- Best Results4-10+ sessions
- Treatment Recovery1-5 days
- Procedure Time5 to 15 minutes
- Skin SpecialistDavin Lim
- Duration of ResultsCan be permanent
- Back to Work1-5 days
- Cost$ Medicare
This is a common birthmark that affects the eye area. It is mainly seen in females & occurs in early childhood. Lasers provide the best outcomes. Newer generation pico lasers are more effective in clearing Ota, with less side effects & less pain. Once treated, recurrence is rare.
FactsFacts on Naevus of Ota
- This birthmark affects one side of the face
- It can be present at birth or develop in early childhood
- Once treated, Ota does not usually recur
- Ota can affect eyelids to the inner eye
- Lasers are highly effective
- Once established it grows in proportion to development
- Pico lasers gives the best outcomes
What is a nevus of Ota?
This is a birthmark & falls under the classification of skin pigmentation. The colour is blue to grey. It can occur at birth or in early childhood. Ota affects one side of the face. It frequently involves one or more of the following areas;
- Eye area including upper & lower lids
- Within the whites of eyes
- Deeper structures of the eyes
What treatments are there for nevus of Ota?
Lasers are the definitive answer to nevus of Ota. They work by targeting the pigment packets called melanosomes which are produced by melanocytes in the deeper dermal layer of skin. Laser therapy is classed a medical procedure & not cosmetic, hence why it is partially covered under Medicare. Read more below to understand.
What other conditions resemble Ota nevus?
The most frequently confused condition is a Hori nevus. This usually occurs on both sides of the cheeks, spares the upper & lower lid, with an onset that is much later than Ota. Hori contains more discrete dots.
Other diagnoses include melasma, & periocular pigment (dark circles). These conditions affect areas bilaterally (both sides of the face).
Is Ota hereditary?
No. You will not pass it on to your children. Ota is thought to be an isolated genetic mutation in the way you express your DNA.
What is the cause of Ota?
It is a genetic expression of pigmentation that occurs in the deeper dermal layers of skin. Hormonal factors have been implicated as it affects females five times more commonly compared to males.
Ota is more commonly seen in Asians & ethnicities, supporting the fact these genetic factors come into play. Ota can be classed as dermal melanocytosis, much like Mongolian Blue Spots.
When does Ota appear?
Nevus of Ota can be present at birth, or it may have a delayed onset & present in early childhood, most often before the age of 8.
What other conditions can be associated with Ota birthmarks?
As this involves the eye area, there are 2 conditions that are associated with Ota.
Glaucoma as pigment calls can obstruct the drainage of the eye, in turn causing increased pressure. A referral to an ophthalmologist to monitor your progress is recommended.
Melanoma has been associated with Ota. It is very uncommon. There is possibly a higher chance of malignant change in fairer skin types.
Which lasers can treat naevus of Ota?
I employ two lasers to treat Ota. The laser with the most evidence is a nano Q switched 1064 Nd Yag laser. This has been the gold standard for Ota birthmarks for nearly three decades.
I also use a pico laser. I have replaced the old Picosure with the Picoway, as the latter has more power & the correct wavelength. Pico lasers are less painful with a quicker recovery time compared to nano lasers. In most patients they are also more effective, giving better response in the first few sessions.
IPL should not be used to treat Ota. You require lasers with a very short pulse duration (nano or pico, not millisecond).
View our Treatment Gallery
Nano vs pico, which is better?
I suspect the true answer will be that some patients respond to pico faster than nano, but possibly pico may give better clearance initially. In practice I use both nano & pico. One paper has suggested better results with pico, however in the context of clinical improvement the effects are marginal.
Much like tattoos, the rate limiting factor is the immune system’s ability to remove shattered pigment. Hence, we maybe at the limit of power & pulse duration. Time will tell.
What is involved in the laser procedure for Ota?
This is rated as a basic procedure (in the context of what I do). I treat at least 2-3 Ota a week, so it’s a common diagnosis. Treatment goes something like this;
- Numbing creams & injections can be used prior to treatment.
- Eye shields, either internal* or external are placed.
- Laser test spot is then performed (5 seconds).
- Area is treated (about 1-3 minutes).
- Eye shields are removed, ointment is applied. That’s it.
* I use an intraocular eye shield if the birthmark occupies the upper & or lower lids. This is done to protect your eyes from the laser.
How many laser sessions are required?
4 to 12. It really depends on how your immune system responds to clear up the pigmentation. On average, six sessions are required to clear between 80 to 90% of Ota. Pico lasers can give faster results compared to nano lasers.
Does laser surgery cure naevus of Ota?
Now for some good news, once faded patients can expect a long-term remission & cure. Recurrence, though reported, is unlikely. The end goal of treatment is to aim for >90-95% resolution. This gives the highest remission rate.
Is laser treatment painful?
Yup, it can be. On this basis I normally prescribe a strong numbing cream prior to laser. I also numb the area up with local aesthetic. If you are anxious, I can gas you, or prescribe some chill pills.
How long does it take to recover from the laser?
It depends on the location & area treated. Expect bruising & swelling for 3-5 days. If I treat the lower & upper eyelids, swelling can be so marked that it can be hard to open the eyes for 24 to 48+hours. I will warn you about this before I lase.
Does treating Ota earlier alter the prognosis?
No. Unlike vascular birthmarks, Ota nevus heralds the same prognosis & number of treatments regardless of age.
What are the side effects of lasers?
Fortunately, side effects are rare following lasers. Swelling, bruising is expected outcomes & not classed as side effects. If you have darker skin (Asian skin types), 25% of cases can result in hyperpigmentation (temporary darkening of skin). Pigment will return to normal in a few weeks to months.
Scarring is very rare (less than 2%) & occurs if scabs are formed. Keeping the treated area moist for one week can markedly reduce the rate of scabbing.
Do creams & chemical peels help?
No. Creams do not help because the cells of Ota are deep in the dermal layer of skin, in between collagen bundles. Creams can be useful as a pigment corrector post laser to reduce post inflammatory hyperpigmentation.
As with topicals, chemical peels are not used as they only penetrate to the upper dermal layers of skin. Pigment is below this level. Dermabrasion (very different from microdermabrasion) was used 40 to 50 years ago. It has been outdated for three decades.
How much does it cost to remove Ota nevus?
In Australia, Ota laser removal is partially covered by Medicare. Patients are out of pocket between $490 to $590. Private health insurance may provide a subsidy to overseas patients.
Davin’s Viewpoint on the Nevus of Ota
This, along with Cafe Au Lait Macules & Hori nevus accounts for the top three birthmark lesions I treat. Ota, much like Hori nevus, are much more common in ethnic-Asian skin types. Hori affects both sides of the face, Ota one. Ito is another form of latent or tardive-like dermal melanocytosis that has histological features of Ota.
The first step in any birthmark treatment is a diagnosis. Ota patients must see an ophthalmologist on a regular basis to exclude rises in intraocular pressure that can give rise to glaucoma.
My favoured treatment is with a pico laser. I did use Picosure 7 years ago, it can work, but it is very underpowered. My preference is the 1064 Picoway device. Pico lasers can give a faster initial clearance rate. Pico lasers provide less pain & a greater safety profile. The average patient requires 5-8 sessions, more with nano lasers. I space treatment intervals every 10-12 weeks. Procedure time ranges from 1 to 3 minutes, it is partially covered under Medicare.
Unlike other forms of pigmentation such as sunspots, lentigo, & melasma, once treated, Ota & Hori nevus do not recur (remaining cells can darken with UV exposure). Prognosis is excellent for this birthmark.
Join the conversation
Join Dr Davin Lim on Instagram to stay up to date