I am often asked “Should I get my varicose veins or spider veins treated?” The answer is generally “yes” for someone with cosmetic concerns provided the patient has been fully informed of the risks of treatment and they are realistic in their expectations for treatment. If the cosmetic concerns are minor and the patient is young then I generally advise that they seek treatment when their cosmetic concerns are more significant to justify the cost and risk of treatment. Often a patient will present with large varicose veins that are not really concerning them cosmetically and are not associated with any aching. This situation warrants an assessment of whether the patient has significant risk of complications if the situation is left untreated. This is assessed by making a decision about the relative risk based on the pressure effects into the ankle (and the associated risk of ulceration) and the risk of thrombosis (based on past history and size of varicose veins). For some patients the risk of bleeding is also a consideration.
Obviously the older the patient is then the less likely I am to advise a procedure is appropriate unless there has already been a complication (complications tend to recur). If I am in any doubt whether treatment is in the patients best interests I will suggest a review in 6-12 months to determine the rate of progression.