Varicose veins

Varicose veins are veins that have become enlarged and twisted. They occur most often in the superficial veins of the legs, where standing puts them under sustained pressure.

The mechanism is straightforward. Leg veins contain one-way valves that stop blood flowing backwards. When those valves fail, blood refluxes downwards and pools, the vein stretches under the extra pressure, and the stretching stops adjacent valves from closing properly - so the problem spreads.

This is a medical condition, not only a cosmetic one

Varicose veins are visible, and many people come about appearance. But they are a sign of venous insufficiency, and untreated they can progress to:

Aching, heaviness and throbbing, worse after standing and at the end of the day
Swelling of the ankles
Night cramps and restless legs
Itching and skin irritation over the vein
Skin changes - brown staining, thickening and hardening of the lower leg
Superficial thrombophlebitis - a painful, inflamed, clotted vein
Bleeding from a vein close to the surface
Venous leg ulcers

Because of this, varicose vein treatment sits differently from the cosmetic work elsewhere on this site: it may attract Medicare rebates, and it starts with a proper vascular assessment.

Risk factors

Family history - the strongest single factor
Age
Being female, though men are affected too
Pregnancy, particularly repeated pregnancies
Prolonged standing at work
Obesity
Previous deep vein thrombosis
Previous leg injury or surgery

Assessment: duplex ultrasound first

What you see on the surface is rarely the whole problem. A duplex ultrasound maps which veins are refluxing and where the incompetent valves are, including deep veins you cannot see.

This matters practically: treating visible surface veins while leaving an incompetent vein feeding them almost guarantees recurrence. Assessment before treatment is the difference between a result that lasts and one that does not.

Vein work at Me Clinic is led by Dr Tim French (MED0001790529), a phlebologist with AHPRA specialist and general registration and over a decade of clinical experience in venous medicine, including at the Royal Melbourne and Royal Adelaide Hospitals.

Treatment options

Compression stockings

Graduated compression supports the veins and relieves symptoms. It does not remove veins, and it is management rather than treatment - but it is often the right first step, and is used after most procedures.

Sclerotherapy

A solution is injected into the vein, causing its walls to close and the vein to be absorbed. Suits spider veins and smaller varicose veins. Several sessions are usually needed.

Ultrasound-guided sclerotherapy

The same principle applied to deeper veins that cannot be seen, guided by real-time ultrasound.

Endovenous laser treatment

A thin laser fibre is passed inside the vein under ultrasound guidance and withdrawn, closing the vein from within. Done under local anaesthetic as a day procedure, with a walk-out recovery. See varicose vein laser treatments.

Surgery

Ligation and stripping is now used far less often, having largely been replaced by endovenous techniques for most patients, but remains appropriate in some cases.

See all vein treatments.

What to expect

Most treatments are done under local anaesthetic, take under an hour, and let you walk out and return to ordinary activity the same day. Walking is encouraged; strenuous exercise, heavy lifting and long flights are restricted for a period.

Compression stockings are worn afterwards - typically for days to weeks depending on the procedure. This part is not optional, and skipping it compromises the result.

Expect bruising and tenderness along the treated vein, and some firmness under the skin for weeks as the vein is absorbed.

What results are realistic

Treated veins close and are absorbed, symptoms usually improve substantially, and appearance improves.

New varicose veins can develop over time. Treatment deals with the veins you have; it does not change the underlying tendency, which is largely inherited. Long-term follow-up, and sometimes further treatment, is normal. Individual results vary.

Risks

Bruising, tenderness and firmness along the treated vein
Brown staining of the skin over a treated vein, which can take many months to fade and occasionally persists
Matting - fine new vessels appearing near the treated area
Superficial thrombophlebitis
Deep vein thrombosis and pulmonary embolism - uncommon but serious
Nerve injury causing numbness or altered sensation, usually temporary
Skin ulceration at an injection site
Allergic reaction to the sclerosant or anaesthetic
Infection
Incomplete treatment, recurrence and new veins
Burns or scarring with endovenous laser, uncommon

Tell your practitioner about any previous clot, bleeding disorder, pregnancy, or medication - particularly blood thinners and hormonal treatments. See risks and complications.

Self-care that genuinely helps

Walk daily - the calf muscle pump is what moves blood up the leg
Elevate the legs when resting
Avoid long periods of standing still; shift weight and move the feet
Wear compression stockings if advised
Maintain a healthy weight
Move regularly on long flights

Cost and Medicare

As at September 2024 and including GST, a vein consultation is $230. Treatment is quoted after ultrasound assessment.

Where varicose veins are symptomatic and treatment is clinically indicated, Medicare rebates may apply, and private health insurance may contribute. Purely cosmetic vein treatment is not covered. Me Clinic is not a no-gap provider, so an out-of-pocket cost will apply. You are given the expected gap before proceeding.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.