Birthmarks tend to appear, like the name implies, at birth or soon thereafter. If, however, a birthmark is a health concern, causing you aesthetic discomfort, or you simply don't want it on your body any longer, you've got options when it comes to removal.
Ahead, two leading cosmetic dermatologists—Dendy Engelman, MD, and Michele Green, MD—explain the different types of birthmarks, and how they are best removed. Skin tone, color, and the type of birthmark all play a factor in what type of birthmark removal method will prove most effective.
Meet the Expert
- Dendy Engelman, MD, is an award-winning, board-certified cosmetic dermatologist and Mohs surgeon at The Shafer Clinic in New York City.
- Michele Green, MD, is a board-certified cosmetic dermatologist who performs birthmark removal at her New York-based dermatology practice.
The Different Types of Birthmarks
"Birthmarks are patches of skin discoloration, typically benign, that appear at birth or soon after," explains Green. Engelman adds that birthmarks come "in various shapes, colors, and sizes." Although there are many different types of birthmarks, for the most part, they fit into one of the two categories: pigmented or vascular, according to Engelman. "Pigmented birthmarks appear due to an excess of melanin (pigment) in one area of the body," she says. "Vascular birthmarks appear when blood vessels form irregularly in certain parts of your skin." Green notes that vascular birthmarks occur "when there is an irregularity in the structure of the blood vessels—either that they develop to be much wider than they should be or a cluster of vessels forms in a particular area."
Here's a breakdown of different types of birthmarks, according to Engelman:
"Moles are pigmented birthmarks that often appear as round raised or un-raised shapes on the skin," says Engelman. "Moles come in various different shades, but most often are dark brown. Although most moles are harmless, moles can be cancerous." She advises checking your moles regularly for any changes in appearance. "Your dermatologist can perform a checkup called 'mole mapping' and keep track of your moles over time, to help with early detection of skin cancer," she says.
Mongolian Blue Spots
These "pigmented birthmarks are often mistaken for bruising due to their blue-grey color," explains Engelman. Mongolian Blue Spots are flat and "most commonly on the lower back or buttocks. These moles are harmless and appear most commonly in infants." She says they usually fade during a child's toddler years.
Cafe au Lait Spots
These harmless pigmented birthmarks are often "flat oval-shaped marks on the skin," says Engelman. "Cafe au lait spots are often a pale pink-brown color, commonly compared to the color of coffee with milk, hence the name."
A port-wine stain is, Engelman notes, a vascular birthmark that "appears as a larger pink or red mark on the body." If left untreated, she says it can become darker in color. "A port-wine stain may become rough and thick in texture, and can become dry easily."
These vascular birthmarks often appear at birth. "Hemangiomas start as blue, red, or pink colored flat marks on the skin," says Engelman. "Throughout the first months after birth, a hemangioma may become elevated and larger in size. This usually subsides within a couple of years." She notes it's not uncommon for these to leave a light-colored mark on the skin after fading with age.
A stork bite is a vascular birthmark that most often appears on newborns. These birthmarks are light pink or red and most often are found on the eyelids, forehead, nose, in between the eyes, and on the neck. Stork bites are harmless and often disappear without treatment as the child ages.
Why Remove a Birthmark?
Monitoring a birthmark under a dermatologist's care is critical in determining if you should remove it for health reasons. "Health concerns are often a large factor in birthmark removal," says Engelman. "If a birthmark is precancerous or cancerous, removal is necessary to prevent the condition from worsening."
However, because most birthmarks are benign, Green explains that "patients seek out their removal for cosmetic reasons." She adds that the "superficial discoloration of a birthmark" might make some people self-conscious. If that's the case, there are different birthmark removal procedures.
Birthmark Removal Treatments
There are several options for removing a birthmark, from medication that addresses the mark from the inside out to laser therapy and surgical removal. Your skin tone and type of birthmark are two major considerations when approaching different types of birthmark removal treatments.
"There are a few different medications that help with the removal of birthmarks," says Engelman. "Most medications help treat vascular birthmarks rather than pigmented birthmarks. Beta-blockers and corticosteroids are prescribed medications that help shrink blood vessels, reducing the appearance of birthmarks. These medications do not remove the birthmark completely but rather minimize its appearance."
