Laser treatment of facial venous vascular malformations

Facial venous vascular malformations (VVMs) can be cosmetically and functionally disabling. Few studies separate the treatment of these lesions from other vascular birthmarks, despite their unique physiology and natural history. This study retrospectively evaluates the treatment of 34 patients with facial VVMs treated with laser photocoagulation in 63 consecutive procedures. Twenty-two procedures used an argon laser, 12 used a yellow dye laser, and 32 used a yttrium aluminum garnet/potassium titanyl phosphate (YAG/KTP) laser. In 11 procedures the fiberoptic wand of the KTP laser was passed percutaneously for deep photocoagulation. Office charts and operative reports were reviewed, and patients were given a follow-up questionnaire. Bulkiness and discoloration usually improved in the early postoperative period. Partial or complete recurrence was common, most frequently noted at 2 to 6 months. Healing usually occurred within 1 to 4 weeks. Postoperative pain was minimal in most patients, although severe pain occurred in a small number. The complication rate was 5%, including an oral commissure scar contracture following treatment by KTP laser, a small cutaneous burn following deep fiberoptic photocoagulation, and a herpes flare-up following argon laser treatment. Satisfaction was high, and all but 2 patients would have laser treatment again. Laser photocoagulation provides palliation for facial venous malformations with minimal scarring and morbidity, but recurrence and the need for repeated treatments is common.