EL-ROUBY-CLINIC

Birthmark Removal (Pigmented and Vascular Malformations)

What is the Birthmark?

A birthmark is a splotch on the skin formed before birth, which can appear in a variety of colors, shapes and sizes. An one per 10 babies have a vascular birthmark. They are part of the group of skin lesions known as nevi or naevi. Mole is a non-specific term for nevus, which is a pigmented skin spot.
The exact cause of most birthmarks is unknown, but vascular birthmarks are not hereditary and a lot of people have them.
They are soft raised swellings on the skin, often with a bright red surface, and some may look a bit like a strawberry. They are also known as "strawberry naevi" or as "infantile hemangioma". They appear after birth, usually in the first month, and can occur anywhere on the skin. They are more of a problem when they affect the face.

They are a benign overgrowth of blood vessels in the skin. They are particularly common in premature babies. Strawberry marks are not a sign of ill health, nor associated with cancer. However, in some cases, certain types of birthmarks can become a health risk.

While some birthmarks are small and inconspicuous, others have a more prominent appearance, which can be bothersome to some, and can even lower their self-esteem.
Some birthmarks do fade or completely disappear over time, however, there are others that will never fade or go away. Birthmark removal offers a solution to people who are self-conscious about their appearance and even help reduce the possibility of health risks associated with certain moles.

With the increasing popularity of various cosmetic surgery procedures, including birthmark removal procedure, it is imperative that the prospective patient research and understand different issues like what the procedure can and cannot treat, inherent risks, costs, and so on. Keep in mind, cosmetic surgery is just that – a surgical procedure whose results cannot simply be erased. When considering any form of cosmetic surgery, it is important to have a good understanding of the procedure before making a decision. Take some time to view the introductory information we have provided on birthmark removal. While the information contained in this website will provide you with a basic understanding of the procedure, it may not answer all of your questions. To get complete answers to the questions you are seeking, we recommend that you contact us.

Types of Birthmarks:
A number of different types of birthmarks are known that include, but are not limited to, stork bites, Mongolian blue spots, strawberry marks, café au lait spots, congenital melanocytic nevi, and port-wine stains. The most common types are:

- Pigmentation-type birthmarks:
These can include various types of birthmarks including moles (congenital nevi), Coffee-cream spots, and Mongolian spots.
While most moles pose no health risks, some large nevi may have cancerous effects later on during one’s life.
Coffee-cream spots are caused by too much pigment in the skin. They do not fade away, but do not require treatment.
Mongolian spots are flat, slate blue-grey patches commonly found in children. These birthmarks usually disappear when children reach school age.

Café au lait spot:
While these birthmarks may occur anywhere on the body, they are most commonly oval in shape and light brown, or milk coffee, in color. These birthmarks may be present at birth, or appear in early childhood, and do not fade with age. One to two patches is common; however, more than four patches may be an indication of neurofibromatosis disease.
Congenital melanocytic nevus:
Congenital melanocytic nevus is a type of melanocytic nevus (or mole) found in infants at birth. Occurring in about 1% of infants, it is located in the area of the head and neck 15% of the time, but may occur anywhere on the body. It may appear as light brown in fair-skinned people, to almost black in darker-skinned people. Coming in a variety of sizes and appearances, they may be irregular in shape and flat, or raised and lumpy in appearance and feel.
Mongolian blue spot:
A Mongolian blue spot is a benign flat congenital birthmark with wavy borders and irregular shape, most common among East Asians, and named after Mongolians. Authentic Mongolian blue spots do not disappear before puberty, and last well into adulthood. The most common color is blue, although they can be blue-gray, blue-black or even deep brown.
The Mongolian spot is a congenital developmental condition involving the skin. The blue color is caused by melanocytes, melanin-containing cells, which are deep under the skin. Usually, as multiple spots or one large patch, it covers one or more of the lower back area, the buttocks, flanks, and shoulders. It results from the entrapment of melanocytes in the dermis during their migration from the neural crest to the epidermis during embryonic development.
Port-wine stain, or Nevus flammeus:
Port-wine stain is visible on the head of Mikhail Gorbachev. Port-wine stains are present at birth and range from a pale pink in color, to a deep wine-red. Irregular in appearance, they are usually quite large, and caused by a deficiency or absence in the nerve supply to blood vessels. This causes the blood vessels to dilate, and blood to pool or collect in the affected area. Over time, port-wine stains may become thick or develop small ridges or bumps, and do not fade with age.
Port-wine stains occur in 0.3% of the population, equally among males and females. Often on the face, marks on the upper eyelid or forehead may be indicative of a condition called Sturge-Weber syndrome. Additionally, port-wine stains in these locations may be associated with glaucoma and seizures.
Macular stains (salmon patches, Stork bite, or Telangiectatic nevus):
These are very thin, light pink, flat patches of discoloration. These are usually found on babies, either on the back of their neck, or on their upper eyelids.
Most of the salmon patches on the eyelids disappear during the child’s first year, while most of the ones found on the neck do not.

