Port Wine Stain Laser Treatments

Port Wine Stain Laser Treatments

Port wine stains are common birthmarks seen in 2-3 out of a thousand births. The use of vascular laser treatments is the most promising method of port wine stain removal, 90% of patients will achieve fading of the lesions. Westside Dermatology treats Port Wine Stains with VBeam a vascular laser which is the gold standard for fading lesions.

port-wine-stain


  • These are common red birthmarks that occur in 0.2-0.3% of births
  • Most port wine stains are just present on the skin
  • Port wine stains around the eye area maybe associated with ocular problems
  • Port wine stains on the limbs can be associated with limb length changes
  • Laser treatment of port wine stains are effective in 90% of cases
  • At least 90% of port wine stains can be faded by over with laser
  • Depending on the thickness of port wine stains, different lasers maybe needed
  • Port wine stains in all ages can be treated, including infants, teenagers and adults
  • We use the V beam laser as the treatment of choice for portwine stains

Dr. Davin Lim states that – “Laser treatment can have a profound effect on port wine stains, especially if treated early. The number of laser treatments needed to fade and or remove a port wine stain independent on many factors including; location of the birthmark, age of patient, size of port wine stain, and skin type of the patient. A consultation with your laser dermatologist will enable discussion on what is possible.”

Port wine stains are capillary malformations made up of thousands of abnormal patterns of blood vessels that lie just below the surface of the skin. Port wine stains can occur on any part of the body, but most commonly affect the face, scalp and limbs. Early stains appear as pinkish areas, however over time they may get darker. Lumpy areas (known as nodules) may form over time, and stains often thicken as one grows older.

2-3 out of 1000 babies born in Brisbane will exhibit port wine stains, some small, some large. Most patients and parents are unaware that effective laser treatments can fade or remove the majority of port wine stains especially when treated early.

Yes! Rarely port wine stains around the eye area can result in eye abnormalities including glaucoma.

Extensive port wine stains on the limbs can result in limb growth changes.

All children with port wine stains in these areas should obtain an a consultation with a paediatric dermatologist to discuss further investigations.

The ideal time for port wine treatments is ‘as soon as practically possible.’ Many leading centres throughout the World, including the Royal Children’s Hospital in Melbourne are starting treatment when babies are only a few weeks old, however port wine stains can be treated at any age.

At Westside Dermatology treatment can begin for port wine stains from 12 years old and above. This is due to the fact that Westside Dermatology cannot cater for general anaesthesia. For babies and children with port wine stains in Queensland, Lady Cilento Children’s Hospital can provide laser treatment.

Laser treatment is the only method for treating port wine stains. The choice of laser will depend on the age of the stain, and the depth of the blood vessels. Westside Dermatologist has two lasers which can treat port wine stains. 90% of port wine stains are treated with the VBeam vascular laser. This laser is considered the gold standard for treatment of port wine stains due to the dynamic cooling system, which protects the upper layers of the skin. Deeper port wine stains (generally older stains, or lumpy areas) are treated with another laser called an ND Yag laser. This wavelength penetrates into the deeper layers of the skin.

Lasers work by a process call selective photothermolysis, transferring selective laser light waves to blood vessels, which in turn transfers heat to ‘seal off’ the vessels of red birthmarks.

Regardless of what laser is used, multiple treatment sessions (4-8 on average) are needed to fade port wine stains. Some patients may require ‘top up ‘ treatments yearly.

Port wine stains are best treated with a vascular laser. The type of laser used will depend on factors such as; thickness of the port wine stain, age of the patient, and skin type of the patient.

At Westside Dermatology has three lasers suited to treat port wine stains; VBeam (595nm), ND-Yag (1064nm) and Gentlelase (755nm). All devices are suitable to treat port wine stains however without a doubt, VBeam is the gold standard for port wine stain treatment due to the built in dynamic cooling device as this protects the upper layers of the skin, whist the laser targets the blood vessels below the skin.

Westside Dermatology has 3 types of vascular lasers to treat port wine stains. Treatment choice depends on the depth of the port wine stains, VBeam (595nm), ND Yag (1064nm) which targets deeper vessels, and GentleLase (755nm Alexandrite) for intermediate vessels. Our centre represents the largest Specialist Laser Centre in Queensland – we have the ability and skill level to treat all forms of vascular lesions from port wine stains through to venous lakes.

All laser treatments are performed in our laser suites at Westside Dermatology. On average, treatments take between 2 – 10 minutes to perform, depending on the size of the port wine stain. As anaesthesia may be required for treatments, patients may be required to monitored for 45 minutes following treatment.

The number of treatments will vary from person to person. Other factors that influence the number of treatments required include the age of the port wine stain, the area, the thickness of stains, the site and the patient’s skin type.

Most port wine stains start to fade after 2 treatments. On average patients require 4-8 treatments. Port wine stains on the limbs may require up to 15 treatments.

As a rough guide, 90% of patients can expect improvement with laser treatment. The earlier the treatment, the better the clearance rate.

  • 10-20% will be completely treated
  • 80% will have at least 50% improvement with laser
  • 10% will have no response to laser treatment

In all cases multiple laser treatments are needed (6-15) over months to years.

In short, the answer is YES. Due to the high power settings of laser treatments there will be pain involved. The question is how do we deal with the pain involved in laser treatments? Children under the age of 12 will usually need a general anaesthetic and therefore are referred to Lad Cilento Children’s Hospital in Brisbane for treatment, however older patients can be treated with –

  • Sedation and skin cooling
  • Inhaled anaesthesia and skin cooling

The dynamic cooling device of the laser functions to protect skin from the laser beam, as well providing pain relief, combined with sedation, the procedure is very well tolerated. The patient is required to continually ice the area following treatment. Panadol is recommended for pain relief over the next 24 hours. After care instructions will be discussed with the patient following laser treatment.

