Ralph Carullo, MD - Account Suspended

Hello Ursul12,

Telangiectatic Matting can present as “ blush type” area containing large numbers of tiny red blood vessels that are less than 0.2 mm in diameter, directly associated with previously sclerosed or surgically removed veins.

Telangiectatic matting is a recognized complication occurring in approximately 15-20% of patients treated by sclerotherapy. Although the exact mechanism of the phenomena remains unknown, reactive inflammatory and/or angiogenic mechanisms are felt to play a role. Patients are advised that telangiectatic matting is usually not permanent and usually resolves spontaneously in 3-12 months. 

Postsclerosis pigmentation is appearance of persistent, increased pigmentation running the course of an ectatic blood vessel treated by sclerotherapy. The general incidence of hyperpigmentation ranges from 10 to 30%. Although hyperpigmentation may persist for months, its presence rarely deters patients from continuing treatment. Spontaneous resolution occurs in 70% at 6 months with 99% resolution occurring within 1 year.


It will look worse before it gets better cosmetically. It is very very important to wear compression stockings in the injected areas to help prevent pooling of blood which is responsible for the discolored (thrombosed veins).  A study comparing different times of postsclerotherapy compression in treating leg telangiectasia also demonstrated a decrease in TM when compression was maintained for one to three weeks (5%) versus three days (30%) or no compression (40%). Early on in the process, inadequate compression gives this brown green discoloration.  

Thank you for your question,

Venaseal is a minimally invasive endovenous technique for treating varicose veins without the need of tumescent analgesia.

When Venaseal is applied to the inside the saphenous veins to close them off, only a few drops are applied every inch or so along the vein. A total of about only 1.2 ml or a quarter of a teaspoon of glue is all used to seal off the inside of the vein.  The adhesive has a high viscosity like honey solution and because it is so thick, it doesn’t travel through your circulation like Varithena or Clarivein does.   Venaseal hardens very quickly within three minutes.  

The glue has been trialed and tested in other areas of medicine for decades.  It has been recently been the center of large trials which show it be both safe and effective.  The glue does not shown any significant harmful effects to the body.

In my experience, Venaseal is an effective and durable solution to the problem of incompetent saphenous veins. Long-term effectiveness is high. The elimination of the need for perivenous tumescent anesthesia and post interventional compression stockings, along with the associated side effects, results in significantly improved treatment.  Venaseal offers higher success rates than other non-thermal options and equivalent to thermal endovenous procedures with lower midterm complication rates.

Ralph Carullo, MD


Certified by The American Board of Venous and Lymphatic Medicine

Las Vegas Vein Center

Hello dccummin,

Thank you for the question,


I  recommend that all our patients wear compression stockings for 2 weeks after any vein procedure.

Compression stockings reduces post-procedural swelling, hematoma formation and pain following surgery for varicose veins.

In my experience, higher levels of compression (30-40 mm hg) are more effective than lower levels in moderating postoperative pain and complications.


A lack of evidence as to the optimal strategy for compression has resulted in a marked variation in clinical practice. There is no suggestion that this variation is becoming less over time indicating that experience is not helping to form a consensus and, therefore, further research is required.




Thank you,

Ralph Carullo, MD

Hi and thank you for the question,

At our practice each treatment vial (2cc) of Asclera is $250 per treatment.  It typically takes 2 -3 treatments to resolve the visual and the feeding veins.

I would recommend a consultation with a board certified phlebologist who can assess
the areas and see if you are a candidate.

Often, spider veins may be a sign of vein disease deeper in the leg. It’s wise to have a Venous Insufficiency evaluation, along with an overall treatment plan, BEFORE beginning to address spider veins.


In most cases, spider veins themselves are easy to treat. 

I hope this helps, 

Dr. Carullo

Las Vegas Vein Specialist

My standard recommendation for post-sclerotherapy activity is "no high impact aerobics and heavy weight
lifting.  Also important to avoid extreme prolonged heat such has saunas, hot tubs or hot baths for 7 days, followed by avoiding full intense sun exposure for about a month". This regimen requires the use of adequate continuous compression stockings for the first 48 hours followed by daily wearing for two weeks after the procedure.  It is also important to wear compression stockings  to minimize the occurrence of any complications.

Always check with your phlebologist on their treatment and post-treatment recommendations