- Vascular Birthmarks:
These are caused by abnormal development of blood vessels and are almost always present from birth. There are essentially two very different type of vascular birth marks:
• Vascular Malformations
• Hemangiomas

• Vascular Malformations
Vascular malformations are benign (non-cancerous) lesions. Unlike hemangiomas, vascular malformations do not have a rapid growth cycle followed by regression. They continue to grow throughout life. Types of vascular malformations include:

• Port Wine Stains
• Venous Malformations:
Often confused with a hemangioma, these malformations will always grow, are soft to the touch, and the color disappears when compressed. Most commonly found on the jaw, cheek, tongue, and lips. These lesions have low blood flow and can sometimes be injected or sclerosed.
• Lymphatic Malformations:
Formed when excess fluid accumulates within the lymphatic vessels. Lymphatic malformations are very difficult to treat but newer injection therapies are available.
• Arteriovenous Malformations:
Arteriovenous Malformations are always present at birth but are usually not noticed until later in life. Sometimes they do not appear until adulthood. As the lesion ages, the vessels enlarge and thicken to compensate for the increased blood supply. There are two grades: low and high.
  - Low grade grow slowly with the child.
  - High grade expand rapidly, growing faster than the child until the lesion may eventually become life threatening.
An AV-malformation is a firm mass. Common sites are the lips and other head and neck areas.
Mixed malformations include a combination of two or more vascular lesions.

• Hemangioma:
These are lesions that develop on infants within two to four weeks after birth. These are caused by many tiny blood vessels that are bunched together and can grow quite rapidly during the child’s first six to nine months.
These are the most common tumors found in babies and usually develop around the head and neck. Some hemangioma will grow on internal organs, like the stomach, liver, intestines, or kidneys. This can be identified with discolorations in the skin.
Some disappear within a few months after birth, while most take years before they disappear or fade.

Who would be an Ideal Candidate for Birthmark Removal?
People who feel their birthmarks may cause risks to their health constitute as qualified candidates for the procedure, as would those who are bothered by the appearance of birthmarks.
Undergoing birthmark removal can help enhance one’s appearance and possibly provide a boost to one’s self-esteem. However, one must remember that cosmetic surgery is meant for improvement, not perfection. It is important to have realistic goals and expectations when considering birthmark removal.

Where do I begin?
During the consultation visit, we discuss issues such as reasons for wanting the procedure, desired outcome, various options available, a detailed description of the procedure itself, the risks, limitations, and benefits.
We will provide information about anesthesia options, the location and description of where the procedure will be done – in a hospital or office surgical suite – and associated costs. The patient’s medical history is taken, and the area to be treated is examined.

How is Birthmark Removal Performed?
There are different ways that a birthmark can be removed, depending upon its type, size, location and other factors.

- Steroid Treatment:
This can be an oral medication or injected
- Laser therapy:
Lasers are used to treat birthmarks that are close to the surface of the skin, such as port-wine stains. This method can be performed at any age.
During treatment, short bursts of laser light are aimed at the birthmark in order to shrink it or cause it to stop growing. Multiple visits may be necessary to achieve optimal results.
Laser therapy may also be used for hemangioma, however it is not used to treat cases where it is found on an internal organ, or deep within the skin.

