Vascular Lesions
facial plastic and reconstructive surgery in Winston Salem North carolina

Vascular Lesions before and after photos

Congenital vascular malformations are vascular lesions of children. One type is called a hemangioma. Hemangioma has been incorrectly used to describe all larger vascular lesions. In fact, hemangioma is a very specific type of lesion. In general, hemangiomas are not present when children are born but grow in the first year. They usually then involute on their own. There are a few different types of hemangiomas. A capillary or strawberry hemangioma was the old term for a hemangioma that arises in the superficial layer of the skin called the papillary dermis. A cavernous hemangioma is an older term for a hemangioma that arises in the deeper layer of the dermis. A compound hemangioma is the old term for a hemangioma that arises in the superficial and deep layer of the skin.

Lymphatic malformations can occasionally be confused with hemangiomas. These are lesions that actually change in size, usually when patients have colds. Hemangiomas, on the other hand, do not change in size with colds. A vascular malformation is a very specific type of blood vessel tumor that is almost always present at birth. Unlike a hemangioma, it does not grow rapidly in the first year of life and it does not ever involute or disappear. It tends to slowly grow over the course of a lifetime. A good example of this is a spot like seen in Mr. Gorbachev.

Treatment
Our lasers are not good enough as of yet to remove them entirely without also injuring the skin. Our lasers are good enough, however, to help smooth the skin when it thickens and to help decrease the intensity and color of these lesions. Unlike spider veins these usually take 1-2 treatments.

The most common vascular lesions, which people are interested in treating in our practice, are the small blood vessels caused by sun damage. These are also called "spider veins" or telangiectasia. They are sometimes referred to as" broken blood vessels". Essentially ultraviolet radiation usually from excess sun exposure, possibly decades earlier than the broken blood vessels and spider veins present on the face, cause irregular growth of these small blood vessels in the skin. These blood vessels are not the major blood supply to the skin and are not necessary for the health of the skin. A good way to see if it is a spider vein, a telangiectasia, or a broken blood vessel is to look closely at the lesion in the mirror and compress it with your fingertip. When you let go if it is a broken vessel, or a spider vein, or a telangiectasia, it will refill with blood usually from a center vessel spreading out to multiple branches. The most common place for this to occur is in areas that get sun, for example, the corner between the nose and the cheek and the upper surface of the cheek just below the eyes. Another common place that these occur is on the legs. Since our practice is strictly limited to cosmetic and reconstructive surgery of the face, and we consider ourselves facial specialists, we limit our treatment to these blood vessels to the face as well.

Spider veins, broken blood vessels, and telangiectasias of the face are best treated with different lasers. Most of these lasers will not require any anesthesia.

• A pulsed-dye laser is a laser with a wave-length of 585. This wave-length has energy that is preferentially absorbed by the pigment in blood vessels. The theory behind lasers for treatment of these blood vessels is to cause an injury to the blood vessel and try to maintain the surrounding tissue and skin uninjured. The laser actually passes, hopefully, through the skin to the blood vessel whereupon it is absorbed by the blood vessel, becomes heated and destroys the integrity of the blood vessel. With the pulsed-dye laser, when the blood vessel is destroyed it breaks temporarily and leaves you with a small bruise. The bruise lasts between 6-10 days in most cases. Since the laser pigment that absorbs the wave-length of blood is also very close to the pigment in melanin, our skin pigment, it is very important that patients who use this laser not have a lot of pigment in their skin. This means that patients who are dark or tanned, if they use this laser, may end up with an area where the pigment absorbs some of the energy and will result in a paler spot of skin compared to the surrounding area. In many cases, therefore, we will pretreat our patients with a good skin care program to help minimize the risk of this problem. The procedure takes only 10-15 minutes and feels like the snapping of a rubber-band on the skin.
• The KTP 532 wave-length laser is another laser that can be used to treat these small blood vessels. It is quite nice for blood vessels with small lumens of approximately 1-2 mm like those commonly found on the cheek and nose. Compared to the pulsed-dye laser, the spot size is much smaller and there is no bruising. Occasionally, where the blood vessels were, there is a small cat-scratch type of appearance for a few days. With either of these lasers, there is no real care that is required afterward except to occasionally use antibiotic ointment if there are any areas that are scratched or raw. Once again no anesthesia is needed for these treatments.