Birthmark Removal

There are several different abnormalities in the skin and underlying tissue that can lead to a birthmark. The optimal method of birthmark removal depends somewhat on the type, however laser irradiation and treatment seem to work well regardless of the cause. We discuss the various types of congenital birthmarks, various treatment options, and what the advent of clinical lasers has done for the field of birthmark removal within cosmetic surgery.

 

Perhaps the most common type of birthmark—the type that affects one in ten children—is called a hemangioma. Hemiangiomas are essentially a small cluster or tangle of blood vessels that have grown relatively large and do not serve a useful purpose. While they are called birthmarks, as many as a third of hemangiomas are not actually present on the day of birth but rather they show up at some point within the first year. Lymphangiomas are similar to hemangiomas but instead of being composed of blood vessels, they are made up of lymphatic tissue and ducts. Whether lymph ducts or blood vessels, these marks usually appear different than the surrounding tissue.

 

 

The other major type of birthmark is referred to as a port wine stain. Readers who are old enough to remember the Russian leader Mikhail Gorbachev will know of an excellent example of a port wine stain if they recall the dark colored mark on his upper forehead. The medical term for a port wine stain is nevus flammeus and is related to a hemangioma in that it is composed mainly of thin blood vessels. The birthmark may not appear like “port wine” early in life where it could actually be light pink.

 

A number of methods have been used for birthmark removal. Birthmarks have been removed by surgical resection, that is, cutting it away directly. This method is likely to leave scars and, if the birth mark is on the face, the remaining skin may pull in unflattering ways. Cryotherapy or cryosurgery has been used successfully—basically freezing off the birthmark—but is limited to lesions that are close to the surface of the skin. Hemangiomas may be treated with injection of corticosteroids or other drugs that cause them to shrink and disappear over time. These methods, while they allow the patient to avoid surgery, take a while before they are fully effective. Also, a single injection may not fully remove the birthmark.

 

Laser ablation or irradiation has been demonstrated to be very effective in birthmark removal, regardless of the birthmark type or cause. Recent improvements in the laser systems allow for specific targeting of birthmark-causing tissue while sparing the surrounding healthy tissue. The concentrated light energy in a laser focuses on destroying the chromophores or color-causing particles in skin. Earlier laser versions did not so this and lead to skin damage in some cases.

One of the reasons for the success of laser treatment for birthmark removal is that there is now flexibility in light wavelength, pulse duration, and energy intensity among the commercially available systems. Thus when a plastic surgeon or dermatologist is going to perform a birthmark removal using a laser, she first identifies the birthmark type and the approximate depth below the surface of the skin. Then the clinical laser device is adjusted to deliver the appropriate amount of laser light energy to the birthmark itself. For example a port wine stain would likely be treated with a pulsed dye laser while a deep lymphangioma may be best treated with an argon laser.

 

When seeking a physician to perform birthmark removal using laser energy (usually the best choice), it is important to find a physician that is experienced in differentiating between birthmark types and has a laser device that has the flexibility of delivering the proper type of laser in the right wavelength and intensity.