Port Wine - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Port Wine or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Port Wine Stains Philadelphia and Mainline Pa
Treatments: PDL, Nd:YAG, KTP
These birthmarks present as wine-colored areas on the skin with or without swelling. They gradually enlarge for the first year of life and do not regress.
Laser treatment is possible at any age, yet the newer the birthmark, the more likely it is to completely eradicate the unpleasant color. Many treatments are often necessary to achieve results, and bruising can be expected with each treatment.
With darker skin types there may be a chance of lighter-color skin remaining at the site of the original birthmark. Scarring is extremely rare.
I am interested in getting treatment for a port-wine birthmark on my face and would like to know how to go about doing it.
Port wine birthmarks can be effectively treated by laser without leaving a scar. Our treatment causes only minimal discomfort but numbing cream can be applied prior to the procedure.
The earlier in life a port wine birthmark is treated, the fewer treatments are needed. However, recurrence even after complete clinical resolution in adults is possible but treatment can be repeated.
Many insurance plans cover laser treatments for port wine birthmarks in noticeable locations and we assist in obtaining pre-certification.
What type of PDL laser do you have for treating port wine stains (e.g., pulse width, wavelength, cooling device)? Thanks.
We are using Candela VBeam Perfecta for treating port wine stains. Look at http://www.candelalaser.com/products/vbeam/vbeamBP1.pdf for full specification of that laser.
My daughter has been undergoing pulse dye laser treatments for nearly 16 years(since she was 6 months old)for a portwine stain extending from her back to her foot on her right leg. Her first Dr. passed away a few years ago and the practice was purchased by another dermatologist. I am not noticing any significant change in her Portwine since the new Dr. started treating her and thought perhaps it is time to get a second opinion on whether any more can be done for her. Is there ever a point where nothing more can be done? Her Right foot is a 1/2 size bigger than her left and I am “afraid” it will change even more if we don’t continue with something. On the other hand, I am not willing to put her through the discomfort of laser if it is no longer capable of working.
Please advise.
Thanks so much,
The description of you daughters leg raises the possibility of Klippel Trenauney Weber syndrome, a condition where port wine stains are present over areas of deeper venous malformations, which leads to a greater size of the affected limb compared to the unaffected. Pulsed dye laser treatment can unfortunately only treat the superficial capillary malformation, the port wine stain, but fails to reach the deeper venous malformation. Typically compression garments are recommended when deeper venous malformations are present that lead to increase limb size.
There are two possibilities that can cause the failure to incompletely resolve the port wine stain in Klippel Trenauney Weber syndrome: First, the laser settings are inadequate or second, treatment may have come to a standstill because the underlying venous malformations do not allow complete resolution of the overlying capillary changes. Considering the length of time your daughter has received treatment, I have to favor the latter.
Everything is very open with a clear explanation of the issues.
It was really informative. Your website is extremely helpful.
Thanks for sharing!
I would finally like to get treated for my port wine stain with the most current treatment available, is there anywhere close to Joplin, Mo to have laser treatments done by an experienced Dr?
The easiest is to go on the website of the American Academy of Dermatology at http://www.aad.org and type in your zip code in the physician locator.
You can contact the dermatologists closest to you by calling their offices or visiting their websites to find out if they use a pulsed dye laser to treat port wine stains. Pulsed dye lasers are the gold standard for treatment of port wine stains. They make them go away after several treatment sessions. When treated in adulthood, port wine stains can come back partially after several years but they can be retreated using the same laser.
I have port wine stain splattered down my left arm from shoulder to fingers. I have been dealing with this for 26 years now and I have finally reached the point in my life where I am absolutely sick of wearing long sleeved shirts and sweaters out in public and at work all year round. I was unaware that insurance will cover the laser treatments, had I known that I probably would have looked into this sooner. I have definitely been psychologically affected by this my whole life. The few times in my life where I find the nerve to actually go out in public without a sweater, total strangers come up to me and ask what happened to my arm? was I in a fire? is it poison ivy? does my boyfriend beat me? not to mention the eyes I feel staring all the time from the people who kindly say nothing. what I want to know is how do I go about finding out if my insurance covers the procedure? I have Aetna and live right outside of Philadelphia, PA. I want to get this done as soon as possible. I was weeks away from starting a sleeve of tattoo’s to cover it up, although it would totally conflict with my career. It has destroyed my confidence and I am ready to be more than just the girl with the birthmark holding her back!
