All laser treatments are performed in our laser suites at Cutis Clinic or Cutis Medical, located in Taringa- just 10 minutes from Brisbane’s CBD. On average it takes me 10 minutes to perform a treatment. Small port wine stains may only take 30 to 60 seconds to treat.

This is very difficult to say, however most patients will require between 5-10 sessions. Sometimes up to 15 sessions are needed. You will see a fading after one or two treatments.

The number of laser sessions will depend on the following factors-

• Age of port wine stain- older lesions will need more sessions are they are thicker
• Thickness of PWS- thick lesions may require me to use another laser that penetrates deeper into the skin.
• The location of your Port Wine Stain- PWS on the face responds best, whilst PWS on the hands and feet take the most treatments
• Size of your PWS- smaller lesions are much easier to remove than larger ones
• Skin colour of the patient- the fairer you are the less treatments needed
• Treatment intervals – should be every 4-10 weeks apart

As a rule over 90% of PWS will respond to laser.

90% of patients can expect improvement with laser treatment.

• 10-20% will be completely removed without scarring
• 80% will have 50% or greater improvement with laser
• 10% will have no response

Fair skin patients will improve faster compared to ethnic skin types.

Yes. (Sorry, but that is the truth). This is because the power setting of the laser has to be very high to achieve bruising. If you bruise, your PWS will improve. The question now arises as to how to decrease the pain.

These are some methods I use to treat PWS and to make this treatment less painful-

1. I use a laser with the dynamic cooling system that cools the skin and eases pain. A cold spray both protects your skin, but also distracts you from the laser beam.
2. Pre-chill the area with ice before laser.
3. Laughing gas before laser
4. A strong numbing cream applied 30 minutes before laser can decrease pain by up to 80%
5. Sedation prior to laser- especially if I am performing treatment to large areas of port wine stains.

After laser you will be required to ice the area for at least 10 minutes per hour for the remainder of the day. This reduces swelling, pain and bruising.

Much like surgery, laser for your port wine stain will need to undergo a healing process over a week to 10 days.

Straight after laser: You will experience swelling and bruising. I bruise all my PWS patients because a ‘prupuric’ or bruising setting has been scientifically shown to be the best. Ice packs to the area will help reduce swelling, and aid in recovery. You should use ice for 10-15 min on per hour for the first 24 hours post laser. Prior to laser you should avoid fish oil, asprin and anti-inflammatory medications. You can recommence these meds after laser.

Day 2-7: Swelling will decrease over 48-72 hours, as well as the intensity of bruising. You should use a bland moisturiser such as aqueous cream during the healing up stage. Blisters should not form (however may occur in ‘thin skin’ areas such as the eyelids). I normally prescribe an antibiotic ointment such as Chlorsig if I expect blistering- I will inform you prior to laser.

Day 7 to week 3: Swelling, and bruising will subside. In some cases bruising  may take up to 10 days to completely fade. Your skin should not peel now, and you may notice that your PWS will start to fade (maximal fading maybe seen 2-3 months after the laser). This is the time whereby delayed side effects such as skin colour changes may occur. It is vital you stay out of the sun, wear hats, and sunscreen- especially important if the PWS is located on your face.

Week 4- week 8: Sun protection should be carried out throughout your treatment – towards week 8 you will notice that your birthmark will continue to fade this is called the delayed ‘inflammatory cascade’ that causes the blood vessels to shrink even more.

Expected effects: These can be considered as normal and part of the healing process. Expect a mild degree of post laser pain (controlled with ice and anti-inflammatory tabs/ panandol), also expect bruising. This occurs in 100% of patients that I treat. Bruising subsides within a week.

Uncommon side effects: These occur in less than 10% of patients and include the following-blistering. This occurs in areas such as the eyelids. The use of an antibiotic ointment can aid in healing, and prevent infection. Skin colour changes such as darkening or lightening of the skin can be seen after laser. Most commonly darkening of the top layer of the skin can be seen in ethnic skin types, or if you expose the treated areas to sun.

IPL or intense pulse light can be used to treat birthmarks but lasers are better. This is because lasers are much more specific in their target. IPL does not have the energy needed to deliver optimal results. Another important difference is that skin cooling from IPL devices are not optional in the context of treating birthmarks. Additionally Medicare does not recognise IPL as a treatment for birthmarks, and a rebate does not apply if IPL is used.

IPL can fade red marks such as blood vessels and rosacea, however for red birthmarks, lasers are by far the best treatment.

