Timing and Rationale of Treatment: Achieving the "Best Result"

Various clinical disciplines defend the modality of therapy available to them (eg, medical vs surgery) when, in fact, multi-modality therapy is usually in the best interest of the patient. The aim of any modality of treatment is to obtain the best possible result for a given patient. To successfully achieve that aim for infantile hemangiomas (IH) and all vascular anomalies, defining what is meant by the best possible result and by when to achieve that, the result needs to be defined. Perhaps more important is to make a determination of what is an acceptable result. The impact of a 1-cm IH of the nasal tip is different from that of the same exact lesion on the thigh. The functional import of a 5-mm IH involving the lower eyelid is potentially very different from the same lesion involving the upper eyelid. These examples highlight that variables, such as size and location, are important. What is considered acceptable as a result of treatment of the nasal tip and upper eyelid IH is different from that for the corresponding thigh and lower lid lesions.