Laser surgery for birthmarks

Birthmarks are patches of coloured skin that are formed before birth or shortly after. They can appear anywhere on the body and face, and can change size and shape as the body grows. While in most cases harmless, they may be a cause of cosmetic concern that patients may want removed later in life. In this article, a consultant dermatologist provides insight into how laser surgery can be performed to remove birthmarks.

What are birthmarks? 

There are two groups of birthmarks: vascular birthmarks, which are formed by clusters of irregular blood vessels underneath the skin, and pigmented birthmarks, which are clusters of pigment cells – called melanocytes or nevus cells. Most birthmarks are permanent without intervention, but they may change over time to appear lighter or faded.

Common birthmark types include:

• Café au lait spots: flat and without texture patches of skin that are a few shades darker than the rest of the skin tone- They are permanent and my increase in quantity or size over time.
• Nevus of Ota: darker patches, appearing as grey, blue, brown, or black on the face originating from nevus cells deep within the skin.
• Port-wine stains: vascular birthmarks that look red or wine-coloured. The skin of these birthmarks may be thicker or textured.
• Salmon patches: a common type of birthmark that is flat, red or pinkish without a distinctive border. Some are not obvious and may only be noticeable in certain circumstances, such as a change of temperature.
• Haemangioma: raised, bright red or purple spot that is typically soft and compressible to the touch.

Though birthmarks are largely safe, some birthmarks may potentially develop into cancerous tissue due to abnormal melanocyte behaviour, which makes removal preventive. Some birthmarks, like nevi of Ota, can contribute to vision problems. In most cases, removal is pursued by the patient for self-image and aesthetic reasons.

How can birthmarks be removed?

There are several approaches to birthmark removal – such as corticosteroids and traditional surgery – but laser surgery is an option that most patients prefer due to being minimally invasive and a shorter course of treatment with little-to-no downtime or pain. The laser beams target the pigment cells or irregular blood vessel clusters directly, breaking them down for the body to absorb gradually (similar to how laser tattoo removal works). The birthmark will lighten and fade away over the next few weeks, but patients can return to normal activities almost immediately after treatment, though there may be some redness and slight swelling in the treatment area.

Each session is short, no longer than 30 minutes, and patients are expected to feel only slight discomfort during, with the skin protected by numbing cream. Multiple sessions are typically needed to completely remove the birthmark, and some birthmarks may be resistant to treatment, leaving behind a faint impression rather than complete removal.

Are there risks with laser birthmark surgery?

While a highly effective treatment, patients should be aware of the risks, however minimal they may be:

• Stinging sensation during treatment
• Redness and swelling for the first few days after treatment
• Scabbing and bleeding (more likely for stronger lasers or bigger, darker birthmarks)
• Scarring (rare)
• Infection