Case 2

“Get out of the way…. And let the body heal..”

Neal Lehrman, DDS, MS
[email protected]

A 49 year old caucasion female presented with a small hemangioma on her lower lip. Its duration was approximately 2 yrs. Admittedly, it was not noticeable if she wore lip-gloss, but as she is “ approaching the magical age of 50 she had decided to fix her dentition and all associated with it. After consultation with a plastic-surgeon, she was advised that she would require multiple procedures and or injection of steroids directly into the lesion should she want it removed. She was referred to me for evaluation and the treatment sequence was as follows. Any of these carries with it specific morbidity, not to mention post-operative pain and discomfort. 

Procedurally, local anesthetic was given intra-orally in the mandibular labial vestibule with care taken to not use epinephrine. Any chance of vasoconstriction could possible compromise the optical properties of the laser light being absorbed. There are many that choose to perform this procedure under topical only, and I have no feeling on that one way or another. On the hemostasis setting approximately 132 j were utilized in a non-contact mode. By holding the fiber perpendicular to the lesion, there is usually a change within seconds of the beginning of treatment. Once blanched, the patient is finished, and no special post-operative instructions were necessary.

There are more than one way to perform any procedure, but bearing in mind that we want to be as compassionate as possible without compromise  to sound surgical principles it would seem that a modality that allows for minimal intervention and maximum results should be the preferred approach. In this situation, and ones like it, we expose the patient to minimal risk and potential for complete healing. There is anecdotal evidence that these lesions, similar to herpetic lesions treated in a similar manner, do not return to this position.

Essentially, by removing the lesion without involving other surrounding tissues, the body has the capacity to focus only on the task at hand. The lack of inflammation surrounding the “laser wound” allows for rapid healing with minimal to no post-operative scarring.

 fig 1. Pre-op lesion is dark pigmented and “palpable” to percussion.

 fig 2. Immediate post-op. Once the tissue blanches, there is no need to continue to lase the area.

 fig 3. 4 day post-op. the lesion has gone from an “internal “ one to a surface phenomenon. Patient reports no post-operative pain.

 fig 4.  8-10 days post-op. lesion has shrunk and is now barely noticeable.

 12 day post-op. Lesion is gone and no post-op care needed beyond this point.