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Frequently Asked Questions

Vein Disease, Conditions, and Treatment

We’re a medical practice run by a physician who chose to specialize in both dermatology and phlebology (the diagnosis and treatment of vein diseases). That in itself offers a number of advantages but why us and not another practice? No reason whatsoever. We’re just another practice to choose from for the treatment of vein disease. Whatever you do, get your vein treatments from a practice that specializes in vein disease. Our understanding of vein disease and its treatments has advanced rapidly and so much in the past decade that only those physicians who actively keep up will have the know-how.

We are a boutiques practice that chooses to treat one patient at a time and not run an assembly line type process. All our procedures and the mandatory ultrasound scans are physician performed. There is a role for ultrasound technicians in a vein practice but that should not include the decision making as to which patients benefit from which treatments or planning how to treat any one vein. The treating physician should be actively involved in performing the ultrasound used for planning treatment and not merely reviewing snippets of ultrasound pictures the technician chose to capture. Every one of our patients is seen by the physician from the first appointment to each time they come back.


  • Genetics: There is an inherited propensity towards having varicose veins. One is more likely to get varicose veins if other close relatives have them than when they don’t.
  • Occupation: Those on their feet at work for extended periods are at increased risk
  • Trauma: Prior injury to legs may lead to varicose veins forming.
  • Pregnancy: Whereas pregnancy itself is not the cause, women who have been pregnant are more likely than those who have not. The gravid uterus puts pressure on pelvic veins which in turn causes increased pressure in the leg veins. Varicose veins are a result of increased pressure in the leg veins (venous hypertension). Although they’re unlikely to disappear, varicose veins that come on during pregnancy do often get a lot better after delivery.
  • Body habitus: Obesity and being overweight are contributory factors.
  • Blood clots: Those who have had deep vein thrombosis (DVT) are at increased risk for varicose veins.
  • Birth Defects: There are certainly anomalies of the blood vessels (veins, arteries and lymphatics) that predispose to varicose veins.

The visible varicose veins tend to be a later stage of the disease. One can have significant varicose veins that are not visible to the naked eye but quite readily found by ultrasound examination. Indeed the symptoms of varicose veins are mostly due to the underlying disease process and not so much the visible varicose veins.


Varicose veins are almost always a sign of chronic venous insufficiency (also called venous reflux disease or venous hypertension). This is a medical condition which causes, leg pains and aches, itching, restless legs (restless leg syndrome), swelling of lower legs, ankles and feet, leg ulcers, red painful skin of the lower legs, eczema like disfigurement of the lower legs and many more symptoms. The underlying cause of varicose veins is the reason varicose veins are now accepted as a disease process by insures (indeed when they do, the discussion is over)


The treatment for varicose veins during pregnancy should be medical grade prescription compression stockings. These should be properly fitted by a trained individual. Merely picking them up from a dispensing pharmacy without a degree of customization is not good enough. The curative treatments should wait until several months after delivery. Indeed a proportion of women will improve sufficiently in symptoms to allow deferring the curative treatment for a while.


We offer a full complement of vein treatments including endovenous laser ablation (EVLA), endovenous chemical ablation (ECVA), ultrasound guided foam sclerotherapy (UGFS), visual sclerotherapy and ambulatory phlebectomy. We do not perform vein stripping. Advances in medicine have made vein stripping obsolete. No one should be doing vein ligation and stripping in America today.

We do also use surface lasers selectively to treat spider veins but only as a complement to a comprehensive treatment of the underlying pathology.


Seamlessly embedded within our establishment is MD Laser Surgery Center, our Joint Commission Accredited ambulatory surgery center. The majority of our vein procedures are performed within that entity. Your procedure will be performed by the physician under local anesthesia. What discomfort you feel will be the administering of that local anesthesia in much the same way it feels when administered for dental procedures by the dentist. Some patients chose to accept the anti-anxiety medication we offer prior to starting the procedure. Although our procedures are mostly performed under sterile surgical setup, we do not require that patients disrobe.

We expose and surgically clean only the leg being worked on. Since general anesthesia or sedation is not used, there is no restriction to eating prior to the procedure.

Most of the procedures we perform for varicose veins require that you take a walk on our premises prior to being discharged home. So bring comfortable walking shoes. You will be able to drive yourself home.


Whereas the vein ablation procedure takes 45 minutes to an hour, expect to be at our facility for about 2 hours.


There is no need for observation after any of our procedures. You’re able to leave as soon as all the steps are complete.  There is no restriction on normal daily activities. We encourage people to maintain as normal a routine as possible while undergoing our procedures. However, it is probably not a good idea to try and run a marathon within two weeks of the procedures. We advise restriction to vigorous leg exercises in that time.


Most of our patients choose not to take time off work as that is really not necessary. Spare the two hours and you’re back at work. Leaving work early the day of the procedure and back to work the next morning seems to work best.


All medical insurance carriers have coverage for varicose veins. They also all do have specific conditions for doing it. Indeed everyone’s individual policy spells this out but do not try to figure this out on your own. Often calling your insurance carrier is not terribly helpful either (for good reason in most cases as they need to know what the diagnosis is and what the proposed treatment is). Let MD Vein & Skin Specialist help you figure this out.


Spider veins are the little red vein clusters (spider legs) one sees on the surface. They are often the tail end of the disease process going on beneath the surface. Medical science has advanced sufficiently that it is poor practice anymore to treat spider veins without checking for underlying vein pathology with an ultrasound scan. Some may not have significant underlying disease and they may be treated with visual sclerotherapy, surface lasers or any number of the other technologies offered for this purpose on the market.

However, you really ought to consult with a specialist vein physician prior to doing these treatments for spider veins. Indeed you can choose to be treated by any number of these technologies elsewhere but get the expert opinion offered by MD Vein & Skin Specialist or a vein specialist elsewhere.  The little blue veins are not spider veins. Attempts to treat them with surface lasers or any of the other technologies for spider veins will cause you too much pain and will be futile. Blue veins larger than 3 millimeters diameter are varicose veins.