Varicose veins are a very common problem, affecting women more than men. The major concern is usually the unsightly appearance of the veins. Various options to deal with this problem are discussed-- compression stockings, compression sclerotherapy and surgery. For good results and patient satisfaction, the cause and natural history of varicose veins must be understood. Depending on the type of varicose vein, different modalities of treatment are required and may need to be combined. "Cosmetic" varicosities can usually be managed conservatively with compression stockings. Sclerotherapy is best used for dilated superficial or residual varicose veins, recurrent varicosities or leg perforators. Operation should be reserved for very large varicose veins or an incompetent long or short saphenous vein. A sound understanding of the problems and discussion of anticipated results with the patient will prevent unrealistic expectations.