Are Varicose Veins Cosmetic? – Happel Laser & Vein Center

Are Varicose Veins Cosmetic? – Happel Laser & Vein Center

My Doctor Said My Varicose Veins Are Cosmetic

We live in an age where pizza comes to your house before the police.

Rapidly evolving medical technology in the varicose vein world is the same. New vein treatments are approved by the FDA every year and are coming “to your door”.

Often we require specialists who can keep up with these rapid changes in health care.

The point is – primary care doctors are not vein specialists.

Usually they are required to refer to vein doctors who are in their hospital’s network.

Dr. Mark Whitely summed this concept of medical self-advocacy up very well. Being from England, he referred to the concept of watching out for your own interests in regards to your varicose vein care as “carrying the can”.

Primary care doctors don’t deal with the complications of neglected veins.

  • They aren’t aware of the rapidly changing treatment options in this ever-changing specialty.
  • They aren’t familiar and don’t have personal access to ultrasound to fully evaluate venous disease.
  • Most primary care physicians are more familiar with the outdated vein stripping and its results.

You get the picture.

You need to seek an unbiased, qualified, and trained vein expert in the field for a complete evaluation.

My Varicose Veins Are Ugly But Are They Also a Medical Concern?

Most people would agree that varicose and spider veins are unattractive and ugly.

Often this results in men and women not participating in outdoor activities because they are embarrassed to let other people see their unsightly legs. At the least, people suffering from these venous conditions will stop wearing shorts, skirts, or bathing suits.

These people often will not even go outdoors in the summertime or warm weather because of sheer embarrassment.

They are extremely self-conscious.

Some southwestern and southern states are hot nearly year round. Imagine the shame and humiliation of not being able to go outdoors and enjoy life in these areas of the country.

This aspect alone, which is cosmetic, absolutely compromises their quality of life.

This standpoint is controversial. It is generally not recommended to treat varicose veins prophylactically if there are no symptoms.

Some vein experts would call this position heresy.

However, if you carefully question many people who are “asymptomatic” you will often elucidate symptoms of heaviness, swelling, itching, cramping, or tiredness in the affected leg.

Many people are just plain stoics. They believe that these symptoms are just part of “getting old”.

What Do Insurance Companies Require for Treatment of Varicose Veins?

Insurance companies and many vein experts would not agree with this previous stance.

Of course not.

They just want to make as much money as possible. The CEOs of health companies make millions of dollars every year to restrict care as much as possible. Health insurance companies and not doctors determine medical necessity in this country.

Getting rid of large varicose veins that do not cause symptoms would be costly. Already there has been a 1600% increase in the number of varicose vein procedures over the past ten years.

For millions of men and women in this country with varicose veins, clear-cut symptoms interfere with their quality of life.  Now they are more than a cosmetic nuisance.

At this point, these large bulging veins are more than just a cosmetic concern.  As these symptoms worsen, more serious medical conditions can occur.

They can progress to clots in the varicose veins (phlebitis), bleeding, skin damage and even ulcerations.

When symptoms occur, everyone would agree that minimally invasive procedures are usually necessary to prevent further deterioration and to increase the quality of life.

All insurance companies require that the symptoms from your varicose veins must interfere with your quality of life before covering them.

What Happens If I Ignore My Asymptomatic Varicose Veins?

As time passes, your large varicose veins will inevitably get larger.

Varicose veins never get smaller.

They never just go away if you ignore them.

Many men come to see me after they have ignored their varicose veins for years. Many men can live with the unsightly large varicose veins as long as they don’t hurt or limit their daily activities.

These men show up in my office with the complications of neglected varicose veins. One of the most common complications that these patients present with is thrombophlebitis or phlebitis for short.

Phlebitis often occurs after a long car or plane trip. When you don’t walk and are inactive, the blood in your veins becomes stagnant. When it is stagnant, blood clots in your varicose veins can occur. Blood clots can also occur in your deep veins when you sit or stand too long.

Once phlebitis occurs in the varicose veins, the treatment becomes more complicated. There is a threat that the clots in these superficial veins will progress into the deep veins. I have personally followed patients where this has occurred. At this point, full blood thinners must be given until the clot resolves.