Pulsed dye laser treatments of port wine stains are extremely effective. It can take 4-6 treatments 4-6 weekly intervals to sufficiently remove a port wine stain on the arm. Occasionally, part of the port wine stain may return after several years and may be treated again. Aetna covers laser treatment of port wine stains that are located on the face and neck. Please see their “clinical policy bulletin Pulsed Dye Laser Treatment Number: 0559”
http://www.aetna.com/cpb/medical/data/500_599/0559.html. Coverage may vary amongst insurance companies. If your insurance does not cover treatment, we will be happy to evaluate you and work with you on pricing.
Hi, I am 26 and have been thinking of having my port wine stain removed for the past 10 years but have not been able to do so do to having small children. However I am at the point where it bothers me everyday just to drop my son off at kindergarten or go on school outings with my children. I also am asked if I need domestic violence help every time I go to a new doctor or am having a child. The outrageous things that people as me that happen. I have Gateway insurance and would love to have it removed since it covers 50% of my face and has now caused glaucoma in my right eye. if you could help or if you work with my insurance I would love the opportunity to schedule an appointment at your office to have this removed from my face.
Thank You,
Jacqueline
Port wine stains can be efficiently treated with pulsed dye laser. It takes several sessions to undo the birthmark. When treated in adulthood, it is possible that years down the road some or all of the birthmark returns but it can be treated again. Laser treatment of the skin will unfortunately not reverse the glaucoma. Most insurance companies cover treatment of port wine stains when they involve the face. This is something that we will be able to check for you after your consultation.
My daughter has a port wine stain (hemangioma) on her face. It’s not a large, dark port wine stain, it’s more a reddening near and around her eye, cheek, and nose. She has had laser treatments for years (since she has been a year old) but it’s still very prominent. She’s now 10 yrs. old and very self conscious if it.
We tried Dermablend make up, but it looks very “cakey.”
Last time she had a treatment she was burned and now has a scar. 🙁
Do you recommend another treatment option? A different laser?
I keep reading that some birthmarks are being treated and going away in a LOT fewer treatments than my daughter has had. Why isn’t hers going away or being diminished significantly? Thoughts?
Some port wine stains may have a component that is deeper than an external laser can reach and then treatment can be very challenging. While embolization of deeper vessels may be an option elsewhere on the body, in the area around the eye it may not be a safe option. I recommend that you discuss imaging studies with your pediatrician to learn if a deeper component is the culprit for the slow response to treatment. Depending on the findings, an interventional radiologist versed in embolizations may be consulted to see if other measures can be taken.
about how much will it cost to have a port wine stain birthmark removed from the low back of a 16 year old girl? maybe the size of her hand? a few scattered irregular shapes?
Do you think insurance will cover it? We have a $3000 deductible for individual.
Thanks!
Port wine stain removal takes between 8-12 treatments every 4-6 weeks. The outcome can be enhanced by simultaneous treatment with laser and a topical medication. Some insurances cover port wine stain treatment in visible areas on the face. Very few insurances cover the treatment on the trunk but you should check with member services of your insurance using ICD9 757.32 and CPT code 17108. If your insurance does not cover the treatment, we charge $350 per treatment. Please note that this fee is substantially less than what an insurance company would allow for the same treatment. With your current deductible per individual, about 4-6 treatments would go through insurance but paid by you as the deductible and any additional treatment would be covered by your insurance (unless you had a coinsurance after meeting the deductible). Please calculate what may be best for you.
Good morning, I have a question about treating small hemangiomas that are scattered over my body. About 10yrs ago I had them treat with the V beam laser and gone with one zap. Is this still the recommended treatment for them and if so, can you tell me how much it may cost to have some of them zapped.
Pulsed Dye laser treatment (Vbeam perfecta) is still state of the art treatment for cherry angiomas. The flat ones will always disappear 10 days after the treatment. The elevated ones will take more than one treatment. Pricing depends on the number of cherry angiomas. At this time, the first angioma on each treatment days is $105 and any additional are $20.
Can you reverse poikiladerma of civatte? How would you treat this?
Reversal of poikiloderma is performed with pigment correcting lasers such as pulsed dye laser and alexandrite laser. We see great results when the overlying component is red and not as good results when it is predominantly brown.