Port wine stains are one of the most common birthmarks we treat at Cutis Dermatology, Brisbane. We treat patients of all ages from babies through to adults. The treatment of choice is with the updated V Beam Prima & Derma V lasers with larger spot sizes compared to older generation lasers. Lasers can markedly reduce the appearance of port wine stain birthmarks.
- Port wine stains are common, occurring in 1: 300 births
- Early treatments are indicated
- Big spot size lasers with dynamic cooling are the gold standard
- The number of treatments depends on the size, thickness & location of the birthmark
- Treatments are partially covered under Medicare
Port wine stain treatments at a glance
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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 Gold Standard 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.
Learn more (link to vascular laser in the laser section)
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 Jibreal is our paediatric dermatologist who also consults at the Children’s Hospital, Brisbane.
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.
Learn more (link to our staff bios)
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. Treat 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-
- Patients are nervous about treatments
- Dermatologists need to see the most likely outcome from lasers
- In complex cases such as port wine stains in very dark skin types
In short, yes. Your dermatologist will discuss methods to reduce discomfort based upon the size of your birthmark & the proposed treatment. As a guide we can markedly reduce discomfort with-
- Zimmer cooling & ice packs
- Nitrous gas
- Numbing gels
- Pain killers
85% of port wine stains respond well to vascular laser treatment. It takes between 2-12 sessions for optimal results. Your dermatologist will give you an accurate time frame as it depends on –
- The location of the birthmark
- The size of the port wine stain
- The thickness & colour of your birthmark
- Your skin colour
- The degree of background tanning
- Your downtime
Cutis Dermatology Brisbane treats over 200 cases of port wine stains annually. We have the very latest pulse dye lasers as well as newer generation vascular lasers. Our dermatologists also perform birthmark removal at the Children’s Hospital Brisbane.
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. If you have a child under the age of 13, consult Dr Jibreal privately (or publicly). She will 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
This will help accelerate your laser treatments. If you have tanned skin, to reduce the chances of blistering, your dermatologist will dial down the power setting on the laser. Less power (or longer pulse duration) means more sessions. So, get pale.
Eczema & dryness can develop over a PWS. It is easy to fix. Use a soap substitute to wash, then apply a simple moisturizer such as aqueous cream three times a day.
These birthmarks thicken with age, changing colour from pink red to a deep purple. They can be lumpy & cause bleeding in time. This usually happens after the third decade.
hicker birthmarks are treated with modifications to our normal SOPs, they include-
- Bigger spot sizes using both Derma V & Prima over the 10 mm from Perfecta
- Using longer 755 or better still 1064 wavelengths
- Compression of the lesion
If you have resistant blebs (usually in patients >40 yo), simple cautery or surgery can be used. Lasers are preferable as scarring is much less