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Hemangioma Removal with Nd:YAG Laser

This is a 7o y/o/w/f who has had this hemangioma on her lip for at least 10 years and hates it.  She said little children would point and stare at her lip.  She had seen plastic surgeons about having it taken off over the years,  but they wanted to “cut part of my lip off, so I was afraid”.  When I told her I could use a laser to removed it without cutting off part of her lip she wanted it done that very day.

Nd:YAG with a 300µ fiber, 650µs, 20 Hz, 2.0 W.  Use a small amount of local anesthetic.

Because this laser wavelength is absorbed by pigments such as hemoglobin, the laser light will pass through the outer layer of skin and be absorbed in the underlying blood vessels and blood cells. This makes the lesion look whitish in color and very acceptable to the patient immediately post-op.  Be careful not to burn the outer flesh.

Immediate post-op photos:

One week post-op.  Surprisingly the patient didn’t seem to mind the herpes looking lesion on her lip.  She said at least people know what a cold sore looks like.

One month post-op.  She was very satisfied, but her tongue missed it!

The actual note in the patient’s chart:

Noted an pigmented lesion that looks like a hemangioma/mucocele on the lower left lip next to the corner of the mouth.  It has been there for several years and the patient wanted it to be removed.  Explained to the patient that lesions such as these are probably due to a localized trauma and may take more than one treatment to resolve.  Completely resolving this may not be possible due to the complex nature of the underlying lesion. Patient accepted treatment, Diagnostic Photos Taken, 20% lido/4% Tetra/2% phenylephrine topical placed,   1/12 carpule  3% mepivacaine plain,  Nd:YAG laser (300µ fiber, 650µs, 20 Hz, 2.0 W) with eye protection, Post-op instructions given which include avoiding sunlight for the next week and to use sun block chap stick.  NV re-eval in 1 week

Case #2

This 49 y/o/w/f patient bit her tongue many years ago in a car accident.  A large hemangioma formed in the middle of  her tongue and has had it injected to try and get rid of it twice about 5 years ago.  I told her about the Nd:YAG and she quickly wanted me to take it off.

Pre-op

Immediately Post-op

One week post-op.  She said it was sore.

Actual chart note:

The patient has had this hemangioma diagnosed and treated twice approximately 5 years ago with injections.  It didn’t go away and the patient wanted it to be removed with a laser.  Explained to the patient that completely resolving this may not be possible due to the complex nature of the underlying lesion. Patient accepted treatment, Diagnostic Photos Taken, 20% lido/4% Tetra/2% phenylephrine topical placed,   1 carpule (54mg/1.7ml)  3% mepivacaine plain,  Nd:YAG laser (300µ fiber, 650µs, 20 Hz, 2.0 W) with eye protection, Post-op instructions given and she was told it may scab over for a week or two.  NV re-eval in 1 week

1 month post-op.

The patient liked the results but kept asking if the hole was going to go away.  My answer was, “I don’t know, but sure looks like it is heading that way.  See you at your next cleaning to re-eval”.

8 months post-op photo.  The patient is extremely happy with the results!

Case #3

Noted a pigmented lesion that looks like a hemangioma/mucocele on the right lower lip. She went all the way to Boston to have it surgically removed and it was very painful, then it grew back. It has been there for several years and the patient wanted it removed.  Explained to the patient that lesion such as these are probably due to a localized trauma and may take more than one treatment to resolve.  Completely resolving this lesion may not be possible due to the complex nature of the underlying  lesion.  Diagnostic photos taken. 1 carpule (54mg/1.7ml)  3% mepivacaine plain,  Nd:YAG laser (300µ fiber, 650µs, 20 Hz, 2.0 W) with eye protection, Post-op instructions given and she was told it may scab over for a week or two.  NV re-eval in 1 week

Pre-op photo

One week post-op.  Looks like it needs to be retreated more aggressively next time.

Retreated after 1 month

One week post-op.  Good sign that is has scabbed over, but I would like to see more scab.

More post-op photos to come…

Case #4

70y/o/w/m with a hemangioma of long standing and just wanted it removed.

Immediately post-op

1 week post-op.  Good scab formation.

1 month post-op

More post-op photos to come…

Case #5

73 y/o/w/m with a long history of a hemangioma on the right lower lip.  His physician told him not to cut it with his razor because it will bleed heavily.  I told him at a hygiene appointment that we could remove it with a laser and he wanted to have it removed immediately.

Immediately post-op

1 week post-op

We will see him at one month post-op

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