Varicose veins are often discussed as if there is a single “best” treatment. In reality, there isn’t. The right option depends on why the vein has failed, how advanced the disease is, and what the patient needs from recovery. In my practice at Trinity Hospital and Heart Foundation, I spend most of the consultation helping patients understand which option fits them-not selling a technique.
This guide explains how I clinically differentiate surgery, laser, and glue for varicose veins, and when each makes sense.
First: Why Varicose Veins Need Individual Planning
Varicose veins develop because the valves inside leg veins stop working properly. Blood flows backward, pressure builds up, and veins enlarge. However, the pattern of valve failure varies from person to person.
Before choosing any treatment, I assess:
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Which vein is incompetent (great saphenous, small saphenous, perforators)
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Length and diameter of the diseased segment
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Presence of skin changes, swelling, or ulcers
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Patient’s occupation, activity level, and recovery expectations
Only after this evaluation do we discuss options.
Option 1: Surgical Treatment for Varicose Veins
What it involves
Traditional surgery usually includes ligation and stripping of the diseased vein through small incisions.
When surgery still makes sense
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Very large, tortuous veins not suitable for endovenous techniques
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Recurrent varicose veins after previous procedures
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Associated complications needing direct vein removal
Limitations to consider
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Requires anesthesia
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Longer recovery time
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More postoperative discomfort compared to minimally invasive options
Surgery is effective, but it is no longer the first choice for most patients today.
Option 2: Laser Treatment (EVLT / Endovenous Laser)
What laser treatment does
Laser energy is delivered inside the vein using a thin fiber. Heat seals the faulty vein from within, allowing blood to reroute through healthy veins.
When laser is a good option
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Straight, incompetent saphenous veins
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Patients looking for minimal downtime
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Those with swelling or early skin changes
Key advantages
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Minimally invasive
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Performed under local anesthesia
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Faster return to daily activity
Laser treatment is one of the most commonly chosen options when anatomy is suitable.
Option 3: Glue Treatment (Cyanoacrylate Closure)
What glue treatment involves
A medical adhesive is used to close the diseased vein without heat or tumescent anesthesia.
When glue works best
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Patients sensitive to heat-based procedures
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Those who want no compression stockings post-procedure
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Select vein anatomies confirmed on Doppler study
Points patients should understand
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Not ideal for all vein patterns
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Material cost can be higher
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Requires precise technique and patient selection
Glue treatment is not “better than laser”—it is simply different, and useful in specific situations.
How I Decide Between Surgery, Laser, and Glue
I follow a step-by-step decision process:
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Clinical examination – symptoms, skin changes, swelling
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Venous Doppler mapping – identifies exact vein failure
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Risk–benefit discussion – recovery time, comfort, cost
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Long-term outcome planning – recurrence prevention
The goal is not just vein closure, but symptom relief and durable results.
Common Myths I Clarify During Consultation
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“Laser is always better than surgery” → Not always. Anatomy matters.
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“Glue is painless and suits everyone” → Selection is critical.
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“Varicose veins are cosmetic” → Symptoms like swelling and skin damage are medical concerns.
Understanding these points helps patients make informed decisions.
Recovery Expectations
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Surgery: Longer rest period, gradual return to activity
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Laser: Most patients resume normal routine quickly
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Glue: Minimal restrictions in selected cases
Recovery advice is individualized based on the procedure and patient profile.
Frequently Asked Questions
Is laser treatment permanent for varicose veins?
Laser closes the treated vein permanently. New veins can develop if underlying risk factors persist.
Is glue treatment better than laser?
Neither is universally better. The choice depends on vein anatomy and patient needs.
Do all varicose veins require surgery?
No. Many cases can be managed with minimally invasive techniques.
How is the right treatment chosen?
Through clinical examination and Doppler evaluation of the veins.
A Clinical Perspective
Varicose vein treatment works best when it is planned, not rushed. Choosing the right method reduces recurrence, improves comfort, and supports long-term leg health. I consult at Trinity Hospital and Heart Foundation, Basavanagudi, where treatment decisions are made after structured evaluation rather than a one-size-fits-all approach.
Next in this series:
Laser Varicose Veins Treatment Cost in India: What Influences the Price and What Patients Should Know