Varicose Veins in Singapore
Understanding venous reflux, leg symptoms and your treatment choices.
Varicose veins are enlarged, twisted veins visible beneath the skin, usually in the legs. They often develop when one-way valves do not close effectively, allowing blood to flow backwards. This is called venous reflux. Some veins cause little trouble; others are associated with aching, swelling or changes around the ankle.
An assessment connects the symptoms, examination and ultrasound findings. A prominent vein alone does not determine whether treatment is needed. Dr Andrew Choong’s explanation of why varicose veins are not always just cosmetic introduces this distinction.
For a non-emergency vein assessment, contact Andrew Choong Vascular Surgery. Our consultation preparation guide explains what records to bring and which payment or insurance questions to ask before your visit.
Which symptoms deserve an assessment?
Common concerns include:
Aching, heaviness or tired legs, particularly after standing.
Ankle swelling or shoes that feel tighter later in the day.
Itching, eczema or brown discolouration near the ankle.
Bulging veins, a tender surface vein or previous bleeding.
A wound around the lower leg that is slow to heal.
The calf muscles help pump blood back towards the heart. Long periods of stillness can make venous symptoms more noticeable, as explained in why varicose veins may feel worse by evening. These symptoms can also have other causes, so their pattern is useful information rather than a diagnosis.
How are varicose veins assessed?
The consultation considers when symptoms began, whether one or both legs are affected, previous blood clots or vein procedures, pregnancy history, medicines and other health conditions. Examination includes the veins, swelling, skin and circulation.
A venous duplex ultrasound looks at the veins and the direction of blood flow. It can identify reflux, assess the deep veins and map the veins involved before a procedure is considered. A scan for reflux differs from a scan directed at a suspected new clot. Find out about venous reflux scans in our vascular lab.
Read what a duplex ultrasound shows and why the scan comes before varicose-vein treatment. The findings need to explain the problem being treated; a scan abnormality does not automatically require an intervention.
What treatment options may help?
Advice, movement and appropriate compression
Regular walking, avoiding long periods of stillness and resting with the legs elevated may ease discomfort. Weight management can be relevant where appropriate. Mild symptoms may be managed with advice and observation.
Properly selected compression stockings can help some symptoms but do not repair faulty valves. Their pressure and fit need to suit the patient. Strong compression may be inappropriate when arterial circulation is impaired, including in some people with peripheral arterial disease. Do not use stockings to postpone assessment of new, unexplained swelling.
Procedures to treat affected veins
When symptoms, skin changes or ulceration justify intervention, options may include heat-based closure using radiofrequency or laser, non-thermal closure techniques, ultrasound-guided foam injections or removal of surface branches through small incisions. Conventional surgery remains suitable in some circumstances.
For one non-thermal option, read the guide to VenaSeal vein glue.
The choice depends on the pattern of reflux, vein anatomy, previous treatment, medical risks and your preferences. Treatment aims to address the veins responsible for the problem while preserving effective venous drainage. The discussion should cover what improvement is realistic and whether more than one stage may be needed.
Benefits, risks and recovery
Possible complications vary by procedure and include pain, bruising, inflammation, skin staining, bleeding, altered sensation or nerve injury, and blood clots. No method can guarantee that new or recurrent veins will never develop. Ask about aftercare, any compression, follow-up and when to resume work, exercise or travel.
What about skin changes and venous ulcers?
Persistently high venous pressure can contribute to eczema, hardened or discoloured skin and an open wound near the ankle. These findings deserve assessment even if the visible veins are not large.
Ulcer care considers both venous and arterial circulation, infection and other reasons for poor healing. Management may combine wound care, appropriate compression and treatment of underlying reflux. Applying a dressing alone does not establish why a wound developed.
Read the guide to chronic venous insufficiency and venous leg ulcers for a fuller explanation of persistent swelling, skin changes and ulcer care. It also explains why arterial circulation matters when choosing compression for a leg ulcer.
When is help urgent?
New one-sided swelling, pain, warmth or a tender, hard vein needs prompt medical assessment. A deep vein thrombosis is different from longstanding varicose veins and cannot be excluded by appearance alone. Bleeding from a vein also needs urgent attention.
Call 995 in Singapore for life-threatening symptoms such as sudden severe breathlessness, chest pain with breathlessness, collapse or heavy bleeding. Do not wait for a routine clinic appointment. A clot reaching the lungs can cause a pulmonary embolism.
