The use of laser therapy in vascular birthmarks is essentially limited to the superficial layer, although in some cases, there can be noticeable shrinkage of the overall size after treatment. At New York Eye and Ear Infirmary of Mount Sinai (NYEE), patients can be treated with a variety of lasers that are targeted to a specific wavelength depending upon the type of vascular birthmark to be treated. In all cases, the goal is to reduce the color or reverse the involvement of the overlying skin or mucous membrane, which often requires several treatments spaced over several weeks to maximize the overall effect.
The specialists at NYEE are skilled in using a wide range of laser therapies, including the following:
For flat, superficial hemangiomas, pulsed-dye laser treatment is often successful in reducing the red color and removing the telangiectasias (“spider vessels”) within the involved skin. When performed early on, laser therapy can also preserve collagen and improve skin texture.
Patients with smaller hemangiomas may often be given laser therapy without anesthesia; for larger lesions and older patients, laser therapy is often delivered under inhalational general anesthesia for patient comfort. For patients with large or segmental hemangiomas, early intervention with serial laser therapy and concurrent oral propranolol therapy can dramatically reverse the vascular changes that would otherwise cause damage to the collagen layer of the skin, potentially avoiding the need for surgery.
For port wine stains, pulsed-dye laser is used to treat the superficial layer of the affected skin to prevent further progression. In many cases, when laser is begun within the first year of life, early intervention can even reverse the color and lead to near-normal appearance. Most patients then require additional laser therapy at regular intervals, particularly during the years of early childhood and adolescent growth, to prevent recurrence or further progression or darkening of the stained areas.
YAG Laser Therapy
Venous malformations cause purple or blue appearance, both on the skin and inside the mouth. YAG laser therapy is very effective, and can completely reverse the dark purple changes commonly seen on the skin and mucous membranes. Furthermore, the use of serial YAG laser therapy can not only restore normal color, but also reduce the overall size, and restore texture to involved tissues.
For lymphatic malformations, the vascular birthmark specialists at NYEE pioneered the use of Coblation therapy for lesions involving the mucous membranes of the oral cavity. In the past, treatment of lymphatic malformations often relied on the CO2 laser that, despite its destructive nature, still led to early recurrence of lesions in most cases. In order to tailor treatment to just the superficial layer, our specialists pioneered a technique using Coblation to refine and control the involvement of the surface of the tongue and mucous membranes, leading to fewer procedures, less pain, and increased long-term control of these difficult lesions.
Arteriovenous malformations can create significant vascular changes within the skin and can often benefit from combined laser and surgical therapies. Laser is typically reserved for management of the involved skin after surgical therapy is completed.
For other vascular malformations or birthmarks that have not shown significant improvement from past treatments, a combination of different lasers or even the use of different settings may be most effective. Such specifics are determined by our birthmark specialists on an individual basis.