SAVANNAH, Ga. — Sequential treatment with 1550-nm nonablative fractional focal point technology (FPT) followed by pulsed dye laser (PDL) is both safe and effective for adults with port-wine birthmarks (PWBs), a new retrospective study suggested.

Results showed that 56 of 58 patients had improvement after undergoing FPT plus PDL, and 53% had focal areas of complete clearance. Among the 30 participants who filled out a subsequent patient survey, all reported seeing noticeable improvement overall and in the color of their PWB, and all but one said they planned to continue with the sequential approach.

Additionally, 96% of individuals who had previously received other treatments reported improvement after undergoing the sequential therapy — as did 100% of those who underwent 10 or more previous treatments. The protocol was also deemed well tolerated, with no significant adverse events reported.

“The take-home message is that we now have an adjunctive method that is helping to clear thick and resistant port-wine stains without injury to the skin,” senior investigator Roy Geronemus, MD, clinical professor in the Department of Dermatology at New York University in New York City, told Medscape Medical News.

“Also notable was that almost all patients wanted to continue treatment. Patient satisfaction was extraordinarily high,” Geronemus added.

Co-investigator David Hashemi, MD, who works with Geronemus at his practice in New York City, presented the results at The American Society for Laser Medicine and Surgery (ASLMS) 2026 Annual Meeting.

Energy Without Injury

A PWB is caused by the malformation of blood vessels just beneath the skin and usually appears at birth as a flat pink or red patch on the face or neck that can darken and thicken over time without treatment.

“They can become more difficult to treat over time due to structural changes that they undergo,” Hashemi said at the meeting. “There have been some modifications over the years geared around the delivery of higher and deeper energies, but these technologies were limited.”

The introduction of 1550-nm nonablative fractional FPT (Avava) significantly increased the capacity for dermal plus subdermal energy delivery while avoiding substantial epidermal injury, he said. The energy delivery is nearly double what was provided by prior 1550-nm technologies, Hashemi added.

Geronemus noted that he has had conversations with the co-inventor of FPT, Dieter Manstein, MD, PhD, of the Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School in Boston, one of the study authors.

“We had recognized that there was some impact on blood vessels from this particular laser and the hypothesis was that it might also be beneficial for treating resistant birthmarks. There was a microscopic finding on optical coherence tomography; so it was an observation that we put into clinical practice,” said Geronemus, who is also a past president of the ASLMS.

For the current analysis, the researchers performed a retrospective chart review of 82 patients with PWBs (mean age, 37.5 years; range, 10-74 years; Fitzpatrick skin types I-IV) who had received at least one FPT plus PDL treatment (median, two treatments; range, 1-9) from February 2025 to January 2026 to assess “synergistic incremental improvement.”

The session began with sequential 1550-nm nonablative fractional FPT at two levels: deep treatment (typical parameters: treatment level 4; total energy, 140 mJ), followed by superficial treatment (level 4, energy, 20 mJ). Density was 80 CTZ/cm². The median energy used for FPT was 0.46 kJ for deep passes and 0.08 kJ for superficial passes.

Immediately afterward, patients underwent 595-nm PDL treatment (VBeam Prima or Pro), with a typical spot size of 13 mm, fluence range of 7-8 J/cm², and pulse duration of 0.45-1.5 msec. During follow-up visits, a 17-question survey was also offered to patients to rate their experience.

New Standard of Care?

Among the 58 patients with sufficient follow-up photography, 96% showed improvement after the protocol, and 53% showed complete clearance areas.

Among the 30 survey participants, 100% reported noticeable improvement in the look and color of the PWB, 53% reported a reduction in the size or area involved, and 47% reported improved texture; the median patient-reported improvement score was 3 out of 4, which was categorized as “good.” Additionally, 10 out of 11 patients with a hypertrophic/thicker PWB reported reductions in the hypertrophic component.

Twenty-eight survey respondents had undergone other treatments for their PWB prior to the study, and all but one reported incremental improvement after receiving the FPT plus PDL protocol, as did all 16 who had undergone 10 or more prior treatments.

“It was also very well tolerated,” Hashemi noted. The median score for patient-reported discomfort was 5 out of 10. Among those who had experienced other treatments previously, 21% reported that the study treatment was more uncomfortable. The overall median downtime score was also 5 out of 10, with 18% reporting that the sequential protocol required more downtime than previous treatments.

There were no reports of serious adverse events, including significant bleeding, scarring, infection, or prolonged edema or hyperpigmentation.

Overall, “this raises the possibility that one does not necessarily need selective photothermolysis to treat vascular birthmarks,” Geronemus told Medscape Medical News. He added that his practice is now routinely performing the sequential protocol for patients with thicker and/or resistant PWB. “It’s become our standard of care,” he said.

‘Major Impact’

Commenting for Medscape Medical News, session co-moderator Chris Robb, MD, PhD, co-founder of the Skin & Allergy Center, Tennessee, noted that he was impressed with the study results, and that the protocol “could have a major impact” for both children and adults without previously successful treatment.

“Anything that shows promise” for that patient population is noteworthy, said Robb, who was not involved with the research. “The combination approach was very effective.”

Robb noted that it is common for PWB to require multiple treatments, but after seeing the before and after photos, “it looks like they accomplished these results more quickly than would be done with pulsed dye laser alone.”

Geronemus reported that he performs clinical trials for the companies that made the FPT and PDL devices used in the current study. Hashemi and Robb reported no relevant financial relationships.