I noticed my first varicose vein when I was 24, a prominent blue streak across my right calf. Six years later, despite being a slim exercise-lover who had never had a child, I had squiggly blue lines down both legs, framed by bruise-like patches of broken veins. By my mid-thirties, I could wear skirts only in winter, as opaque tights were essential. Now I know I’m not alone – about 40% of women have varicose veins. You don’t have to be overweight or to have given birth to the Brady Bunch to get them. In many people, including me, the condition is inherited – if one of your parents has varicose veins, there’s a 65% chance you will get them, too.

Because I hated the idea of having my varicose veins “stripped”, or surgically removed, I put off treatment for 10 years, until I developed red, inflamed skin around my ankles that could no longer be ignored. It was only then, when I began to research my options, that I learnt of the alternatives to stripping. In fact, in the past 10 years, several less invasive, less painful techniques have been developed. So, if you have had enough of covering up, consult our guide to vein removal.

The causes

Not all prominent veins are varicose – in some people, veins are simply more visible. A telltale sign is a lumpy appearance; the worst varicose veins can bulge out of the legs. Varicose veins are caused by a plumbing, rather than a circulation, problem – it is the structure of the veins that is at fault, not the heart’s ability to pump blood. A network of surface veins in the leg returns the blood to a deep vein, which pumps it back to the heart after it has delivered oxygen and nutrients to the cells of the body. Problems start once a valve in a surface vein becomes faulty, and the blood, instead of being pumped on to the deep vein, leaks back through the valve and pools in the vein.

The symptoms

The most obvious sign of varicose veins is aching legs, with veins that are tender to the touch. Left untreated, varicose veins can become inflamed, a painful condition called phlebitis, and cause red eczema above the ankles and ulcers that may be slow to heal. Vein specialists agree that varicose veins should never be ignored, and the sooner they are treated, the more successful the results.

The treatments

1 DUPLEX SCAN

Vein treatment usually starts with an ultrasound scan, known as a duplex scan, which allows the surgeon to see exactly what’s happening in the vein before he operates. He will look to see which valves are faulty, how much blood is flowing back down the legs, how big the vein is as a result and whether it is straight or twisted. The scan provides the surgeon with the information he needs to decide which technique is best to use on your veins.

Cost About £300 – or free on the NHS, if you get a referral from your GP.

2 RADIO-FREQUENCY ABLATION

The newest techniques for getting rid of veins eliminate them from the inside, rather than physically removing them from the leg. The very latest, VNUS ClosureFAST, uses radio-frequency (RF) energy to heat the vein to 120C, which seals it; it will then shrivel up and be absorbed by the body. First, you are given a local anaesthetic; then, a fine, metre-long catheter is inserted into the vein, near the inside of the knee. The catheter is pushed up towards the groin, and a blast of RF rays seals the vein off at the top. It is then moved down the vein in regular intervals, blasting the cells walls as it goes.

Recovery time Minimal. As the name suggests, it is a quick process: a vein can be treated in about two minutes. You can go back to work afterwards, and most people do not have bruising or pain.

Best for Small- to medium-sized, straight rather than twisted veins. If you have a vein that has several branches, you will need more than one treatment because it only treats the main feeding vein. Further treatments may involve injections or minor surgery.

Where to go The Whiteley Clinic in Guildford and Harley Street, W1 (www.thewhiteleyclinic.co.uk). The consultant vascular surgeon Mark Whiteley introduced the technique to the UK in March this year.

Cost From £2,000 (not including duplex scan or initial consultation).

3 LASER TREATMENT

Endovenous laser ablation was introduced about four years ago. The laser is inserted via a catheter, in a similar way to the radio-frequency type, under local anaesthetic. This treatment is probably not for needle-phobics, as large quantities of fluid are also injected around the veins to protect the surrounding tissues from the heat of the laser.

Recovery time The treatment takes 15 minutes, and you can go home straight afterwards. About 25% of patients suffer pain in the legs for a week or so, caused by the laser burning a nerve ending or the surrounding tissue.

Best for Patients who want to be treated under a local anaesthetic but whose veins are not suitable for radio-frequency treatment because they are too large or too twisted.

Where to go Mike Gough at Leeds General Infirmary has done the most research on this technique.

Cost From £2,000 (not including duplex scan or initial consultation).

4 ULTRASOUND-GUIDED FOAM SCLEROTHERAPY

Plastic canulae are inserted, under a local anaesthetic, along the vein, while you lie on a couch with your leg raised. A foaming agent is inserted, which kills off the cells of the vein wall, causing it to shrivel up and die. The blood is then rerouted by the body into more efficient veins.

