Port Wine Stain Q & A

Questions and Answers for Port Wine Stain Treatment

Questions and Answers for Port Wine Stain Treatment


Why laser treatment for port wine stains?
We are fortunate that the treatment of port wine stains is generally effective and safe.  Laser therapy is considered the treatment of choice for port wine stains.  Typically, a series of treatment sessions are required to obtain the maximum benefit of laser treatment in port wine stains.  The degree of success in the treatment varies based upon the anatomical location of the port wine stain. Treatment is usually suggested as port wine stains most commonly darken and thicken as one ages sometimes leading to spontaneous bleeding.

Which lasers should be used for treatment?
There are several lasers available for port wine stain treatment.  The most commonly used is the pulsed dye laser (Vbeam Perfecta and Vbeam Prima).  We also use the Excel V laser for thicker port wine stains in older patients. The choice of laser is based on the characteristics of the birthmark.

How effective is laser treatment?
The data from the treatment of port wine stains is variable in terms of the clinical response.  Recent published studies have shown an improvement ranging anywhere from 75 – 100% following a series of treatment sessions.  More recently, improved technology and treatment protocols have allowed for a tendency towards more lightening and clearing of port wine stains.  A recent study from our Center revealed close to 90% clearing when treatment begins in infancy.

When should treatment begin?
Treatment protocols and choice of technology may vary from physician to physician.  In my experience, early intervention makes a significant difference.  I prefer to initiate treatment during early infancy with treatment parameters that approximate those given to adults at relatively short intervals of two to four weeks.  This “window of opportunity” during infancy allows for more complete clearing than is seen with older patients in all anatomical sites. Treatments have begun as early as several days of age.  
Our 2019 publication in JAMA Dermatology on the treatment of port wine stains in infants confirmed the value of early intervention. Read Publication.

How is treatment during infancy handled?
Dr. Geronemus and the physicians at the Laser & Skin Surgery Center of New York have pioneered the treatment of infants with port wine stains. We believe that early intervention will lead to a faster and more complete response to treatment while minimizing the requirements for anesthesia. While we offer all options for anesthesia (see below) treatment during infancy can usually be performed without the need for anesthesia and is well tolerated by the babies. Our physicians are experts at the placement of protective ocular shields in the office setting, allowing for the treatment of the upper and lower eyelids during infancy.

Do all areas respond the same to treatment?
There are some areas that are more difficult to treat than others.  Typically, the central portion of the face and the lower arms, hands, lower legs and feet are much more resistant to therapy that other anatomical sites. 

What does the skin look life after treatment?
In almost all cases there is bruising following each treatment session that will last for approximately seven to fourteen days.  The risks from these laser treatments are small.  Textural and pigmentary changes following treatment are not common. 

What are the options for anesthesia or pain control?
We are often asked by parents and patients to comment on the choices for anesthetics for port wine stain treatment.  For young infants, we typically will not give topical or general anesthesia unless we are dealing with a very large area.  We defer the use of topical anesthesia until the child is one or two years of age, depending upon the choice of topical anesthetic.  We sometimes use general anesthesia on a same-day surgery basis for those children who are uncooperative in the office setting or have large birthmarks that require a significant amount of time.  In adults, topical anesthesia is usually sufficient to achieve a comfortable treatment

What are the qualifications of the physicians at the Laser & Skin Surgery Center of New York?
The physicians at the Laser & Skin Surgery Center of New York are amongst the most experienced in the world in the treatment of port wine stains.  We continually upgrade our technology to offer our patients the best treatment possible.  We lecture nationally and internationally regarding our experience.  We also publish extensively in peer reviewed literature and are presently investigating new technologies and techniques to improve port wine stain treatment.

I am interested in traveling to NY for treatment. How do I make arrangements?
Many of our patients and their families travel to our center for treatment from across the country and internationally. You may call the office for an appointment or series of appointments. Our staff can be of help with supporting documentation required for entry into the US or with insurance issues.

Are there support groups available for patients with birthmarks?
Children and adults undergoing laser treatment of their port wine stains often require significant support by their family and friends as this is a long process that usually leads to significant physical and psychological benefit.

(Birthmark Groups)