- Surgery:
This method is used when other non-surgical treatments have not worked. A hemangioma that is large, or found on an internal organ also requires surgery and general anesthesia.

- Radiology Treatment:
For embolization or sclerosis
- Combined Treatment:
Combinations of the above methods .

N.B.: Sometimes, medication is enough to treat certain types of birthmarks.

How Much Pain is Associated with Birthmark Removal?
This depends upon the type of procedure used. For laser therapy, patients may feel mild pain, like a rubber band snapping at the skin. Some experience a transient, mild burning sensation. An anesthetic may be given to those people sensitive to pain.

What should be expected after undergoing Birthmark Removal?
After undergoing laser therapy, the treated skin becomes dark purple. This should only last about seven to ten days and disappear soon after. However in some cases, it can take six to eight weeks for the purple area to completely disappear.

Following treatment, it is recommended that patients do not scratch the treated area.
It is also important to stay out of the sun while healing. When in the sun, patients should use sunscreen.
The healing process takes about six weeks after treatment; during that time, the results of the procedure should become more evident.
For children that undergo a birthmark removal, parents should make sure they follow the doctor’s instructions.

What Are the Risks of Birthmark Removal?
Surgical removal of birthmarks carries the same risks associated with any surgical procedure. This includes bleeding, infection and scarring.
If a scar is left, other treatments like skin grafts may be used to correct this condition. This also applies to large hemangiomas removed from the body.
If general anesthesia is used, an allergic reaction to the anesthesia is also a risk.

What Are The Typical Costs Associated With Birthmark Removal?
The costs for birthmark removal vary depending on the method used and the size of the area to be treated. Estimated costs for birthmark removal can range anywhere from 400 - 500 U.S. dollars (LASER treatment) or from 1000 - 1500 U.S. dollars (Surgical treatment).

Frequently asked questions from patients when considering undergoing Birthmark Removal?!

Q - What is the type of anesthesia, and when I can return to normal life?
A - According to your preference and the procedures. General anesthesia or Local anesthesia with sedation, and you can practice your normal life 2 hours (LASER treatment) up to few weeks (Surgical treatment).

Q - What are the symptoms that may occur in the first five days after LASER Birthmark removal procedures?
A - Soreness which could be managed by pain killer’s medications and there may be edema or swelling of the face.

Q - What are the guarantees that the success of the process?
A - There is no doubt that the followers of the medical instructions and close follow up visits are the main factors for the success of any surgical procedure. If not, the process to achieve the agreed outcomes before, the process repeats at reduced cost. The procedure may needs refine touch after 2 weeks.

Q - When can we get the final results?
A - The final results is achieved after the first three weeks.

Q - What is ideal age for birthmark removal?
A - It could be done at any age after 2 years.

Q - If you are not Egyptian, What is the minimum period for follow up?
A - Five days.

Q - What are the contraindications of the procedures?
A - There are no absolute contraindications but the patients should inform their surgeons about any allergies, serious medical conditions, and medications they may be taking.

Q - Where will the Birthmark removal procedures be performed?
A - In hospital (Surgical treatment) or may be in outpatient bases (clinic) (LASER treatment).

Q - How much does LASER / Surgical procedure cost and what elements factor into that cost like hospital fees, anesthesia, and so on?
A - Ranging from 400 to 1500 U.S. dollars. Medical insurance dose not cover facial rejuvenation procedures.

Q - What is the surgeon’s level of experience in performing birthmark removal procedures?
A - Consultant or Doctoral in Plastic surgery.

Q - What percentage of patients experience complications with these procedures?
A - 4 - 14 %. Commonly, recurrence, infection and scaring.

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Summary of Birthmark Removal Procedures:

The time of the procedure: from half to two hours.
Type of anesthesia: local anesthesia +/- sedation or General.
Location: hospital or clinic with or without postoperative hospital stay.
Expected Side effects: Temporary swelling and pain.
Recovery time: return to work after 2 hours and the final outcome within 3 weeks.
Cost: according to procedure ranging from 400 to 1500 U.S. dollars, or 2000 to 8,000 Egyptian pounds.
Results: usually permanent results.

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