Abstract
Introduction: Port-wine stains (PWS), congenital vascular malformations affecting approximately 0.3-0.5% of live births, present as pink to red patches that darken and thicken over time, potentially leading to disfigurement, functional complications, and significant psychosocial distress. While pulsed dye lasers (PDL) are considered the standard treatment, they often require multiple sessions and exhibit variable clearance rates. Alternative laser modalities, such as the 532nm KTP laser, have shown promising results, particularly in PDL-resistant cases. However, managing complex PWS with diverse vessel calibers, hypertrophy, and scarring remains a challenge, highlighting the need for tailored treatment strategies. Case Presentation: A 22-year-old female presented with a complex PWS affecting the V2 dermatome of the left hemiface, including the lower eyelid, inner canthus, and associated lip/gingival hypertrophy and scarring from previous surgical intervention. She underwent five monthly sessions of a novel sequential laser protocol. This protocol combined long pulsed KTP 532nm laser treatment with quasi long-pulsed 1064nm Nd:YAG laser treatment to target both larger and smaller superficial vascular structures. In the final two sessions, ablative Er:YAG 2940nm laser treatment was added to address existing scars. Fluence and pulse duration were dynamically adjusted throughout the treatment course. Post-treatment care consisted of gentle skincare, emollients, and broad-spectrum sunscreen. The patient achieved significant lightening of the lesion, reduced vascular prominence and hypertrophy, improved facial symmetry, and softening of scars, with minimal and transient side effects. Conclusion: This case demonstrates the potential of a tailored, sequential combination of long pulsed KTP 532nm, quasi long-pulsed 1064nm Nd:YAG, and ablative Er:YAG 2940nm lasers for effectively managing complex PWS with associated hypertrophy and scarring. This multimodal approach, adjusting parameters to target specific lesion characteristics, suggests a promising strategy for achieving superior aesthetic and functional outcomes in challenging PWS cases and improving patient quality of life.