Comparing varicose vein treatments
Most people with symptomatic reflux in a main (truncal) vein are offered an endovenous procedure first. International guidelines place heat-based closure (radiofrequency or laser) as the usual first choice for a suitable saphenous vein, with non-thermal closure, foam sclerotherapy and surgery used when anatomy, previous treatment or personal factors make them the better fit. The table summarises what each option involves in day-to-day terms. Figures are typical ranges, not promises, and your own plan depends on the ultrasound map.
| Treatment | How it works | Anaesthetic | Typical time off | Compression afterwards | Usual follow-up | When it may not suit |
|---|---|---|---|---|---|---|
| Radiofrequency ablation (RFA) | A thin catheter heats and seals the refluxing vein from the inside | Local anaesthetic infiltrated along the vein; sedation optional | Walk out the same day; desk work usually within 1–3 days | Commonly 1–2 weeks, adjusted to the individual | Duplex scan in the first weeks; review at about 6 weeks | Very tortuous or very superficial veins; veins close to the skin or a nerve |
| Endovenous laser ablation (EVLA) | Laser fibre delivers heat to close the vein | Local anaesthetic along the vein | As for RFA | As for RFA | As for RFA | Similar limits to RFA; choice between RFA and laser is largely surgeon and device preference |
| VenaSeal (cyanoacrylate glue) | Medical adhesive closes the vein without heat | Single needle-stick of local anaesthetic; no fluid along the vein | Return to most activities the same or next day | Often not required | Duplex scan in the first weeks | Known adhesive sensitivity; very large veins; some skin reactions (phlebitis-like) occur and are usually self-limiting |
| Ultrasound-guided foam sclerotherapy | Foam injected under ultrasound irritates and closes the vein | None needed | Same day | Usually 1–2 weeks | Often more than one session; scan between sessions | Large truncal veins (higher chance of reopening than ablation); known allergy; a history of migraine with aura or a known heart shunt needs discussion |
| Microphlebectomy | Surface branches removed through 1–2 mm incisions | Local anaesthetic; often combined with ablation in one sitting | Same day to a few days | Usually 1–2 weeks | Wound check and scan if combined with ablation | Veins that are too small or too deep to hook; it does not treat the underlying reflux on its own |
| Ligation and stripping (surgery) | The faulty junction is tied off and the vein removed through small incisions | General or regional anaesthetic | Typically 1–2 weeks; longer for heavy manual work | Usually 1–2 weeks | Wound review; scan if symptoms persist | Where an endovenous option is possible it is usually preferred; surgery remains useful for very large or tortuous veins and some re-do cases |
Sources: ESVS 2022 chronic venous disease guidelines; NICE CG168. See the references at the end of this page.
Two further points matter more than the choice of device. First, the duplex ultrasound decides what is treated: an ablation of the wrong vein, or of a vein that is not refluxing, does not help. Second, many people need a combination – closure of the main vein plus treatment of the visible branches – and it is reasonable to ask whether that will be one visit or two.
What recovery usually looks like
After endovenous treatment under local anaesthetic, a typical course is:
- Day of treatment. You walk out of the clinic or day surgery. A short walk every hour or so while awake is encouraged. Simple pain relief covers most discomfort.
- Days 1–3. Bruising and a feeling of tightness along the treated vein are expected. Desk work and light daily activity are usually possible. Avoid hot baths, saunas and strenuous exercise.
- Week 1–2. Compression, if advised, is usually worn for this period. Most people are back to normal routines, including driving once they can brake comfortably.
- Weeks 2–6. A follow-up ultrasound confirms the vein has closed and checks the deep veins. Residual firmness or tenderness along the vein settles over weeks.
- Around 3 months. Skin discolouration from bruising or staining continues to fade; this is the usual point to judge the cosmetic result and decide whether any residual branches need treatment.
Discuss long-haul travel and any planned surgery before booking a procedure, as both affect timing. Recovery after conventional surgery under general anaesthetic is slower, and the table above gives the usual range.
Will the veins come back?
Treatment closes or removes the veins that are refluxing today. It does not change the tendency of other veins to develop faulty valves over time, so new veins can appear years later and some treated veins can reopen. Our guide to why varicose veins come back after treatment covers this in detail. Recurrence rates in the published literature vary widely with the technique, the completeness of the original treatment and how long people are followed, which is one reason the follow-up scan matters.
What reduces the chance of a disappointing result is treating the correct source of reflux at the outset and dealing with the branches that feed from it. Keeping active and managing weight help symptoms but do not prevent valve failure. If symptoms return, the right first step is a repeat duplex scan rather than assuming the original treatment has failed. Our page on chronic venous insufficiency explains why longstanding reflux deserves attention even when the visible veins are modest.
What affects the fee for varicose vein treatment?
We do not publish a price list, because the right plan and the right setting for you set the cost. The main variables are:
- What the scan shows: one leg or both, how many veins are refluxing and whether surface branches need separate treatment.
- The method: device-based closure (radiofrequency, laser or adhesive) carries a consumable cost that foam sclerotherapy does not; adhesive closure uses a single-use kit.
- Where it is done: a clinic procedure room, a day surgery centre or a hospital operating theatre, and whether an anaesthetist is involved.
- Investigations and follow-up: the duplex scan before treatment, the confirmation scan afterwards and any later sessions.
Our fees are governed by the insurance panels and schemes we participate in, and we comply with every panel's fee guidelines. Treatment of varicose veins that are causing symptoms or skin changes is usually claimable under Integrated Shield plans and many corporate schemes, subject to the insurer's assessment; purely cosmetic treatment generally is not. Once your treatment plan is clear the Clinic Team will give you a written estimate, and will help check your cover. See payment and insurance for the panels we work with, and our guide to what varicose vein treatment costs in Singapore.