So why wait until this scenario occurs?

If varicose veins inevitably will enlarge, do you want to wait until you experience these late complications?

If your varicose veins will inevitably enlarge (which they will), do you want to wait until you are too frail to undergo varicose veins procedures?

You certainly don’t want to struggle with heavy support stockings which most elderly patients can not pull on and off without assistance. Many of my elderly patients live alone.

They simply cannot physically doff and don the heavy support stockings required for varicose veins. Most elderly patients suffer from some degree of arthritis or inflexibility making this approach impossible.

My advice is to seek competent medical advice from a vein specialist. Review your options before complications or age related debility prevent either conservative care with support stockings or minimally invasive varicose vein procedures from being possible.

What Exactly Are Varicose Veins?

Varicose vein are the large, bulging veins that are seen on the surface of the skin. They are usually soft to the touch. If they have been present for years, the overlying skin may become thin. These veins appear blue or purple.

They can bleed externally. When they bleed, the blood squirts out from the high venous pressure. This usually occurs in the shower. While you shower, the skin becomes softer, the pressure in the veins increase and the veins dilate from the heat.

Varicose veins can occur anywhere on the legs from the upper thighs to the foot. From a cosmetic perspective, they are unsightly and can cause embarrassment. From a symptomatic standpoint, they can ache, hurt, and cause swelling, brown discoloration, and even skin ulcers.

Common symptoms include:

  • Aching in the lower legs
  • Heaviness
  • Dull pain in the legs
  • Swelling
  • Itching
  • Cramping
  • Restless legs
  • Ulcerations and sores of the lower leg and ankles
  • Skin changes of the lower legs and ankles
  • Eczema in the area of the varicose veins

Elevation of the legs helps to alleviate many of these symptoms by promoting venous return back to the heart. The symptoms of varicose veins increase during the day as gravity takes hold and the venous pressure increases. The varicose veins enlarge after standing or sitting with your legs dependent for any length of time.

For many people, these symptoms increase over time preventing you from participating in normal daily activities. Your quality of life deteriorates.

Some people stop wearing shorts or bathing suits because of the embarrassment that results. Insurance companies often cover these large bulging veins because of these obvious health issues.

What Exactly Are Spider Veins?

Spider veins are the small veins that appear of the skin surface that appear that someone drew with a pen. They are not usually symptomatic. Insurance companies will not cover their treatment unless they bled in the past.

Spider vein are a cosmetic concern for most people. They are a result of your genetics or heredity. Most vein centers will incorporate sclerotherapy or injections of medicine for their treatment.

Three to five treatments are often necessary to improve their appearance. New spider veins will occur after their treatment. Most people need yearly touch ups of sclerotherapy to maintain the improvement in appearance.

What Are Reticular veins?

Reticular veins are the veins in between (in size) varicose and spider veins. They can be visible on the surface of the skin as faint blue or bluish green veins. They may or may not bulge. Therefore, you may or may not be able to feel them.

Reticular veins are also called “feeding veins”. They feed into spider veins. Without first treating reticular veins, spider veins will not usually go away after a vein treatment.

Lasers cannot treat reticular veins. That is why laser alone is unsuccessful in clearing spider veins. For that reason, injections or sclerotherapy remains the gold standard in treating spider veins.

Reticular veins are usually less than 3 mm in diameter. Most insurance companies will not cover veins this size.


Don’t suffer the embarrassment of unwanted bulging varicose veins any longer.

The visual aspects of these unsightly veins alone can influence your quality of life.

Varicose veins will inevitably enlarge as time passes.

It is easier and less risky to treat your varicose veins before complications like clots, skin changes and sores or ulcers appear.

Insurance companies will cover the treatment of varicose veins if you have symptoms that interfere with your quality of life.

Treatments for varicose veins are rapidly evolving and have improved dramatically over the past couple of years. Modern treatments are less invasive and allow you to resume normal activities and exercise much faster.

Call us at 724-969-0600 to learn more about these latest techniques to get rid of your varicose veins. We can help you select a treatment option that is designed and customized for you.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.