Varicose Vein Treatment

Varicose veins are abnormally dilated and tortuous veins, often visible just beneath the skin. They can vary in size from quite small (1-3mm across) to very large (2-3cms across). These can be purely cosmetic or can be a sign of more significant and sinister symptoms.

Very small veins are called “thread veins” or “spider veins”. These veins are different to varicose veins because they are situated much closer or within the overlying skin. Although they may be unsightly, they are mainly a cosmetic issue and are often more challenging to treat and can cause a range of symptoms and problems.



                                                  Spider Veins                                           Varicose Veins

What causes varicose veins?

Veins are blood vessels that drain used blood up the leg back to the heart. There are two types of veins in your legs. The deep veins which do the bulk of the work, and the more superficial draining system.

The deep veins are larger veins deeper in the muscles that drain the majority of your legs blood back to the heart. These veins develop conditions such as deep vein thrombosis, colloquially known as “economy class syndrome”.

The skin draining system consists of 2 veins, the long saphenous vein running from the ankle to the groin on the inside of your leg and the short saphenous vein running up you calf from the Achilles to the back of your knee. These veins drain into the deep system. The malfunctioning of these veins is the common cause of varicose veins and are the focus of treatment in many cases.

These veins have no pump but rely on a system of hydraulics moving blood up the leg against gravity. When compressed, blood moves up these veins with one-way valves stopping the blood flowing back down the leg. Under certain circumstances these valves fail or become “incompetent” with blood now flowing up and down the leg. This reverse flow back down the leg causes abnormally high pressure in the veins. The veins cannot cope with this abnormally high pressure and dilate, thus causing varicose veins.

In addition, veins particularly at the ankle are “watertight” at these high pressures and thus become “leaky”. Fluid and inflammatory cells leak out causing many more sinister, non-cosmetic symptoms such as swelling, pigmentation, itching and even ulcers. This is known as chronic venous hypertension.

Varicose veins are associated with:

  • increasing age
  • a family history of varicose veins
  • following pregnancy
  • prior deep vein thrombosis
  • obesity
  • pelvic hypertension or congestion syndrome

Symptoms of Varicose Veins

Varicose veins can cause:

  1. cosmetic concerns
  2. tired and heavy legs particularly at the end of a long day
  3. restless legs including discomfort that disrupts sleep
  4. swelling
  5. pigmentation – commonly brown brawny stains
  6. itchiness or venous dermatitis
  7. thrombophlebitis – clots in the varicose veins
  8. lipdermatosclerosis – shape changed to the leg with very inflamed and thickened skin to lower leg
  9. bleeding varicose veins
  10. ulcers – may take months to heel

When should I treat my varicose veins?

This is generally a personal decision for many patients, particularly if your veins are purely a cosmetic concern. If they bother you, given the low risk, minimally invasive and durable solutions are now available for treating varicose veins. In most instances, Dr Ponosh would recommend having them treated.

Veins will never improve if left alone and will only progress, so treating them in most cases makes sense.

However, if you have more complicated veins (symptoms 5-10 from above) treatment of your veins is essential to avoid more sinister outcomes.

Seeing Dr Ponosh

Your GP may contact Dr Ponosh’s office directly, however in some cases they will provide you a referral to contact the office yourself. Dr Ponosh’s caring and helpful staff will walk you through the process of making an appointment with Dr Ponosh. His staff may also contact you directly. For further information please regarding referrals, click here.

When you see Dr Ponosh, he will undertake a full history and appropriate examination. In many instances (if required), he will order appropriate tests before he sees you to streamline your management and avoid unnecessary appointments. These tests are bulk billed at all times if possible. These tests most commonly include an ultrasound of your legs and occasionally your abdomen. In some cases, additional tests and appointments may be required.

Based upon Dr Ponosh’s expert review, an appropriate treatment plan will be suggested and explained to you in an open, straight-forward, jargon-free manner with all options and questions addressed. We will also discuss the cost involved for your varicose vein treatment or surgery.

If you have any questions, please do not hesitate to contact our friendly team on (08) 9386 6200.

Varicose Vein Treatment Options

Treatment is not “one size fits all” especially when it comes to varicose veins.

Dr Ponosh if one of the few vascular specialists in Perth to provide a truly comprehensive management service for varicose veins, offering all the up-to-date available therapies to tailor your treatment for the best outcome. The cosmetic varicose veins treatment options range from non-invasive or minimally invasive procedures, such as sclerotherapy (injection therapy) ,laser vein removal or radiofrequency ablation, to varicose vein surgery options. Dr Ponosh’s experience of treating veins extends into the thousands over many years.

Our service is not a matter of “square peg for a round hole” like others do but finding the correct round peg for that round hole.

Options are different for every patient and depends on multiple factors including; underlying symptoms, nature of your disease, your age and underlying health issues, medications and expected outcomes for you. Dr Ponosh takes all these factors as well as his vast personal experience and evidence-based practice to tailor the most optimal treatment for you at the lowest risk and with the best outcome.

Your treatment may include one or a combination of the below options.


These include wearing compression stockings, elevation, and exercise.

Minimally Invasive Techniques

Radiofrequency Ablation (RFA) or Laser Vein Ablation (EVLT)

This is a more modern and minimally invasive varicose vein treatment. It is designed to be a “walk in walk out” procedure, so you can leave on the same day. It is conducted under local anaesthetic with excellent long-term outcomes.

Click here see additional information about endovenous ablation


Injection Sclerotherapy

This is used in all types of varicose veins and a microinjection technique may be used for thread veins. It is a simple, low risk and non-invasive vein treatment.

However, it may not be as effective as other techniques for larger varicose veins especially if there is a major draining vein malfunction.

Click here see additional information on sclerotherapy


Topical Excel V+ Laser Therapy

Ponosh Vascular has recently acquired the latest and most comprehensive topical laser system available. The Cutera Excel V+ laser system allows us to treat spider veins beyond the scope of sclerotherapy with amazing results as well as other conditions such as port wine stains, benign pigmented skin spots, rosacea as well as a number of cosmetic treatments. 

Click here see additional information on topical laser therapy


Varicose Vein Surgery

Cosmetic surgery for varicose veins is still a common form of treatment and an effective way of removing veins. Techniques have changed over the years with excellent outcomes and shortened recovery.

Click here see additional information on vein surgery