Laser beam diameter for port wine stain treatment.

Optimal port wine stain treatment requires the selective absorption of light by the ectatic blood vessels. We investigated whether deeper blood vessels can be coagulated, without damaging other cutaneous structures, by varying the laser beam diameter. The penetration of the light was simulated with a random walk (Monte Carlo) program. Scattering of the light plays a major role: practically all light that is absorbed in a blood vessel in the dermis is scattered light. In the epidermis, where the distribution is more centered, a larger beam diameter does not increase the energy density as much as deeper within the dermis where the blood vessels lie and where the light is totally diffuse. Increasing the laser beam diameter from 200 microns to 1 mm or more, makes a typical blood vessel absorb 2.5 times more energy, while the energy absorbed by the epidermis remains the same. The larger the laser beam diameter the better the treatment.