IPL or intense pulse light is not a gold standard treatment for port wine stains. IPL is a general treatment for pigmentation, and in some cases rosacea. This is NOT the first choice for port wine stains, but can improve the condition if used correctly. The wavelengths used in IPL is not specific enough for port wine stains, and the power settings of IPL machines are not strong enough. Additionally Medicare does NOT recognise IPL as a treatment for port wine stains, and patients do not receive any reimbursement for treatment. In short, IPL can help, but it is our last treatment of choice for port wine stains.

Laser treatment of a portwine stain is much like minor surgery and a recovery process will occur over a few days to a week.

Immediately after laser

Immediate bruising, swelling and redness is seen almost all patients. The area will feel like sunburn. Following laser treatment of your portwine stain, you will be kept in a recovery area, with ice packs applied for at least 30 minutes. Ice packs are encouraged for 10 – 20 minutes per hour, for 4 – 6 hours after laser. This will help reduce the swelling, pain and to a degree bruising.

Several days later

Swelling will subside within 1 – 3 days, as will the pain and redness, bruising may last an additional 3 – 6 days, depending on the power settings, and patient factors. Peeling of the skin may occur after a few days, if this happens, use a simple moisturiser such as aqueous cream a few times a day. You should start to heal within 4 – 7 days following laser.

*Blistering following laser treatment of port wine stains is uncommon, however if it does occur, apply Vaseline to the blistered areas and arrange for a follow-up as soon as possible.

A week or two later

Swelling and redness following laser will not be present, bruising will have almost gone, and the skin will start to look and feel normal. Your port wine stain will still be present, and in most cases will NOT look any different prior to laser. It is only a month or two following the laser treatment where you will see some gradual fading.

A month or two later

Most patients will see that this is the time when their port wine stain starts to fade. The delayed response is due to what is known as a delayed ‘inflammatory cascade’ that causes the blood vessels to shrink

Common side effects

These can be considered as expected effects of laser, and will be encountered in all patients. These include bruising, swelling, redness, and manageable post- laser pain.

Uncommon side effects

These are uncommonly seen and occur in less than 2% of patients- ulceration, pigmentation changes (especially in darker skin patients), infection (if blistering occurs). Early specialist intervention will reduce permanent consequences from laser treatment of port wine stains.

Yes! Make up can be extremely effective in covering up your port wine stain. At Westside Dermatology, we have a colour match service to match you with a make up with extensive colour up abilities.

At Westside Dermatology, Dr Davin Lim and Dr Shobhan Manoharan are specialist dermatologist with speciality training in laser surgery. Both dermatologist frequently treat port wine stains on a daily basis. A consultation will enable assessment prior to treatment, during this consultation outcomes, number of treatments required and side effects will be discussed. we will discuss probable outcome, ,projected number of treatments and side effects with you.

There are several important factors to be considered prior to booking in for a consult- these factors should be carefully considered in the patient’s best interest.

Time off work and downtime

When laser treatments are performed for port wine stains, they have to be performed well, or not at all. What does this mean for patients? In short bruising, swelling and redness will be expected in all patients. The recovery time ranges from 4 to 12 days, depending on the settings, areas treated and individual patient factors. Your Laser dermatologist will give you a accurate time frame for ‘downtime’ following this procedure.

Pain management

The treatment is painful, and sedation cannot be provided for patients under the age of 12. Adult and teenage patients can be treated safely with sedation using inhalers. If prescription medications are provided, the procedure is very well tolerated. Pain management is thus not an issue for teenage and adult patients.

Costs

Costing can be an issue, however we will take into consideration how many treatments you may need. Additionally Medicare will reimburse patients for port wine stains. Up to 6 treatments are allowed per annum and the Safety Net applies to treatment of birthmarks.

Motivation for treatment

Our Laser Specialist will do the very best to achieve the best possible results, rest assured we use the most advanced laser technology in the World, combining this with years of Specialist training. We strive for the very best for you aiming to achieve maximal clearance, but undertaking treatments safely. As a patient you should be motivated to attend laser sessions as prescribed by your specialist, understanding that results may not be seen for several treatments, and that it may take months or sometimes a year or two to complete.

Please contact us for pricing.

Medicare provides up to 6 rebates per annum for the treatment of port wine stains, depending on the area involved. Most patients will reach what is known as the safety net threshold after 1-2 treatments. Reaching the Medicare safety net allows you to claim up to 80% of out of pocket expenses.

In many cases safety net patients pay an out of pocket cost of between $85- 220 per laser session. The number of laser sessions will depend on many factors such as depth of port wine stain, location, age of patient, and skin colour.

*All surgery and laser therapy is conducted in our Specialist Laser and Operating suites at Westside Dermatology.

Port wine stains are common birthmarks occurring three in one thousand births. Laser treatment is the only way of effectively treating these birthmarks. Ideally, treatment should be conducted as soon as possible, often as early as 6-8 weeks old, however even long standing port wine stains can be improved by laser. I define success as at least 50% improvement in the size and/or intensity of colour. We are successful in over 90% of patients. Patients must be motivated for treatments, as it will take between 4-8 treatments to achieve the desired outcome. Treatment intervals are spaced between 1-3 months apart. Downtime following treatment is not usually an issue as the majority of patients can start work a day or two after laser as bruising will subside within 8 days.