How to choose a plastic surgeon to treat varicose veins

Smiling doctors in hospital hallway


Smiling doctors in hospital hallway



> Use WORD-OF-MOUTH RESEARCH from family, friends and other plastic surgery patients


Use advertising for leads, but USE CAUTION.

> Check with the STATE MEDICAL BOARD to see whether the surgeon is licensed. Medical licensing authorities have listings at

> Get a checkup from your primary-care physician to see if you have any health problems that might make COSMETIC SURGERY RISKY.

The venous system is a collection system that gathers the spent de-oxygenated blood in the body and routes it back to the heart and lungs to restore oxygen in the blood in its second-by-second trip back through the circulatory system to nourish every cell in the body. Abnormality of this venous system affects an estimated 80 million Americans.

When veins are in a normal state they have internal one-way valves that route the blood always towards the heart. Due to failure of the internal valves, the direction of flow reverses and is called Venous Valvular Reflux. Stagnation and pooling of the blood results, which could lead to blood clotting inside the vein, leading to dangerous venous emboli which could go to the lung, called pulmonary embolism, a potentially lethal condition. Other manifestations of the condition are daily pain in the legs and potential ulceration inside the lower leg, above the ankle.

Varicose veins are a severe medical condition. There is no known medication taken orally or applied topically that can reverse this progressive condition. It should be treated at the earliest possible opportunity to stop its inevitable progression.

Who can treat varicose veins?

A plastic surgeon, who has an in depth knowledge of the function and malfunction of the venous system offers a good choice. Treatment of varicose veins has become a sub-specialty itself, termed phlebology. Some surgeons have taken advanced educational courses and ongoing medical training to become designated phlebologists.

How should abnormal veins be treated?

They should be treated adequately by eliminating the cause of the condition. To treat less is a disservice, as the condition is known to be progressive (i.e. become worse). The condition will not be adequately treated unless the treating doctor has diagnosed the cause and included in the treatment plan a method to stop the cause. Duplex Doppler (ultra sound) is a fundamental and necessary analytical test and treatment should not be performed without a proper Doppler diagnosis of the problem.

What are the most up to date methods of treatment?

Endovenous Laser is a method by which the vein can be destroyed by heating up the inside of the vein using a laser fiber threaded up the inside of the greater saphenous vein and short saphenous veins to thermally ablate (destroy) the targeted vein. There is a specific technique in performing this surgery and should be used in the hands of a surgeon who has had formalized training in performing of the procedure.

Sclerotherapy is a term used to describe placing a safe medication on the inside of varicose veins to cause chemical ablation; chemical destruction, of the abnormal vein.

Ligation means placing threads (sutures) tied around the vessel to occlude it.  This requires detailed and very exacting dissection in the groin area so the veins can be tied off safely, which will help the other techniques of sclerotherapy and endovenous laser work better.

The above described techniques have primarily made surgical stripping of the veins obsolete, although there are still some surgeons who will perform stripping if that is the technique they are used to and is effective in their hands.

What is a treatment plan for spider veins?

Microsclerotherapy is used to place a safe chemical on the inside of the smallest vessels, to destroy the “spider” vessels. Spider vessels are the “tip of the iceberg” and are a signal that every vein that connects spider veins all the way back to the largest of the veins, have to be refluxing in order that spider veins show up.

For medium size varicose veins, sclerotherapy can also be effective, although the source of the problem should still be treated as the first step.  If you do not treat the source of the problem, you’re going to be going back for repeated sessions of “search and destroy” varicose veins, then you will still eventually need the source of the problem treated. Ideally the Plastic Surgeon can diagnose the problem and recommend a session where sclerotherapy, endovenous laser and ligation can all be done at one sitting instead of having the patient come back multiple times for multiple injections, or having only one extremity treated at a time.

So, what to look for?

Look for a doctor, such as a plastic surgeon, who is trained in phlebology and will perform ultrasound analysis, formulating a plan, and carrying it out competently to improve a patient’s quality of life and prevent future vein disease.

The final word of advice: look for credentials and look for a surgeon having many years of experience treating many different patients, as experience is the true teacher.

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