Pulsed Dye Laser: What You Need to Know

Pros

• PDL treatments are quick (approximately 30 minutes) in-office procedures, with little to no downtime. 
• PDL can treat a range of concerns, from vascular lesions to red-toned stretch marks.
• It’s FDA-cleared for adults and children.

Cons

• You’ll need a number of treatments (around three to five) to fully fade birthmarks and redness, as well as maintenance sessions every six months.
• PDL isn't suitable for all skin tones. After a PDL treatment, people with olive and brown skin have a high risk of hypopigmentation or hyperpigmentation, which can last up to three months. According to Laser Surgery in Dark Skin by Dr. Tina Alster and Dr. Elizabeth Tanzi, dermatologists at the Washington Institute of Dermatologic Laser Surgery, doctors should use a skin-cooling spray to reduce this risk. (For more pigmented skin, a laser like an ND:Yag may be preferable.)
• It doesn’t work on all red marks, especially redness from acne. A 2004 study from the Department of Dermatology at the University of Michigan Medical School shows that PDL isn’t an effective treatment for acne.

The PDL laser generates heat that destroys abnormal blood vessels, which are commonly the source of facial redness. “A pulsed dye laser is attracted to red—the hemoglobin in blood,” explains Dr. Rebecca Fitzgerald, a Los Angeles dermatologic surgeon. “The resulting heat [from the laser] causes some coagulation, and this starts shutting down the pathways for the blood that makes the mark red.” The flow of blood is then redirected into deeper vessels. 

The laser light has a particular wavelength of 595 nm, which bypasses the superficial layers of skin and is absorbed by oxyhemoglobin and hemoglobin in the blood vessels. That allows the surrounding tissue to be left intact.

Because the heat from the laser energy warms the dermis (the skin’s lower layer, where cells regenerate) and prompts a healing response, a pulsed dye laser treatment can also improve skin tone and texture, minimizing fine lines and scarring. But if those are your primary concerns, a laser resurfacing option that’s specifically intended for that purpose can be more effective.

In addition to treating cutaneous vascular lesions, PDL treatments can also work well to treat rosacea. “Modern vascular lasers that include surface cooling (like the Vbeam pulsed dye laser with dynamic cooling) have revolutionized the treatment of the telangiectatic (blood vessel) part of rosacea,” says Dr. Heidi Waldorf, a dermatologist in Nanuet, New York. “Most patients can now have reduced redness without post-treatment purpura (bruising).”

It’s not a guarantee, however. Some RealSelf members report having the laser treatment multiple times and still not seeing the results they’re after. “Without visible vessels, it doesn’t work as well to diffuse redness or flushing,” says Dr. Waldorf. 

She recommends speaking with your dermatologist about a topical vasoconstrictor cream called Mirvaso. “Mirvaso starts working about 30 minutes after application and can reduce redness for about 8 to 12 hours, so it can be applied daily or as needed.” While it doesn't work for flushing, Mirvaso reduces some of the background redness that doesn’t improve with laser in selected patients.

The pulsed dye laser photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

You’ll first need to undergo a consultation with your doctor, to make sure a PDL treatment is the best treatment option for your situation. It's an outpatient treatment, and you can return home immediately after the procedure. 

You’ll be given goggles to protect your eyes, and then your provider begins by placing the handheld pulse dye laser device against your skin and activating the laser. During your first session, the laser may be set to a lower frequency, just to check your tolerance. The light beams quickly zap your skin. 

Depending on the size of the area being treated, the procedure usually takes about 30 minutes. After the treatment is done, you can apply ice packs to relieve any discomfort.

“The laser pulse feels like a brief snap of a rubber band and will cause a small bruise on the surrounding skin,” says Dr. Jeffrey Poole, a dermatologic surgeon in Metairie, Louisiana.  

Because PDL removes birthmarks, this procedure frequently is done on children. For young children (10 years and younger), PDL is performed under general anesthesia, which means they’ll be asleep while it’s happening.

Children over the age of 10 and adults usually need only a topical anesthetic, either a numbing cream or topical cooling agent (cryogen spray) applied directly to the area before the laser treatment begins. These reduce pain from the laser’s heat, but there’s a possibility you’ll still feel some discomfort, described as a snap or flick against the skin.

Along with bruising, you may also experience some swelling, redness, tenderness, and scabbing. Redness and swelling should go down within a couple of days, but bruises and scabs can last a week or more. 

Rarely, side effects like blistering, scarring, and pigmentation issues can occur. In a study of adverse reactions following PDL for port-wine stains in 701 patients, atrophic (indented) scars occurred in 5% of patients and 0.8% of treatments.

Your doctor may give you specific aftercare instructions, but these guidelines typically apply to both adults and children.

• You shouldn’t need any pain medication, but if you feel mild pain, try Tylenol or another over-the-counter option recommended by your doctor.
• You may need to apply a prescription antibiotic ointment three times a day, for up to two weeks. 
• After the first day, you won’t need a bandage over the treated area. 
• Wait to cleanse the area for 24 hours post-treatment, using a gentle soap and lukewarm water.

Avoid direct sun exposure, to prevent any new issues with skin pigment.

There may not be that much of a noticeable difference after a single session, but you can start to see significant results after completing your series of three to five treatments. Typically, you’ll have one appointment every month, and then it can take six to eight weeks after you complete the series to see full results. 

Some redness can return, so you may need annual follow-up sessions.