DEAR DR. GOTT: For the past seven or eight years, I have what has been identified as a venous lake. When it first appeared, I went to my dermatologist, and he cut it to let it bleed out. After that, my lip was swollen and uncomfortable for several weeks, but it seemed to disappear. Within six months, it was back again. I then went to a skin specialist. A few years later, he explained that tiny blood vessels slowly leaked blood into my lip. He recommended my lip be lasered, which he did three times in a row. This procedure did seem like a miracle, but again, within a short period of time, my lip pooled with blood. At that time, he told me that if the laser treatment didn’t work and it came back, my lip could not be lasered again. Well, it came back even larger than before. I no longer can conceal my lower lip with lipstick, and at this point I don’t know what to do. Do you have any recommendations?
DEAR READER: Venous lakes are rather common lesions caused by dilation of small blood vessels that present on the ears and lip, occurring in adults older than 50 who have had long-term exposure to the sun. Men are more prone to them than are women. They are dark blue to purple, soft, smooth and have well-defined edges. Compression of the lesion will often empty the blood contained within. To some degree, they can be compared to a varicose vein, a condition that seems easier to understand.
Diagnosis can often be made by visual examination, but surgical biopsy may be performed as well to differentiate between a benign lesion and a cancerous one. If treatment is accomplished, it is either for cosmetic reasons or because of recurrent bleeding. Medication cannot remove the lesions.
Surgical procedures include excision, electrosurgery, sclerotherapy and cryosurgery. Laser lights such as a flashlamp pulsed-dye process have been used with success. This treatment may require several procedures before removal is successful. Another procedure utilizes a cool gel that protects the epidermis. Reports are few, but this approach is similar to light lasers yet doesn’t require anesthesia and there is no crusting or bleeding under the skin; nor is there scarring.
If your lesion bleeds frequently or is bothersome because of its size, you may wish to proceed with further corrective attempts. If there is a cosmetic issue, you may wish to experiment with a foundation concealing product that can be covered with lipstick.
Complaints from patients who have had undergone surgical excision include a post-surgical lumpy area, discoloration of the surrounding tissue and a wish they never had the procedure done in the first place. Others, however, have experienced good results. I guess the bottom line here is, if you are going to have anything done, choose a person you have confidence in, whom you know will do the best job possible. I’m not sure what the proper procedure for you really is. If you are dissatisfied with your past experiences, seek the services of yet another professional. Present your case, and express your dissatisfaction and the previous lack of progress. Perhaps a plastic surgeon is the answer.
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