Treatment Options for Lip Hemangiomas: Advances and Considerations

Hemangioma on the lips?

My husband has developed a hemangioma on his upper lip.
The last medical treatment was 10 years ago when he underwent surgery at Mackay Memorial Hospital, where they made an incision from the inside of his mouth and stitched it up in a way that resembled a bird's beak.
It has grown back in recent years.
Previously, the doctor mentioned that it cannot be completely cured and that it would likely recur after removal, as it was caused by a bacterial infection from a fall during childhood that went untreated.
I would like to know what current medical treatments are available.
If treatment is possible, will it require stitching it up in the same bird's beak shape as before, or can it be done as an outpatient procedure? Is laser treatment an option? Will it be covered by health insurance, or will it be out-of-pocket?

Ms. Su, 20~29 year old female. Ask Date: 2004/09/02

Dr. Lu Daokuan reply Plastic Surgery

Hemangiomas are classified into several grades, ranging from minor abnormalities such as capillary malformations to more significant issues like arteriovenous malformations, with the largest and most difficult to treat being arteriovenous fistulas.
Treatment for hemangiomas may require excision or ligation to occlude them, and whether the procedure is performed on an outpatient basis depends on the size of the hemangioma.
Typically, unless the hemangioma is very small, laser treatment does not play a role.
Hemangiomas are considered medical conditions, and treatment is covered by health insurance.
However, if a patient requests laser treatment or other specialized procedures, it may be out-of-pocket.

Reply Date: 2004/09/02

More Info

Lip hemangiomas, also known as vascular malformations, can be challenging to treat, especially when they recur after previous surgical interventions. Your husband's situation, where he had a hemangioma removed a decade ago only to have it reappear, is not uncommon. These lesions can be persistent or even progressive, particularly if they are associated with prior trauma or infection, as you mentioned.

Current Treatment Options
1. Surgical Excision: Traditional surgical excision remains a common treatment for hemangiomas, especially if they are symptomatic or causing cosmetic concerns. However, as you've experienced, surgical removal can lead to scarring and may not guarantee that the hemangioma won't return. The technique used in the past, which resulted in a "bird beak" appearance, might still be necessary depending on the size and location of the hemangioma. Surgeons often aim to minimize scarring, but the outcome can vary based on the individual case.

2. Laser Therapy: Advances in laser technology have provided a less invasive option for treating hemangiomas. Pulsed dye lasers (PDL) are particularly effective in reducing the size and color of hemangiomas. This method can often be performed in an outpatient setting and typically requires fewer recovery resources than traditional surgery. Laser treatment can also minimize scarring, making it a favorable option for facial lesions.

3. Sclerotherapy: This involves injecting a sclerosing agent directly into the hemangioma, which causes the blood vessels to collapse and the lesion to shrink. Sclerotherapy can be effective for certain types of vascular malformations and may be used alone or in conjunction with other treatments.

4. Medication: In some cases, medications such as beta-blockers (e.g., propranolol) have been used to treat hemangiomas, particularly in infants. While this approach is less common for adult hemangiomas, it may be worth discussing with a specialist.

Considerations for Treatment
- Consultation with a Specialist: Given the complexity of vascular lesions, it's essential to consult with a dermatologist or a plastic surgeon specializing in vascular anomalies. They can provide a tailored treatment plan based on the hemangioma's characteristics and your husband's overall health.

- Insurance Coverage: Coverage for treatments can vary significantly. Surgical excision may be covered by insurance, but laser treatments and sclerotherapy might not be. It's crucial to check with your insurance provider regarding coverage specifics for these procedures.

- Post-Treatment Care: Regardless of the treatment chosen, follow-up care is essential. Monitoring for recurrence and managing any potential complications is crucial for achieving the best long-term outcome.

Conclusion
In summary, while surgical excision remains a viable option for treating lip hemangiomas, advancements in laser therapy and sclerotherapy offer less invasive alternatives that may provide satisfactory results with reduced scarring. It's essential to have a thorough discussion with a specialist to explore the best treatment options tailored to your husband's specific situation. Additionally, understanding the financial implications of each treatment option will help you make an informed decision.

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