By Kevin DiCerbo
Birthmarks can be a concerning cosmetic condition especially when they occur on the face. They can be challenging to remove, but using the proper laser technology ensures the best possible chance for complete removal.
What type of birthmark do I have? There are many types of birthmarks starting with the simplest differentiation – vascular birthmarks and pigmented (brown) birthmarks. Vascular birthmarks are red and are often referred to as “Port Wine” or “Port Wine Stain” birthmarks. This type of birthmark is caused by an abnormal accumulation of small blood vessels at the surface of the skin. These birthmarks can change (grow or fade) over time. This birthmark is most common in Caucasians and Hispanics. The gold standard laser treatment for port wine birthmark removal is the pulsed dye laser.
There are many types of brown (pigmented) birthmarks and some are easier to remove than others. The most common and easiest to remove brown birthmark is the café-au-lait, which is typically a small coffee colored patch that occurs most commonly in Hispanics and Asians. It is common to all areas of the body. Another type is the Becker’s Nevus, which is more difficult to remove, larger and normally found on the torso. Nevus of Ota and Nevus of Ito are very common in Asian patients. Nevus of Ota is a dark purplish birthmark that occurs on the face and typically surrounds the orbit of the eye. The nevus of Ito is a similar color to the Ota, but it occurs on the body and can be much larger. All brown birthmarks are treated with q-switched lasers and some may also be treated with fractional lasers.
How are red birthmarks treated? Port wine birthmarks are made of a layer of thin capillaries (small blood vessels) at or near the surface of the skin. To remove the birthmark, a pulsed dye laser is used to heat the surface blood vessels, causing them to shrink and withdraw away from the surface of the skin. Depending on how thick the layer of blood vessels is, it can be as few as 1 or 2 treatments or as many as 15-20. In addition, very dense vascular birthmarks may be difficult to remove 100% and in some cases they can regenerate.
How are brown birthmarks treated? Brown birthmarks are treated with q-switched or fractional lasers. Traditionally the laser of choice for any dark birthmark has been the q-switched laser, but in more recent years fractionated lasers have found a place in the treatment plans for birthmarks that are resistant to q-switched lasers. Whether q-switched or fractional, the method is to disrupt, break apart or remove the pigment that makes up the birthmark. During the healing process, the body will regenerate the skin tissue with the new skin absent of the pigment that made up the original birthmark. Although not all birthmarks can be removed completely, the vast majority respond well. Typically between 3-10 treatments are required to remove most or all of the birthmark.
How do I find a provider? Laser Birthmark removal is a fairly specialized field and an internet search is the best way to identify a practice near you. When visiting the practice make sure to ask for before and after photos of patients that have the same type of birthmark, ask if they have the lasers noted above and finally, ask what the expectation for the number of treatments and % removal is.
– Kevin DiCerbo is the Director of Celibre Medical. He has been working side by side with Dr. Kaplan since 2004 and has managed Celibre Medical since its inception. He is a certified medical laser safety office (CMLSO) and uses his knowledge of laser physics to help patients understand laser birthmark removal. He also oversees the day to day administrative activities at the two offices. He has a BS in Engineering from Cornell University and an MBA from UCLA.