Targeted Laser Treatment: The Modern Solution for Hemangiomas

Photos: Dr. Allen Honingman

Initial Presentation of a Hemangioma

A hemangioma is a benign vascular lesion composed of an abnormal overgrowth of blood vessels. These lesions can appear anywhere on the body and are often recognizable as red or purplish raised areas on the skin or mucosal tissues. While many hemangiomas regress naturally over time and require no intervention, some grow larger, causing physical or functional issues such as interference with eating or speaking, or emotional concerns when located in highly visible areas. In certain cases, hemangiomas may bleed, ulcerate, or lead to cosmetic distress, significantly affecting a person’s quality of life.

Modern advancements in laser technology have revolutionized the treatment of hemangiomas, offering minimally invasive, effective, and cosmetically favorable solutions for patients who seek intervention.

The Difficulties of Traditional Treatments

Hemangiomas, although benign, can present notable clinical challenges due to their vascular nature and propensity for complications. Traditionally, these lesions were managed conservatively, adopting a “watch and wait” strategy due to the risks of surgical excision, which include significant bleeding and potential scarring.

Surgical removal with traditional techniques, such as scalpel excision, often posed more risks than benefits, particularly for vascular lesions located in delicate or functionally critical areas.

Historically, alternative treatments such as cryosurgery, electrosurgery, and sclerotherapy have been explored. However, these methods carried their own limitations and risks. Cryosurgery, while effective for smaller lesions, often caused tissue damage and pigmentary changes. Sclerotherapy—a process involving the injection of sclerosants—introduced risks such as skin necrosis, allergic reactions, and systemic toxicity. As such, the need for a safer, more reliable treatment modality remained unmet until the introduction of laser technologies.

Transforming Hemangioma Management with Lasers

The advent of laser technology has transformed the management of vascular lesions, particularly hemangiomas. Among the available options, the free-running digitally pulsed Nd:YAG laser has emerged as a gold standard for treating deeper vascular lesions. Unlike continuous-wave lasers or carbon dioxide (CO2) lasers, the Nd:YAG laser’s wavelength enables moderate absorption by hemoglobin, allowing for deeper tissue penetration without compromising surrounding structures. This unique property makes it ideal for managing hemangiomas that extend beyond superficial layers.

A pivotal 2006 study demonstrated the efficacy of the free-running Nd:YAG laser, reporting a remarkable 94% clearance rate of venous lake hemangiomas after a single treatment session. These results underscore the effectiveness of this technology, not only in eradicating vascular lesions but also in addressing patient concerns about scarring, recurrence, and cosmetic outcomes.

Why Nd:YAG Lasers Are Superior

When compared to other laser systems, the Nd:YAG laser’s advantages become evident. Continuous-wave diode lasers, while effective for superficial lesions, lack the penetration depth needed for larger or deeper hemangiomas. On the other hand, CO2 lasers are effective in ablating surface lesions but often result in significant tissue damage, leading to scarring and pigmentation changes that compromise aesthetic outcomes.

In contrast, the free-running digitally pulsed Nd:YAG laser strikes a balance between efficacy and tissue preservation, providing predictable outcomes with minimal side effects. Additionally, the Nd:YAG laser minimizes the need for multiple treatment sessions, reducing overall patient burden. Its ability to precisely target hemangiomas while sparing surrounding healthy tissue makes it a preferred choice among clinicians, particularly for lesions located in cosmetically sensitive or functionally critical regions.

Case in Point: Hemangioma Removal

A female patient in her late 40s presented with a large vascular lesion on the lateral border of her tongue (Fig. 1). The lesion had been present for over 20 years, and the patient had not been previously offered any treatment. After discussing the clinical situation, the patient agreed to treatment using the free-running digitally pulsed Nd:YAG laser (PerioLase MVP-7). The procedure was explained to her in detail. Local anesthesia was administered while ensuring the lesion itself did not blanch. For smaller lesions, a topical anesthetic like tricaine blue could be used.

Treatment was performed in noncontact mode with the PerioLase MVP-7 free-running pulsed Nd:YAG laser. The laser fiber tip was gently moved back and forth over the lesion, allowing the energy to be absorbed by the stagnant blood in the lesion until the lesion turned completely white. Care was taken to maintain a 1 to 2 mm distance from the tissue and to focus only on the lesion to avoid damage to surrounding healthy tissue. The procedure was completed in less than one minute (Fig. 2).

The treatment duration, laser settings, and energy delivered were appropriately matched to the size of the lesion. The patient was informed that, as the body cleared the debris and reabsorbed the tissue, a sore would form within approximately two weeks (Fig. 3), with full healing expected after another two weeks.

At the four-week follow-up appointment, there was no evidence of the hemangioma (Fig. 4).

Figure 1: Initial Presentation

Figure 2: Immediate post treatment

Figure 3: 2 weeks post -treatment

Figure 4: 4 weeks post -treatment

For decades, treating hemangiomas has been a challenging clinical issue, requiring a balance between effective outcomes and minimizing risks. As a board-certified periodontist who teaches and practices advanced laser techniques, I am grateful for this game-changing advancement. Patients love this treatment because it’s fast, effective, and provides remarkable cosmetic results with minimal scarring and recurrence. This reliable, minimally invasive technique addresses both clinical and aesthetic concerns, whether the hemangiomas are in visible areas of the lips or deeper intraorally.

For doctors, referring patients to a periodontal practice equipped with this technology means connecting them with a service that prioritizes safety, precision, and exceptional cosmetic outcomes. Embracing this modern standard of care means offering patients renewed confidence and a treatment experience that prioritizes their satisfaction and well-being—an outcome every clinician and patient can celebrate.