Some vein treatment centers recommend visual or ultrasound guided sclerotherapy as an alternative to phlebectomy for bulging varicose veins. A more concentrated sclerosing solution than used for spider veins is injected into the bulging varicose veins scarring them closed. However, Dr. Harper prefers phlebectomy over visual or ultrasound guided sclerotherapy for primary bulging varicose veins. In our experience patients heal quicker with phlebectomy and achieve a better cosmetic result over the short and long term.