Vein Treatment

Varicose Veins/Spider Veins

Varicose veins develop when an increase in pressure in the veins of the legs causes dilation and bulging. This process is accelerated in patients with a family history of varicose veins and people who stand to work all day long, and it is more common in females. The reason why females are at greater risk for developing varicose veins is that certain hormones that are present in greater amounts in women, particularly during pregnancy, cause a change in the veins that weaken them and make them more susceptible to dilation. The results of these bulging, dilated veins are pain, swelling, achiness, restlessness, itching, and discomfort. For many people, the symptoms are assumed to just be the results of getting older. It is also common for patients to not realize just what is going on. In some patients, the veins are blue and bulging, and in others, they are more subtle. The way to diagnose the presences of dilated veins and the reflux of blood flow, which is the hallmark of venous disease, is to conduct a non-invasion ultrasound exam. During a consultation, Dr. Mancoll will review your health history and evaluate the areas of concern.  He will also discuss the varicose vein procedure and help you decide if treatment is right for you.

Ideal Candidates

The ideal candidate has already tried and failed more conservative measures. These include medical-grade compression stockings, regular exercise, and non-steroidal anti-inflammatory agents. Most insurance companies typically require 12 weeks of conservative treatment. The only exception may be in patients with open non-healing lower leg wounds that are believed to be a result of the underlying abnormal veins. These are referred to as venous stasis ulcers.

Typically, candidates want to improve one or more of the following:

  • Leg swelling
  • Leg pain
  • Itching
  • Heavy feeling in the legs
  • Restlessness
  • Thickened texture of the skin
  • Pigmentation changes in the skin
  • Skin ulceration between the ankles and the knees
  • Tiredness
  • Large palpable or noticeable veins on the thighs or lower legs, which are painful to touch


Most of the procedures Dr. Mancoll does to treat varicose and spider veins are done in the office with the help of numbing medicine. This allows patients to drive themselves to and from the office for treatment. In the event that a patient is anxious and requires more sedation than just numbing solution, oral or IV sedation is also available.

Endovascular Ablation

The most common way that Dr. Mancoll treats varicose veins is by using a special catheter to access the vein. Once the probe is in the proper position within the vessel, radio frequency energy is delivered to the vessel, which causes it to shrink. The result of this treatment causes blood to return to the heart through other blood vessels. The end result of the treatment is to redirect blood back to the heart through other blood vessels that work the way that they are supposed to. Endovascular ablation is typically used to treat the main superficial veins running down the inner thigh and the ones that are behind the knee over the calf called the greater and lesser saphenous veins.

Ambulatory Phlebectomy

Coming off of the main superficial veins in the legs are multiple branches that can also cause pain and discomfort all by themselves. These troublesome vessels can be removed in a simple procedure referred to as micro- or ambulatory phlebectomy. This procedure can also be done with numbing medicine in the office setting. Here, multiple small 1 to 2 mm incisions are made, and a small hook is used to snag and remove the bulging veins.


Many smaller vessels and spider veins can be treated with sclerotherapy. This treatment involves an injection of a very dilute solution into the vessels, which will cause them to shrink and disappear. The skin will look clear and no longer have blue or purple lines. This type of treatment could take between 3 and 5 sessions to fully clear the area of all of the unwanted vessels.


The total cost of varicose vein treatment depends on various factors, such as:

  • Treatment type
  • Surgeon’s fee
  • Facility fees
  • Laser fees
  • Prescriptions for medication
  • Post-treatment garments

If certain conditions are present pertaining to venous disease, many health insurance companies, including Medicare, will pay for the treatment of varicose veins.

Potential Risks and Complications

Although the chances of complications developing after these treatments are low, blood clots, infection, excessive bruising, blistering, pigmentation changes, and scarring can occur.

Dr. Mancoll prides himself on his ability to communicate with his patients and tailors each discussion to the patient’s individual needs. Dr. Mancoll and his staff will spend time helping you understand your procedure. You should feel free to ask questions at any time, and if you don’t understand the information, we will be more than happy to go over it again.


After varicose vein treatment, you will be required to wear special compression stockings for the first couple of weeks to help minimize any swelling or bruising that exists. Even though it is recommended that you walk as soon as possible, any strenuous activity or rigorous exercise should be avoided for about a week.


The treatment of varicose veins is effective in 97% of patients. Although the results are expected to be long-lasting, touch-up treatments may be needed. Ablation and removal of these symptomatic veins may improve how you feel, but these treatments do not address why you got them in the first place. Therefore, Dr. Mancoll still recommends continued use of exercise and compression stockings to minimize the development of new symptomatic veins.


We welcome you to schedule a consultation with board-certified plastic surgeon Dr. John S. Mancoll by calling Mancoll Cosmetic & Plastic Surgery at (757) 305-9185 or filling out our online contact formDr. Mancoll has been voted by his peers as one of Coastal Virginia’s Top Plastic Surgeons 3 years in a row. He is devoted to helping each individual patient achieve the best results possible.