Surgery to Remove Cafe Au Lait Birthmark?

I have a cafe au lait birthmark on the right side of my cheek. Laser treatments did not work for me. Do I need to undergo a surgery? How much will it cost approximately?

Doctor Answers 5

Try laser before surgery because....

CALMS or cafe au lait macules are notoriously difficult to predict. 50-60% respond to laser, and if so,  I would choose the 1064 (or 755 Alex) Q switch laser. Of those that respond 1/3 to one half will recur over time, but can be retreated. With the event of newer lasers in the PICOSECOND pulse duration, clearance rates maybe higher, studies are now being undertaken all over the world. We don't really know yet how pico lasers will work on CALMS.

If you undergo surgery, more than likely serial excision will be best- you need to discuss with your surgeon what is best. The scar following surgery can always be lasered. 

My suggestion- wait for the pico studies, as if performed correctly, scarring will be minimal.



Dr Davin Lim

Brisbane, Australia

Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Pico Laser for Cafe Au Lait spots

We are seeing very encouraging results with the Picoway, for Cafe Au Lait Macules. It would be useful to give that a try.

Good luck.

Renita (Lourdhurajan) Rajan, MD, DNB
India Dermatologist
4.9 out of 5 stars 16 reviews

Mole removal or cafe au lait removal in Los Angeles

Café au lait spots can be removed by surgery, but laser is the first line treatment for the birthmarks. Our office performs laser and surgical excision of moles and birthmarks on the face and body.


Dr. Karamanoukian

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Surgery for birthmarks

Both laser treatments and surgery are options for your birthmark. We agree with Dr. Rajagopal that q-switched lasers are an excellent option and you should find out what kind of laser was used for your treatments and if it was a 1064 or 755 nm q-switched laser. Just because you did not respond to treatment previously does not mean lasers will not work for you. But you must make sure you are being treated by an experienced practitioner using q-switched lasers. Surgical removal is an option as well and we have done this before in cases where a birthmark reappears repeatedly after laser treatment or does not respond to lasers.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Lasers best option for removing cafe au lait birthmarks

The best way to remove café au lait birthmarks is through the use of laser treatments. A QS 1064 nm or QS 755 nm laser would be the most effective type of laser for removing a café au lait birthmark. Several treatments are required for birthmark removal. Cost of treatments varies depending on the size of the birthmark. I would suggest asking to do a “test spot” of the birthmark with your doctor, which means treating a small area of the birthmark first to see how it responds to the laser treatment.

Usha Rajagopal, MD
San Francisco Plastic Surgeon
4.6 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.