Port Wine Stain Treatments

Port wine stains start off as pink to red flat birthmarks that may change colour when a baby cries. It grows in proportion with the child. PWS birthmarks will thicken up over time. In young adults they can turn purple & nodular with cobblestone blebs. 

New generation lasers can markedly improve vascular birthmarks including port wine stains. Lasers give –

• Minimal discomfort & fast recovery
• Reduce the appearance of red birthmarks
• Safe treatments & no surgical scars
• Medicare subsidized

The commonly used method of port wine stain treatment is with pulse dye lasers with dynamic cooling. At Cutis we have both VBeam Perfecta & the newer Prima lasers. 

We also use the big spot sizes of the Derma V laser to treat more superficial port wine stains. It is important to employ lasers with a big spot size & cryogen spray cooling as it adds safety & efficiency. 

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Laser physics. The larger the spot size the deeper the treatment. For vascular birthmarks like port wine stains, we need to target vessels of every size & importantly deeper involvement. Therefore we use the updated V Beam PRIMA over the decade old PERFECTA laser. 

The Prima & the Derma V gives us almost double the spot size of the older lasers. Bigger spot equals more efficient birthmark removal with less pain.

The two most important factors are the experience of your specialist & the tech of the laser. 

Experience: Our dermatologists have over 20 years’ experience in the management of birthmarks. Dr Devita and Dr Charlotte are our paediatric dermatologists.

Tech: You need BIG spot lasers for effective & efficient treatment. Therefore we invest in specific lasers for birthmarks, including the newest V Beam PRIMA. This has replaced the 10-year-old PERFECTA with a limited spot size of only 1 centimetre. 

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It comes down to the physics of lasers & their targets. Over the past few years, studies have shown that port wine stains have vessels of varying size & depths. 

The current research has shown that using two wavelengths, namely the 532 & 595 may give better outcomes than one laser. As reinforced earlier, a large spot size of up to 18 mm is required for addressing deeper vessels. Older devices have a maximum effective spot size of only 10 mm. 

Typically, 4-8 days. Recovery goes something like this-

• Day 0-2 Massive bruising & swelling
• Day 2-4 No change in bruising
• Day 5-8 Bruising subsides

Your dermatologist will discuss the timeline with you, as we control the settings

As with all laser surgery procedures, there are associated risks. Your treating dermatologist will discuss the specifics pertaining to your skin type. They include-

• Blistering; more common in darker skin types & tanned patients
• Scarring; usually secondary to infection & poor wound care
• Infection; is usually secondary to blisters
• Pigment changes; in tanned or dark skin individuals

Blisters occur in 10-15% of patients. They are more common in thin skin areas such as the eyelid, they are more common in darker skin patients, or when your dermatologist dials up some epic power with the lasers. Address blisters with-

• Vaseline 3 times a day. Clean with a soap free wash. 
• Notify your dermatologist if blister take >72 hours to heal
• In most cases we can pre-empt blisters & will prescribe you an antibiotic ointment prior

Yes. This is called a test spot. We can treat a tiny 1 centimetre area. A test spot is used when-

1. Patients are nervous about treatments 
2. Dermatologists need to see the most likely outcome from lasers
3. In complex cases such as port wine stains in very dark skin types

Yes. We see many cases of port wine stains treated elsewhere with little success. In most cases we can take your treatments up another level with the very latest technology. We use both the Derma V & the V Beam Prima to achieve deeper treatment levels. Settings & skill sets matter. 

Our paediatric dermatologists treat newborns with port wine stains at the Children’s Hospital Brisbane. Our dermatologists can coordinate treatments under general anaesthetic. 

We also treat teenagers in our laser suites. As a guide, most children over the age of 12 can be treated privately. 

Avoid sun for at least 4 weeks before & after laser sessions. This will help you get the best results possible from each laser session. It will also markedly reduce complications including colour changes, blistering, prolonged recovery as well as scarring. 

Use a high factor SPF 50+ sunscreen at least twice a day, regardless of exposure. 

Treatments are subsidised by Medicare. The rebate depends on the size of the birthmark & your Medicare threshold. It can vary between $90-$450 out of pocket. A Medicare subsidy only applies to laser, it does not apply to BBL or IPL treatment.

Port Wine Stains are not hereditary, you cannot pass it onto your offspring. They are however common, affecting 3 out of 1000 births. 

In some cases, PWS are associated with other abnormalities including Sturge Weber syndrome & Klippel Trenaunay. These are usually identified within the first few days to months of birth

Skin colour or melanin competes with the target of the laser. This means we need to be more conservative in darker skin types including Asian, Middle Eastern & Islander skin types. 

As a guide these races required 40-70% more sessions than lighter skin types. Settings are more conservative. 

Apart from skin colour, the location & size of PWS birthmarks are important. Large birthmarks respond slower, whilst birthmarks on the limbs require more treatments