Your first visit for varicose veins
A first appointment for varicose veins is a diagnostic visit, not a commitment to treatment. Most people leave with a clear picture of which veins are faulty, whether treatment is advisable at all, and what the options would involve. A typical visit runs as follows.
- History and examination (about 15 minutes). Dr Choong asks about your symptoms, when they trouble you, previous vein treatment, pregnancies, clots, family history and medication, then examines both legs standing and lying down, looking for the pattern of veins, swelling and any skin changes at the ankle.
- Duplex ultrasound of both legs (about 20–30 minutes). The venous duplex scan is the test that decides everything that follows. It maps which veins are refluxing, how large they are, whether the deep veins are healthy and whether there has ever been a clot. Wherever the schedule allows, the scan is done at the same visit and Dr Choong reviews the images himself.
- Discussion and plan. You see the ultrasound map and hear what it means for you: whether your symptoms are coming from the veins, whether treatment is likely to help, which methods suit your anatomy, and what a sensible first step is. For many people that step is compression and review; for others it is a specific procedure. Nothing is booked on the day unless you want it to be.
- Written summary and estimate. Once a plan is agreed the Clinic Team gives you a written estimate, checks your insurance cover and, if you wish, arranges a date. If you have been referred by another doctor, a letter goes back to them.
Allow about an hour in total. Wear or bring loose trousers or shorts so both legs can be examined, and bring previous scan reports, operation notes and a medication list if you have them. If you need to claim through an Integrated Shield or corporate plan, check whether your insurer wants a referral letter first; the payment and insurance page explains the panels we work with. You do not need a referral to book, and patients travelling from overseas can read the international patients page for how a visit is arranged.
In-depth guides to varicose veins
Each of these answers one question in more detail than this page can, and each ends with the same advice: scan first, then decide.
- Are varicose veins dangerous, or just cosmetic?When they are a medical problem, and how a scan tells the difference
- Treatment options explainedCompression, foam, glue, heat, microphlebectomy and surgery, and how they combine
- Laser, radiofrequency or glue?The three keyhole methods compared
- What does treatment cost in Singapore?What drives the fee, insurance and panels, and how to get a written estimate
- Ankle skin darkening and venous ulcersWhat vein disease does to the skin, and why it is not cosmetic
- Bleeding varicose veinsFirst aid, why it happens, and why the vein should be treated
- Can varicose veins come back after treatment?Why recurrence happens, how often, and what reduces the risk
Common questions about varicose veins
Are spider veins the same condition?
Spider veins are smaller surface vessels. Their appearance alone does not show whether underlying reflux is present or whether treatment is useful. A scan is still the sensible first step when there are symptoms.
Can veins come back after treatment?
Yes. New reflux or recurrent veins can develop over the years. Returning symptoms should be assessed, usually with examination and ultrasound, before further treatment is chosen.
Is varicose vein treatment painful?
Endovenous procedures are done under local anaesthetic and most people describe pressure rather than pain during the procedure, with bruising and tightness for a few days afterwards that simple pain relief covers. Surgery under general anaesthetic involves a longer recovery.
Can I walk, work and drive afterwards?
Walking is encouraged from the same day. Desk work is usually possible within a few days of an endovenous procedure. Driving is reasonable once you can perform an emergency stop comfortably, which for most people is within a few days.
Do I need surgery, or can varicose veins be treated without an operation?
Most varicose veins today are treated with endovenous methods that need no general anaesthetic and leave no significant scars. Surgery is kept for cases where those methods are unsuitable.
Is treatment covered by insurance?
Treatment for veins that cause symptoms, skin changes or ulceration is usually claimable under Integrated Shield plans and corporate schemes, subject to the insurer's assessment and your policy terms. Cosmetic-only treatment generally is not covered. The Clinic Team will help you check before anything is booked.
Should varicose veins be treated during or after pregnancy?
Veins often enlarge during pregnancy and improve in the months after delivery, so treatment is normally deferred until after pregnancy and breastfeeding, with compression and leg elevation used in the meantime. A new painful or hard vein during pregnancy should be assessed promptly.
Can I just wear compression stockings instead?
Stockings can ease symptoms but do not repair faulty valves, and they are not a long-term alternative to treatment when there are skin changes or ulceration. They are also unsuitable for some people with poor arterial circulation, which is why an assessment should come first.
Discussing your symptoms in Singapore
For a non-emergency assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Treatment can be arranged at the private hospital that suits your insurance arrangements. Bring previous scan reports and a medication list, and note what makes the symptoms better or worse. You can also read about Dr Andrew Choong, or see our combined guide to varicose veins, DVT and leg swelling if you are unsure which problem you have.
Varicose vein videos
Watch why an ultrasound scan comes before varicose-vein treatment. His videos also explain what to do if a varicose vein bleeds and same-day walking and recovery after suitable vein treatment. Dr Andrew Choong’s vein and leg-swelling videos also explain venous reflux, evening aching and how symptoms relate to the circulation.
Read the full article here