Laser therapy that targets irregular blood vessels, according to Engelman, works best on vascular birthmarks, "shrinking the vessels and minimizing the appearance of the mark." She adds: "Laser therapy may not be an option for people with darker skin tones, as it can cause hyperpigmentation and actually worsen the problem."
Laser therapy is something that works cumulatively for optimal results, according to Engeleman and Green. "It's often painful but minimally invasive," says Engelman. "In order to achieve optimal results, laser therapy requires multiple sessions. It is not 100 percent effective and may only help with the color of the birthmark rather than remove it completely."
Green adds that there are several different types of laser technology available:
"AlexTriVantage is a dual-wavelength laser," according to Green. She says this type of laser might be the best option for people with dark skin tones. "The laser comes equipped with a 755 nm and a 1064 YAG laser," she says. "This makes the laser multifunctional, allowing us to treat all skin types— including darker and deeper pigmented lesions—safer and more efficaciously." Additionally, she explains it treats only the "targeted area, removing unwanted pigment while leaving the surrounding skin undamaged. In addition to treating birthmarks, the AlexTriVantage laser can also treat scars, tattoos, freckles, sunspots, and Nevus of Ota."
Green, who works with the AlexTriVantage, says treatment can take approximately "four to six visits, with a notable improvement in the appearance after each treatment. In some instances, more treatments may be required to achieve the desired results." She also works with the VBeam laser, which uses "pulsed-dye laser technology that is capable of treating red-pigmented birthmarks and port-wine stains that may be pink, red, or purple in color." She explains, "the laser light is then absorbed into the blood vessels which causes blood to coagulate. The coagulated blood is then reabsorbed by the body. For some birthmarks after treatment, you may see some notable results immediately following the procedure. In some instances, it can also take time to see visible results."
Additionally, Green adds that another type of laser used to treat birthmarks is the Picoway. "The ultra-short pulses of the laser maximize the delivery of energy to the pigment ensuring the effective removal of the pigmentation," says Green. "The speed of the laser energy delivery also ensures the least amount of heat is administered onto the skin."
If medication or lasers aren't the right methods for you, a third option is available, and it might be the most effective. "Surgical removal is more effective on pigmented birthmarks than laser therapy or medications," Engelman says.
In order to optimize the efficacy of birthmark removal treatment, the best candidates are those who can follow their dermatologist's recommendations precisely. "Different treatments require different methods of preparation," explains Engelman. "If you are receiving laser therapy, you should stop shaving, waxing, or bleaching the area of skin to be treated up to two months prior to your appointment. Before removal surgery, follow the steps provided by your surgeon."
Green adds that anyone makes a good candidate for birthmark removal, although what type is best determined by an in-person consult with a board-certified dermatologist.
What to Expect During a Procedure
As aforementioned, laser therapy can be painful. "It may feel like a hot snapping sensation on your skin," explains Engelman. "The pain should subside shortly after the treatment." Green adds that sometimes, "local anesthetic is applied to the treatment area to provide maximum comfort for patients."
As for surgical removal, this procedure is "usually done with a scalpel," notes Engelman. "Local anesthesia will be injected into the area prior, so most patients feel little to no pain during the procedure."
Aftercare is a critical component of birthmark removal and following your physician's instructions is vital for a positive outcome. "One of the most important pieces of aftercare to adhere to is to avoid sun exposure," explains Green. "Having a cosmetic laser treatment can cause increased photosensitivity and lead to skin irritation, potentially even worsening the appearance of the already existing hyperpigmentation."
She also notes that the application of a non-irritating moisturizer can speed recovery. "Moisturizing your skin helps to enhance the natural protective barrier on the skin during the recovery period," she says. "It promotes healing and prevents infection." Finally, she urges patients not to pick or peel the skin if they notice it scabbing after treatment and to let it heal on its own.
The Final Takeaway
Whether you're seeking birthmark removal for health or cosmetic purposes, the process is minimally invasive and requires little to no downtime. Laser therapy requires the most commitment, depending on the type of birthmark and laser treatment you seek out, but most patients see lasting results within six weeks of continued treatment. As with any medical procedure, adhering to your physician's recommendations regarding aftercare is critical to a favorable outcome.