Dallas Pulsed Dye Laser doctors

Hemangiomas are benign (not cancerous) proliferative vascular tumors of infancy.  Generally, they are not present at birth but shortly after birth enter a 6 - 12 month growth phase.  From 12 - 24 months they stay about the same size and from 24 months to 6 - 8 years of age they gradually involute.  Hemangiomas vary widely in their clinical presentation from small, flat, self limiting lesions to large/massive, ulcerated, pedunculated tumors. 

Treatment of hemangiomas also varies widely depending on the size and location of the hemangioma as well as the phase the hemangioma is in:  proliferative or involutional.  Hemangiomas can be treated with medication in the proliferative phase using either steroids (hydrocortisone) or Beta blockers (propranolol).  These drugs do have side effects and their use should be carefully monitored by the treating physician. 

Hemangiomas can then be evaluated for treatment which could include a watch and wait approach, early or delayed laser therapy to minimize scar consequences, or surgery. 

Laser treatment of hemangiomas has several advantages over traditional excisional surgery:  eliminate blood loss, safely treat a hemangioma which is involving critical structures (example facial nerve), and minimize scarring.  The goal of laser therapy is to remove disfiguring color from the hemangioma and reduce the size, making it blend with the surrounding skin as perfectly as possible.

The pulsed dye laser is generally used to treat the red color of hemangiomas.  This laser is very superficial and penetrates only 0.7mm into the skin making it ineffective in treating the underlying mass.  The Nd:YAG laser can be used in combination with the pulsed dye laser to treat the deeper component and mass effect of the hemangioma.  Using a 5 - 7mm spot size, the Nd:YAG laser can penetrate about a 10mm.  A combination of these two lasers of most effective. 

As with most lasers, repeat treatments are almost always necessary.  These treatment are spaced about 6 - 8 weeks apart to allow all swelling to resolve before repeating the treatment.  Photographic documentation is extremely helpful in evaluating the progess and in planning future procedures.

Vascular Birthmarks are characterized by their red color in contrast to pigmented birthmarks which derive their color from melanocytes (brown pigment producing cells).  

The pulsed dye laser is commonly used to treat vascular birthmarks which are also known as capillary vascular malformations or port wine stains.  

These are easier to treat in children than adults because of the skin thickens as we age and the pulsed dye laser penetrates only 0.7mm into the skin making it a very superficial (and safe) laser.  

If anesthesia is to be used, I recommend using a Board Certified Pediatric Anesthesiologist in a facility accredited to meet the special needs of children (PALS staff, proper equipment, access to a pediatric hospital, etc.)  

Complications of pulsed dye laser include:  scarring, pigmentary changes, blistering, failure to get a good result, and need for additional laser procedures.  Sun exposure both before and after the treatment can be a problem and result in scarring, blistering, or pigmentary alterations in the skin.  Generally, it requires between 5 and 10 pulsed dye laser treatments for the average port wine stain.  

After pulsed dye laser, the skin will appear dark purple.  It is important to keep is very moist.  I suggest Bacitracin application about four times per day.  The purple skin is also very sensitive to sunlight and exposure to sunlight can cause the skin to significantly darken and delay healing and the final result.  I suggest using both a barrier (sunhat) and Zinc based sunblocking cream.  Once the skin has returned to baseline, the sun can be more easily tolerated.  This takes about  2 to 4 weeks after treatment.