Varicose veins get treated as a purely cosmetic complaint far more often than they should. For some people that's accurate. For others, those visible veins are the surface sign of a circulation problem that can progress.
Veins in your legs carry blood upward against gravity, and they rely on tiny one-way valves to stop it flowing backward. When those valves weaken, blood pools in the vein, which stretches into the bulging, twisted vein you can see. This backward flow is called reflux.
The visible vein is the symptom. The valve failure underneath is the actual problem — which is why treatments that only address the surface appearance tend to disappoint.
If you have small, visible veins with no symptoms at all — no aching, no swelling, no skin changes — then treatment is genuinely optional and a matter of personal preference. It's reasonable to leave them alone.
Treatment is usually recommended when varicose veins cause symptoms or when there are signs of chronic venous disease:
The skin changes matter particularly. Pigmentation and hardening around the ankle indicate sustained venous pressure, and are a step on the path toward ulceration. Treating at that stage is considerably better than waiting for an ulcer to form.
Before any treatment, a Doppler ultrasound maps your leg veins and shows exactly which vein is refluxing. This is painless and essential — it determines whether treatment will help and how it should be planned. Any assessment that skips this step isn't a complete assessment.
The older approach was to surgically strip the vein out, through incisions in the groin and leg, usually under general anaesthesia.
Endovenous laser ablation (EVLA) takes a different approach: the faulty vein is closed from the inside. Under ultrasound guidance, a fine laser fibre enters the vein through a tiny puncture — no cuts, no stitches — and gentle heat seals the vein along its length. Your body then reroutes blood through healthy deep veins and gradually reabsorbs the closed one.
Endothermal techniques like EVLA are recommended internationally as a first-line treatment for varicose veins, ahead of stripping. It's typically done under local anaesthesia as a walk-in, walk-out procedure.
Most people are up and walking immediately and back to normal activity within a day or two. Two things genuinely affect your result:
These aren't optional extras — they're part of the treatment.
The treated vein is permanently closed. However, venous disease can be progressive, and new veins can develop over time in some people. Follow-up and sensible habits help, and a top-up treatment is occasionally needed later.
If your veins are visible but silent, treating them is a personal choice. If you have aching, swelling, skin discolouration, or a history of ulcers or phlebitis, they're worth assessing properly — with a Doppler scan — because these are signs of a problem that tends to progress rather than resolve.
The free Varicose Veins handbook covers the procedure and recovery in full.
This article is for general patient education only and does not constitute medical advice, diagnosis or treatment. Individual circumstances, eligibility, risks and recovery vary — please consult a qualified medical professional for advice specific to your condition.