involves making a few small incisions (after numbing the area) about 1 mm to 2 mm wide above the varicose vein and withdrawing the vein by hooking it out. The incision is usually so small that sutures are not needed to close it.

However, everyone has different expectations and definitions as to what is best.

If quick results is what you are looking for, surgery with microphlebectomy is best as mentioned above. But this might leave small 1 mm scars. For many people, these heal very well, and for some, I can't even find them again unless I look very very closely.

If one has more time and wants a less painful option (during the procedure), then sclerotherapy injection with foam sclerotherapy is an option and may consider this the best option for themselves. I have found that this requires repeated injections and there is are risks of hyperpigmentation and skin necrosis.

EVLT - endovenous vein laser therapy (Laser ablation) is used in our office when there is underlying reflux in a deeper system of veins such as the greater saphenous vein or lesser saphenous vein. However, we will usually use EVLT in combination with surface varicose vein sclerotherapy or microphlebectomy.

Just a quick word on stockings (compression stockings). Stockings are important in the recovery and healing process to keep the vein flow in the same direction after any of the vein procedures. Among other benefits, stockings will result in faster healing, better results, and less bruising.

There are pros and cons to every procedure, please see your plastic surgeon/vein specialist in person to discuss these in detail and with pertinent facts that are related to your specific case.

Tammy Wu, MD
Modesto Plastic Surgeon

Varicose vein treatments

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Thank you for the question! In my practice, I offer sclerotherapy, endovenous laser ablation, Clariven treatment, and microphlebectomy to treat varicose and spider veins. It's not a matter of one treatment being better than the other. Rather, the choice of treatment will depend on a size and location of your veins.  

In recent years, endovenous laser ablation (EVLA) has replaced traditional surgical method of treating varicose veins. This procedure uses laser to heat the veins instead of surgically removing them. The heat produces a steam bubble inside the vein, which destroys the vein walls, causing the affected vein to collapse. The body, in turn, naturally absorbs the dead tissue. 

Sclerotherapy tends to be one of the most popular and widely-used treatments these days. It uses a sclerosing solution that causes the vein to shrink. Usually, sclerotherapy takes only 1 to 2 sessions to achieve fading of the undesirable veins.  

Microphlebectomy is ideally suited to treat superficial bulging veins that are too large for sclerotherapy.  In the course of this treatment, I will make tiny incisions as small as 1mm to remove an undesirable vein.  He will then insert a small phlebectomy hook to extract the vein through the puncture.  Only a small section of the vein needs to be eliminated because the remaining portion of the vein will clot off and gradually fade from view. 

Clarivein is a minimally-invasive procedure that utilizes a thin infusion catheter clinically proven to deliver faster results and guarantee up to 74% less pain than most other peripheral vascular treatments. 

An in-person exam with a board-certified plastic surgeon would the best way to assess your needs and decide on the appropriate treatment option. Best of luck!

Michael M. Omidi, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 122 reviews

Varicose Vein Removal

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We can treat these veins with one, or a mix, of these treatments—based on what’s right for your particular veins:
Sclerotherapy: inject a liquid solution directly into the vein. The solution irritates the lining of the veins, causing them to seal shut. This stops the flow of blood, forcing blood to be rerouted to healthier veins. The result: the vein is reabsorbed into the body and fades within several weeks.Typically 10 to 40 veins can be treated in one session and sometimes the same vein needs to be treated more than once to get long-term results. Follow-up sessions are required to treat additional veins.
Laser treatment: A laser beam is targeted at the blood vessel and the heat from the laser coagulates the blood inside, causing it to collapse and seal up—without damaging nearby skin, vessels, or tissue. Over several weeks, the vein will shrink and disappear. One to five sessions, spaced four weeks apart, is typically required.

Dennis Gross, MD
New York Dermatologist
4.7 out of 5 stars 11 reviews

Microphlebectomy is best for varicose veins.

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Varicose veins are  large rope-like veins that are commonly seen in legs.  These are usually the result of malfunctioning valves (reflux) present in the saphenous system.  Think of your veins like a tree with the saphenous vein being the trunk and the varicose veins the branches.  The best treatment for varicose veins are tiny 2mm microincisions called microphlebectomy done under local anesthesia.  However, before removing these veins it would be wise to obtain a venous reflux exam to look at the valves in the saphenous system.  If  these valves are leaking then they should be corrected first usually with a laser or radio frequency catheter.  If the valves are not treated, then there is a high recurrence rate of the varicose veins.

John Landi, MD
Naples General Surgeon

Varicose vein treatments include EVLT and sclerotherapy and laser

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Varicose vein treatments must begin with a careful vein mapping and sometimes an ultrasound to determine the source of the problem. I perform EVLT, VNUS, sclerotherapy, injections, and microphlebectomy for varicose veins and tailor to each patient in my LA office. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Best treatment for varicose vein removal starts with best diagnosis

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Varicose veins are almost never formed in isolation; there is most often, a deeper, larger, vein that is "incompetent" that connects to the superficial, visible varicose vein.  This incompetent vein is usually the greater or lesser saphenous vein with valves that are not functioning normally.   These root cause veins typically give rise to the varicose veins seen on the surface, and thus, to treat the varicose most effectively, the incompetent saphenous vein needs to be diagnosed first with a duplex ultrasound.  Once identified, the vein can be treated with laser or radiofrequency (EVLT or VNUS), and the microphlebectomies performed at the same time to remove the varicose veins.  This can most often be performed under local anesthesia under 1 hr.   To simply treat the varicose veins with sclero/laser without treating the root cause will lead to multiple recurrences and failed treatments.   Make sure your physician is using the most cutting edge technologies to effectively treat your veins; the state of the art has moved beyond "vein stripping" and "sclerotherapy."

Charles K. Lee, MD, FACS
San Francisco Plastic Surgeon
5.0 out of 5 stars 16 reviews

Great question on how to remove Varicose Veins

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It all depends on  your particular situation and what veins need to be treated.

For the large saphenous veins, then endovenous laser therapy is usually the standard nowadays.

For smaller tributaries, we can perform an ambulatory phlebectomy or sclerotherapy and for the smallest reticular/spider veins we normally use just sclerotherapy.

Consult your local Board Certified Phlebologist for the best answers.


Craig Crippen, MD
Kelowna Physician

FDA approved Asclera to rid of Varicose Veins

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Asclera just received FDA approval this year for the treatment of veins in the legs.  There is the 1% and half % to treat both the green reticular vessels as well as the smaller red or purple spider veins.  We've found Asclera to be well tolerated by our patients and very effective.  For vein matting, which sometimes occur following sclerotherapy (the recurrence of more smaller vessels), we utilize the VBeam laser or Yag laser.  A combination treatment such as this works well for a majority of patients that we see.

Amir Moradi, MD
San Diego Facial Plastic Surgeon
4.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.