Management of adult facial vascular anomalies

Vascular anomalies are best classified by biologic behavior-active hemangiomas, and inactive vascular malformations. Hemangioma growth is restricted to infancy, but residual deformity may persist to adult life in the form of redundant skin, bulky fibrofatty tissue, and ectatic cutaneous vessels. Treatment largely consists of scar revision and laser photocoagulation of residual vascular pigmentation. Vascular malformations are present throughout life and can cause increasing facial distortion and disfigurement as capillaries, veins, lymphatics, and/or arteries further dilate and the facial features hypertrophy. A variety of treatment options include laser photocoagulation, sclerotherapy, embolization, and direct surgical excision, and often a combination of techniques yields improved results. In many cases, however, therapy is only palliative, and patients should be advised of the limitations of each treatment option to avoid unrealistic expectations and disappointing results.