Laser Services: Treatment of Red and Brown Lesions, Scars, Stretch Marks, and Tattoos

New, state-of-the-art lasers have revolutionized our approach to the treatment of a wide variety of skin disorders including pigmentation, freckles, brown spots commonly referred to as age or liver spots, and tattoos. Lasers are often the treatment of choice to remove ‘broken blood vessels’, spider veins, leg veins, and port wine stain birthmarks as well as redness within hypertrophic scars and stretch marks. All of these lesions can be treated with various lasers which either target pigment or hemoglobin (a component of blood).

Laser Therapy for Redness

How do Lasers and Light Sources Work to Remove Redness from Vascular Lesions, Stretch Marks, and Scars?

Pulsed dye lasers (Vbeam), long pulsed Nd-Yag lasers, and Intense Pulsed Light can be used to improve the appearance of red lesions.  These lasers and light sources produce a bright beam of light to selectively destroy the blood vessels that make up the vascular lesions or that are contained within the scar or stretch mark, without damaging the surrounding tissues. Factors such as the type of vascular lesion, age, color, and the location on the body determine whether the lesions can be removed.

Rosacea is a very common dermatologic disorder in which dilated blood vessels are prominent on the cheeks, nose, and chin resulting in an overall hue of facial redness.   Most patients have tried numerous topical creams to diminish the redness, however most are found to be ineffective.   The pulsed dye laser (Vbeam) and Intense Pulsed Light treatments can significantly improve this very common skin condition.  Similarly, sun damage induces an increased number of dilated blood vessels in sun exposed areas such as the face, neck and chest.  The Vbeam laser, as well as IPL are superb at evening the skin tone.

Leg veins, often referred to as spider veins can be treated with Sclerotherapy or Laser therapy. The long pulsed Nd:Yag laser works well on small diameter isolated vessels on the legs.  The laser light goes through the skin, targets the blood in the blood vessels, and heats the vessels causing them to collapse.  The body clears the vessels over 3-4 treatment sessions.

Red to purple hues within burn/surgical/traumatic scars and stretch marks can be dramatically improved with laser therapy. The pulsed dye laser (Vbeam) is excellent at reducing excess, dilated blood vessels within scars and stretch marks.  Similarly, cherry angiomas, Port Wine Stains, Hemangiomas, and other vascular lesions can be treated with vascular lasers.

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What Does it Feel Like?

You may experience mild discomfort similar to being snapped by a rubber band.  Treatment may require three to four sessions with each session taking between 15 and 30 minutes.

How Will I Look After and Care for the Treated Area?

In most cases you will be given an ice pack to apply to the treated area immediately after treatment.  We recommend that you apply ice or a cold pack to the treated area for the rest of the day.  Most treatments result in redness, similar to the appearance of a slapped cheek that lasts several hours and occasionally a day or two. Swelling may develop shortly after treatment. It usually clears after 2 to 4 days. Most patients can return to work 2 days following the  treatment. Pulsed dye laser treatment rarely leaves a bruise that lasts five to ten days. Dr. Daniels will discuss this possibility with you in advance of treatment. The laser treatment can be modified should you not wish any bruising to occur, however doing this may increase the total number of treatments needed. A water-based makeup may be gently applied as a cover-up, provided that there is no crust formation on the skin’s surface.

Removal of Pigmented Lesions

Short pulsed Nd:YAG and Alexandrite lasers as well as Intense Pulsed Light are used to lighten or remove a variety of dark skin spots. These lasers produce a very bright beam of light that destroys the cells containing pigment, with very little damage to surrounding skin.

These lasers are used to remove pigmented sunburn freckles (solar lentigines), flat brown spots (macular seborrheic keratoses) on the face, hands/forearms, chest, cafe-au-lait birthmarks, blue-grey birthmarks on the face (nevus of Ota), and tattoos.

The number of laser treatments depends on the location and depth of the pigment. For small brown spots, two to three treatments may be needed. Tattoos, birthmarks and Nevus of Ota require multiple sessions.

Tattoo ink varies in color and the laser devices used to remove the ink vary as well.  Each ink color has a corresponding wavelength of laser light that is attracted to it.  The laser light goes through the skin, is attracted to the ink of the tattoo, blasts the ink into tiny particles, and the body clears the ink slowly over time.  It will take multiple treatment sessions to clear the tattoo.  There are some tattoos that can be dramatically lightened but cannot be removed completely.  Green ink is particularly difficult to remove.  The risks associated with tattoo removal include incomplete removal of ink, hypopigmentation, hyperpigmentation, and rarely scarring.

How Will I Look, Feel, and Care for the Treated Area?

Immediately after the treatment there will be a whitish-gray hue to the treated areas.  In addition, the surrounding skin will be pink and slightly swollen.  The treated freckles or sun spots will turn darker brown and form a light crust.  This generally clears in one week. Wash the area with a mild soap and gently pat dry, then apply Aquaphor Healing Ointment multiple times daily until healing is complete. Crusts will fall off on their own during the first week after treatment. Water-based makeup can be gently applied as a cover-up.  After tattoo treatment, the treated area will look whitish-gray and will be pink, swollen, with or without pin point bleeding.  It is important to keep the area clean and covered with aquaphor (Vaseline) and a bandage until all crusting resolves.  It can take two weeks or more for the treated area to heal.

Comfort Control

For most procedures, the discomfort is so minimal that no anesthesia or pain medication is needed. For some treatments, such as tattoo removal, a topical anesthetic cream along with local anesthesia may be used before laser treatment. Following the procedure, ice and Tylenol will soothe any discomfort. It is best not to use aspirin, Advil® or Motrin® prior to or for a few days following treatment. Strenuous exercise and contact sports should be avoided, and alcohol intake limited.  Avoiding the sun, using sunscreen, and wearing cover-up clothing are critical, both prior to and after treatment. Following the procedure, you will receive specific instructions on the care of the treated area.

Side Effects and Safety

There are rarely any permanent problems with laser therapy. Occasionally some lightening of the skin occurs. Normal skin color returns within three months after treatment of vascular lesions. Although rare, a slight depression may develop, which usually resolves in a few months. Scarring occurs in less than one-tenth of one percent of all cases. Because lasers produce an intense bright beam of light, everyone in the treatment room wears protective eyewear.