In the treatment of varicose veins, microphlebectomy (removal of veins through very small incisions) is the most common “surgical” procedure performed. Microphlebectomy is an outpatient procedure which takes about 30 minutes to perform, and is often performed in conjunction with endovenous ablation under local anesthesia with only a small amount of oral sedation. Some varicose veins will resolve or shrink after the underlying problem vein has been sealed with endovenous closure. However, larger veins may require removal at a later date. Before endovenous closure was introduced in 1999, the general perception of varicose vein removal procedures was that they were only a short-term fix and that other veins would start bulging within just a few months. The incisions used in the past were also larger and less cosmetically appealing than the tiny incisions (micro) currently employed. With the modern techniques available today, including accurate ultrasound mapping of leaking veins, endovenous closure of the underlying leaking veins, and skillful surgical removal of large bulging varicosities through very small incisions, one can be much more certain of a favorable and lasting result from varicose vein or venous insufficiency treatments.