Facial Port Wine Stains – Case Studies following Medical Tattooing

Medical Tattooing on Facial Port Wine Stains – Treatment and Results

As a specialist Medical Tattooist, I understand the distress that a visible difference can cause, and the impact it can have on a patient’s life in terms of confidence and well-being. Having worked with many patients with visible skin conditions, my approach will be to treat them with empathy and care, right from the initial consultation. My objective is to achieve the results that are right for my patients.

Here are two case studies from patients who presented with facial port wine stains

Case study one

A male, age 42 presenting with a facial PWS approximately 8cm by 5cm at its widest, and 8cm by 1cm at its thinnest, with a deep purple/red colouring, sought out Medical Tattooing as he was feeling a lack of confidence with anxiety about starting new relationships with women. He was conscious of his PWS and felt it was negatively impacting his decision to speak with women, and their decision to have a relationship with him.

We had a face-to-face consultation discussing whether he had tried laser treatment which he had, but only as an adult. He had 13 treatments over the previous 5-10 years, getting approximately 10% lightening with the initial 6-7 treatments. There was no perceptible change from the remaining treatments. He then continued laser treatments a couple of years ago, having 2 treatments in a different clinic. He noticed a slight change with the first of the two treatments but no perceptible change with the second. He felt the treatments were very painful, and costly and were not making enough of a change to continue. He also had to take 2 weeks off work each time, due to the healing time.

During the consultation the treatment was discussed noting how the pigment will fade over time, the number of treatments needed, the cost, and the expectation of the results. His medical history was discussed, and he had no contraindications, and was on no medication. He was healthy and had no other medical conditions. He was advised that he could have no further laser treatments if he started medical tattooing over the area of the PWS as laser can turn pigment black, he would not be able to give blood for 4 months post treatments, and if he ever had an MRI or CAT scan he would need to inform the radiologist. The aftercare was explained to him, such that he would not be able to bathe, shower, wash his hair, exercise or get the area wet for 48 hours post-treatment. (No swimming, sauna, sun bed, jacuzzi for 10 days post-treatment). A dressing would be applied for 48 hours. After 2 days, he was to remove the dressing, wash the area in lukewarm water, pat it dry with a clean towel, and apply the balm (Vitamin A&D cream or Bepanthen) twice a day with a clean cotton bud. The balm was to be applied thinly allowing the area to breathe, for approximately 5 days (or to stop the balm when the scabbing and sloughing process had finished). He was advised to not pick the scab so as to not remove any pigment from the skin. The area would look darker for the first few days, it would form a scab and then slough away. Once this had happened the area would then look lighter, and would take the next 2 weeks to blend as the pigment settled in the skin.

His treatment plan consisted of a Patch Test and Colour Analysis to test for any sensitivity to the anesthetic or the pigment, as well as testing the colours to see how they healed in his skin followed by 5 treatments of between 1-1.5 hours. He had no negative reaction to the anesthetic or the pigment.

Treatments 1 to 5 were 6 weeks, 8 weeks, 7 months, 4 months apart respectively mainly due to his work schedule and when he could take a couple of days off for the healing time. He found that it took a week for the scabbing to come away completely.

Each session we applied more pigment, with a range of four different colours that were applied in a mosaic fashion depending on the colour of the immediate surrounding skin.

After treatment 4 he was very pleased with the results, he mentioned that his friends had said they couldn’t see the port wine stain anymore. The area was not noticeable to me anymore as he walked into the treatment room.

We did one more treatment in the middle of 2019 and he hasn’t needed a Colour Boost since.

Case study two

Mid 40 year old male musician presenting with a 3cm by 2 cm dark red, facial PWS. He had had laser treatment as a child and it had helped to flatten the raised PWS. He was happy with the results but did not want to continue laser into adulthood because of the healing time, the pain and the fact he could not see any visible changes.

We had a Zoom consultation as this was during the two Covid lockdowns. He had no contraindications, and was advised as to how the pigment will fade over time, the number of treatments needed, the cost, and the expectation of the results. His medical history was discussed, and he had no contraindications. He was advised that he could have no further laser treatments if he started medical tattooing over the area of the PWS as it can turn pigment black, he would not be able to give blood for 4 months post treatments, and if he ever had an MRI or CAT scan he would need to inform the radiologist. The aftercare was explained to him, he would need to not bathe, shower, wash his hair, exercise or get the area wet for 48 hours post-treatment. (No swimming, sauna, sun bed, jacuzzi for 10 days post-treatment). A dressing would be applied for his journey home. At home he could remove the dressing, leaved the area dry for 48 hours other than applying the balm morning and evening. After 48 hours he washed the area in luke warm water, patted it dry with a clean towel, and continued to apply the balm (Vitamin A&D cream or Bepanthen) for 5 days in total. He was advised not to pick the scab so as not to remove any pigment from the skin. The area would look darker for the first few days, it would form a scab and then slough away. Once this had happened the area would then look lighter, and would take the next 2 weeks to blend as the pigment settled in the skin.

The treatment plan was 2-4 sessions with 6-8 weeks in between sessions, each one lasting 45 minutes to an hour.

As he had Fitzpatrick 1 skin we did not do a Colour Analysis, but did the sensitivity test for anesthetic and pigment. He did not have a negative reaction to either.

The first treatment covered the whole PWS with 3 different colours using 2 different needle configurations. It looked dark purple on finishing, was slightly raised and sore. A dressing was applied for 6 hours, and then the balm was applied twice a day for 4 days. The healing time took about 4 days and was pain-free. He experienced no problems.

I reviewed him at 4 weeks online, and the PWS was feeling smoother to his touch (less bumpy) and was approximately 70% covered. The colour of the pigment matched his surrounding skin tone and the patient was feeling relieved and excited about the next session. At 6 weeks post-treatment number 1, he came into clinic for 1 hour for his second treatment. This time an extra colour was added to the 3 colour palette for fine-tuning, and only 1 configuration of needles. Again, the entire PWS was tattooed, with the same immediate effect. It looked darker, raised and felt sore. The same aftercare was administered and again there was no problems experienced. At the 4-week review he was very happy with the result. The full PWS was covered with his skin tone match. He could barely notice the PWS when looking in the mirror, and his friends had commented that they couldn’t see it anymore. Again the raised areas felt smoother to his touch. There was no need for any further treatments as he had the result he wanted. A Colour Boost is required anytime between 1-4 years. He returned after 20 months for a Colour Boost session. The fading was approximately 40% and only required 1 treatment to get the required result.