A pulsed dye laser (PDL) is a laser therapy treatment that minimizes redness in the skin using beams of laser light. These beams target and destroy blood vessels without damaging the surrounding skin.Â
Pulsed dye lasers, such as the Vbeam, are commonly used to treat red-colored malformations (known as port-wine stains), hemangiomas (a birthmark created by a bundle of red blood vessels), red moles (called cherry angiomas), capillaries, and other vascular lesions. The U.S. Food and Drug Administration (FDA) has also cleared it for treating other skin conditions, including warts, hypertrophic scars (such as keloids), and telangiectasias (aka spider veins).
Pros
Cons
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.Â
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.Â
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.Â
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.Â
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. Â
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.Â
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.
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.Â
Some redness can return, so you may need annual follow-up sessions.
Some insurance plans do offer coverage for pulsed dye laser treatments for a documented medical reason, but you’ll need to reach out to your insurer to find out what’s covered. For example, PDL for birthmark removal is deemed an elective cosmetic procedure, so it’s not usually covered.Â
Other insurance providers have determined that using PDL for rosacea (a medical condition) is still considered an investigative therapy, so they won’t cover it.
Updated July 21, 2023