Recovery time It has the shortest recovery time of any of the techniques – you can go back to work afterwards and should not feel any discomfort. You will, however, need to wear a compression stocking for 7 days afterwards. Results can be instant, although, if you’re low on body fat, the foam injected into the vein can make your leg look lumpy until it has been broken down and removed by the body. It is not suitable for very large legs, as it will not be possible to apply effective compression bandaging.

Best for Olive or darker skin, rather than pale types. “The downside with foam is that 25% of patients will be left with brown streaks on the legs, which can take up to a year to disappear,” experts say. It’s not suitable for very large varicose veins, as the foam will not efficiently touch all the cell walls.

Where to go John Scurr, consultant vascular surgeon at the Lister Hospital, Chelsea Bridge Road, SW1 (www.jscurr.com), has a worldwide reputation for treating veins, as does Philip Coleridge Smith at Nuffield Hospital, Gerrards Cross (www.nuffieldhospitals.org.uk).

Cost About £1,000.

5 SURGICAL STRIPPING

Until a decade ago, all veins were removed by surgical stripping, and it is still the treatment of choice for many surgeons. It is done under a general anaesthetic; the surgeon makes incisions at the groin, the inside of the knee and the ankle, and the faulty vein is snipped and pulled out. The incisions are stitched with soluble sutures.

Recovery time As it is done under a general anaesthetic, it occasionally involves an overnight hospital stay. You will feel sore and bruised for at least a week, and will need to wear a custom-fitted surgical stocking for six weeks. You’re encouraged to walk around after surgery to help the circulation, so you do not have to spend a week with your feet up. Depending on your pain threshold, you could get back to work in a couple of days.

Best for Large, complex veins, or veins in both legs that have several faulty valves and are not suitable for a less invasive treatment. “It’s also a good choice if you’ve treated a vein by another method and it has come back,” says Scurr

Where to go Any consultant vascular surgeon should be able to perform this procedure.

Cost About £1,500 per leg.

Spider veins on the legs

Spider veins, thread veins, broken veins and dermal flares are different names for the same fine, dilated veins within the surface of the skin. They may vary in size and colour from delicate pink lines to long, deep purple branches or thick bunches that look like a bruise. “Hormonal changes seem to play a part, as we often see these veins appearing during pregnancy or the menopause,” says consultant vascular surgeon Paul Baskerville. It is also thought that HRT exacerbates them. Here’s how to treat them.

MICROSCLEROTHERAPY

The gold-standard treatment for spider veins is still microsclerotherapy: injecting the veins with a chemical that causes the vein walls to stick together, expelling the blood, so that the vein becomes invisible. A very fine needle is used, which most people find painless; the number of injections needed varies, depending on how many veins you have. Treatment takes about 30 minutes.

Recovery time You can get some itching and redness at the injection sites, and in some people the legs can look bruised for three months afterwards. You may need to go back for a top-up treatment in four to six weeks’ time.

Where to go You don’t need a vein surgeon for microsclerotherapy, but avoid beauty salons and have it performed by a qualified nurse who does the procedure frequently. Ask your GP for a local recommendation.

Cost About £265 a treatment.

VEINS ON THE FACE

Fine red spider or broken veins on the face are unrelated to varicose veins. They can be caused by exposure to extreme weather conditions and excessive alcohol intake, but some people are simply prone to them.

Treatment These tiny veins respond well to removal by an IPL (intense pulsed light) laser such as PhotoDerm, but be warned – they will come back. “Facial veins are like weeds in the garden,” says Scurr. “You treat them and get rid of them, but they always come back.”

Recovery The treatment is quick and painless, although you may have redness, bruising and scabbing for a week afterwards. You will also need to protect the treated skin from the sun.

Where to go Dr Neil Walker, dermatologist at the Lister Hospital, Chelsea Bridge Road, SW1, is a specialist in using lasers on the face.

Cost About £250 per session.

MYTHS AND TRUTHS

— Pregnancy does not give you varicose veins, but it can make them worse, so that you notice them for the first time.

— You do not have to wait until you have finished having babies to have your varicose veins treated.

— The winter months are the best time to have veins treated if you want to reveal flawless legs next summer.

— Support tights may make your legs feel more comfortable, but they will not stop varicose veins getting worse.

— Crossing your legs does not give you varicose veins, or make them worse.

— Creams and supplements may soothe the aching feeling caused by varicose veins, but the only way to get rid of them is to have them removed.

— The body has only a few arteries but many veins, so removing one or two does not compromise the circulatory system.

— Varicose-vein treatment is available on the NHS, although many vascular units now offer it only to patients who have developed complications.

— No matter what treatment you’ve had, there is a 30%-40% risk of varicose veins returning.

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