IPL should never be used to treat brown birthmarks because the energy pulse delivered by IPL is too long, and the machines do not have enough power to break up pigment.  Q Switch lasers are used to treat brown birthmarks. Birthmark treatments should always be conducted by Specialists.

Brown birthmarks are much more complex to explain and to categorise compared to red birthmarks. A diagnosis is essential, as this will give an accurate prognosis as to how well they respond to laser.

The most common brown birth marks are-

• Café au lait macules – this is the most common brown birthmark. They are flat and light brown in colour, and most commonly occur on the trunk and limbs.
• Congenital naevi or moles at birth- these are darker in colour, and maybe present at birth or tardive (present shortly after birth). They are usually slightly raised.
• Epidermal naevi – these are brown bumpy birth marks that appear to have a shape to them, often as line. They are common on the head and face and tend to grow bigger during teenage years.
• Sebaceous naevi – these are yellowish in colour and commonly found on the face and scalp, again growing in size during teenage years.
• Becker’s naevi – very common. More so in males. They appear as slightly raised birthmarks with excess hair. They tend to increase in size during puberty. They do not respond well to any treatments.
• Naevus of Ota – blue to dark brown marks around the eyes. This birth mark lies in the depths of the skin layers.

As I reinforced throughout this page, brown marks are much harder to treat than red birthmarks, with the exception of CALM birthmarks. A diagnosis is essential as this will give you an accurate probably of success or failure in treating these lesions. My treatment philosophy is that I only treat birthmarks that have a HIGH probability of success, this is purely based on ethics.

The Q Switch laser is the laser of choice for brown birth marks- here are some percentages based upon scientific literature –

• Café au lait macules- just over 50% respond to Q switch laser, 50% recur over time. May need 3-5 treatments. Test spot need.
• Epidermal and sebaceous naevi- I frequently treat these birthmarks. If small, best excised. If large I use a curette with a laser to flatten. I also use vitamin A after the procedure to help with remission. Laser will need to be repeated every 18 to 36 months to re-flatten the lesions as recurrence is the rule.
• Becker’s naevi- very hard to treat. I can reduce the hair growth with a 755 or 1064 laser, but multiple treatments with Q Switch and Fractional lasers will yield only a mild flattening and fading of the patch. I discourage treatment.
• Naevus of Ota- 1064 Nd yag laser- multiple treatments needed, internal eye shields needed with each treatment. Test spots are needed prior to treatment. Good success rate.

The good news is that Medicare subsidises laser treatments for birthmarks. Up to 6 sessions are subsidised per year and most patients will reach the safety net threshold after a few treatments. Once this is reached, Medicare pays for up to 80% of the out of pocket expenses.

The cost of laser will depend on the type of laser used and the area treated. As a guide –

Each treatment costs between $690- $890 dollars, inclusive of anaesthetic and theatre costs*. Rebate varies according to size of lesion.

*All birthmark laser therapy is conducted in our Specialist Laser and Operating suites at Cutis Dermatology

I cannot stress the importance of a diagnosis and careful examination before birthmarks are lasered. The strengths of your success will be determined on the factors discussed- namely the type of birthmark (red vs brown), the location, depth, size and also your skin colour. Birthmarks may fade within 2 treatments conversely some birthmarks may take up to 15 sessions to fade. Hence careful planning and a discussion is needed prior to treatment.

Consider the following before embarking on birthmark removal –

Motivation for removal: Removing a birthmark may take many treatments, over months, and in some brown birthmarks years. Treatment sessions vary from 2-3 laser sessions for small red birthmarks, to 15 sessions for large birthmarks or brown colours. Rest assured I use the best lasers to achieve results, but you must be motivated to attend appointments and understand the downtime following treatment.

Time off and sick leave: Most laser treatments will be associated with swelling and bruising for a week. In some cases such as birthmark removal on your eyelids, you may not be able to work for a few days. Removing birthmarks is a medical procedure, and sick leave will be granted depending on what to expect after treatment. Each patient will be different.

Preventing pain: Laser treatment is painful, and I do not provide sedation for children under the age of 12. The new Children’s Hospital can provide treatment under sedation. The laser unit is staffed by consultant dermatologists.

Adult and teenage patients can be treated safely with sedation using inhalers making treatment well tolerated. Pain management is thus not an issue for teenage and adult patients.

Costs: costing can be an issue, however the Medicare Safety Net ensure that treatment can be affordable. Up to 6 laser sessions are subsidised per annum.