Port Wine Stains (Red Birthmark)

What are Port wine stains?








Port wine stains are birthmarks that are due to congenital malformation of the veins and capillaries of the skin.  Present at birth, they affect 0.3 to 0.5% of the population and can have significant psychological implications on the affected individual, especially if the face is affected. Port wine stains commonly occur on the face, but can occur anywhere on the body, and often affect large surface areas. The appearance of port wine stains, as the name suggests, are a reddish/purple colour, and raised nodules can form within the area. It has been proposed that there is a disturbed innervation to the blood supply of the area, and this often leads to the profound dark and nodular appearance of the affected area.

How are Port wine stains treated?

Port wine stains are best treated with lasers that are attracted to the haemoglobin (blood) present in the affected area. The first step of treatment, however, is an assessment to confirm the diagnosis, and to exclude any underlying medical problems. This is performed by our medical practitioners.  Port wine stains can often lead to increased pressure in the eye (glaucoma), or be a sign of an underlying medical problem (e.g. Sturge-Webber syndrome).

Once an appropriate assessment has been made, laser treatment can be performed. Often these are commenced in early childhood. Usually multiple treatments are required, and there is usually lightening of the port wine stain, but complete removal is often not possible. At The Victorian Cosmetic Institute, we treat only the adult population with port wine stains.

Traditionally, the pulsed dye laser has been the laser of choice for the treatment of port wine stains. It has a wavelength of 595nm and is highly attracted to the haemoglobin or the blood in the port wine stain. The heat energy from the laser is preferentially taken up by the port wine stain, and less energy is taken up by the normal skin, thus allowing for selective treatment of the port wine stain. This is a process is called selective photothermolysis.

More recently, port wine stains have also been treated with the 532nm and 1064nm wavelengths of the Gemini laser. The 532nm wavelength is the primary laser wavelength used in treatment of port wine stains. The Gemini laser emits a wavelength of  532nm that is highly attracted to haemoglobin or the blood in the Port wine stain. The 1064nm wavelength is also attracted to the haemoglobin in port wine stains, but not to such a high degree. It does however, penetrate very deeply which helps to compensate for the relatively lower attraction to haemoglobin. The Gemini laser in some studies has been shown to be able to treat port wine stains that are resistant to treatment with pulsed dye lasers (see link to journal article at bottom of page). The Gemini laser head also has a cooled-tip to chill the top surface of the skin, which reduces the damage to the surface layer of the skin as the laser passes through to target the abnormal vessels.

Port wine stain nodules may appear in the third to fourth decade of life. These can sometimes be treated with the Erbium laser to help flatten these lesions. 

Once again, port wine stains are very resistant to any laser treatments, and usually require multiple treatments. Complete fading is not always possible.

 

Video case study: Dr. Sara Read demonstrates the use of the Gemini laser on a patient with a port wine stain.







 

Case study 1

This is a male in his thirties who presents for treatment of his port wine stain. The Gemini laser was used to treat this condition, and the 532nm wavelength was used. The pictures illustrate the port wine stain before, immediately after laser treatment, and after 2 treatments with the gemini laser.








Port wine stains before after - after four treatments

 

Case study 2

This is a patient who presented to The Victorian Cosmetic Institute with a port wine stain covering her hand and arm. She has had a total of 12 treatments with the 532nm and 1064nm wavelengths on the Gemini laser between the pictured before and after photos.


Port wine case study 2 - before

Port wine case study 2 - after


What are the side effects of treatment?

The area treated may feel hot for a few hours and look sun burnt for a few days. Sometimes there is darkening of the Port wine stain initially, and this can take up to a week to fade. If normal skin is affected by the laser, a scab or blister may develop and this can take time to heal. Swelling usually occurs after port wine stain laser treatment, and this may take several days to subside. Darker skins are more affected by the laser than lighter or fairer skins. Scarring from this treatment is very rare.

What is the cost of treatment?

The cost to treat a Port wine stain can range from $165 to $600+ for larger treatments covering larger areas. There is an associated Medicare rebate associated with the treatment of Port wine stains and this rebate will also depend on the size of the Port wine stain. Medicare usually rebate 6 treatments per calendar year.

Also treatments that attract a Medicare rebate count towards the Medicare Safety Net. Once the threshold on the Medicare Safety Net is passed, 80% of the out-of-pocket fee is refunded to you by Medicare.

The following is an example of the Medicare Safety Net for the treatment of a port wine stain , once the threshold has been exceeded
.

 You Pay    

You receive from Medicare

 Medicare schedule fee           $117.05 

Rebate on schedule fee $117.05

 Doctor's additional charge    $377.95   

Safety Net rebate (80% of $377.95) $302.36

Total fee paid                        $495  

Total rebate $419.41



Therefore total out-of-pocket fee is $75.59* per session
 
* Please note that this example assumes that the Medicare Safety Net threshold has been exceeded. Also the threshold will vary for various individuals or families. Please check with Medicare if you have any uncertainties as to your potential rebates. 
The cost of treatment of Port wine stains with the Pulsed dye or Gemini laser depends on the size of the area affected. Again, there is a Medicare rebate associated with this treatment, and the amount of this rebate will also depend on the size of the area treated.

Why should I choose The Victorian Cosmetic Institute as my provider of laser treatments?

At The Victorian Cosmetic Institute, we have the latest laser equipment operated by specialist laser doctors. 

Our doctors are also highly experienced in laser treatments, and will be able to give you the best advice for your treatment.

The first step is simply contacting us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your laser treatment.  
 
Making that first phone call can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate. 
 
It's as easy as clicking either of the buttons below and completing the provided form. 
 
Otherwise, you can phone us directly on 1300 863 824.
  
 

Article Download - Laser Use in the Treatment of Port-Wine Stains

The following article discusses the outcomes of Laser Use in the treatment of Port-Wine Stains.
Click here to download and view.


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