Hemangiomas – Laser Treatment
Since the effective depth of penetration of a pulsed dye laser (PDL) is minimal, laser is only appropriate for the superficial hemangiomas or the superficial component of a compound lesion. We prefer early treatment since early elimination of the hemangioma will allow collagen to regenerate and the skin texture will be more normal.
Sometimes after hemangioma involution, there will be persistent telangiectasias (fine capillaries). These respond well to diode laser treatment.
At some centers, a Nd:YAG (Neodynium doped: yttrium, aluminum, garnet) laser is used to treat the surface as well as the deep component. In the right hands, this can be effective. However, the injudicious use of interstitial treatment with a Nd:YAG laser can result in significant complications. The standard of care for hemangiomas still remains a pulsed dye laser. Several other lasers are used from time to time but unfortunately these appear to carry a higher risk of scarring. While in experienced hands this may not be so, we typically do not recommend these other lasers.
After involution, any atrophic scarring left behind by an hemangioma can be improved with CO2 fraxel laser (dermabrasion). This laser essentially drills tiny holes into the dermis to stimulate collagen formation and organization.