A few issues to keep in mind in the treatment of hemangiomas Hemangioma regression does not mean disappearance Hemangiomas can be simply divided into two categories: regressive and non-regressive. 30% regress at 3 years of age, 50% at 5 years of age, 70% at 7 years of age, and 90% at 9 years of age, but these figures are only estimates. Of course, regression rates reported in the literature vary, and the likelihood of regression of hemangiomas is mostly speculative. With multiple hemangiomas, each lesion regresses at a different rate. More importantly, it is not possible to predict whether hemangiomas will regress and whether regression will cause aesthetic problems. Most reports indicate that nearly 50% of hemangiomas cause permanent deformities. Parents should understand that regression does not mean complete disappearance. Lasers are not magic. Parents of children with hemangiomas have high hopes for laser treatment because they want to remove the lesion immediately. It is important to know that the average depth of penetration of a pulsed dye laser is 1.2 mm, but it is often used to treat hemangiomas 10 times its thickness. Submerged detached skin usually results in marginal necrosis if treated with laser. Parents should be encouraged to use laser therapy as the definitive treatment for residual capillary dilatation, especially in nasal and lip lesions. The pulsed dye laser (PDL) is the standard laser for the treatment of vascular lesions and is used primarily for early intervention of superficial hemangiomas, management of ulcerated lesions, and treatment of residual capillary dilatation during the regression phase. The efficacy of 595 nm long pulsed dye laser with a skin cooling system is superior to conventional 585 nm PDL. low energy PDL irradiation of ulcers on the surface of hemangiomas accelerates wound healing. pdl and long pdl are safe and effective for capillary dilatation. Laser therapy should not be used as a routine treatment for hemangiomas because topical beta-blockers such as timolol solution or gel are also effective and safe for superficial hemangiomas. It is generally accepted that lasers are of little use for angiomas in the prodromal stage: laser treatment does not stop the growth of angiomas and can cause ulceration. The coagulation effect of the laser also fails to arrest tumor progression because the depth of penetration of the 577-585 nm pulsed dye laser into the skin is only 0.75-1.2 mm. In addition, atrophy and depigmentation are three times more likely to occur in laser-treated skin than in untreated skin that has faded. Parents should understand that oral steroids are one of the time-tested treatments for hemangiomas. However, short-term applications of propranolol (3 to 9 months) are so effective that they have replaced hormones as first-line treatment. In children younger than 3 months of age, consult a cardiologist before taking the medication and take baseline measurements, including photographs, ultrasound, blood counts, and EKG. Hospitalized for 1 day, observe for bradycardia, hypotension, hypoglycemia after taking the drug, and take the drug at 2-3 mg/kg?d in 2-3 doses for 3-9 months. the drug was gradually discontinued in 3-4 weeks. For periorbital hemangioma, 1% propranolol cream or 0.5% timolol can be applied topically. In patients in whom propranolol is ineffective (resistant), consider subcutaneous injection of alpha interferon or intravenous push of vincristine. Timing of surgery and laser therapy The child should not be operated before the age of 1 year except in certain cases (life-threatening or affecting vital functions). It is generally advocated to be performed before school age, mainly for the removal of residual lesions after regression or treatment, such as scar, skin depression, bloated skin, fibro-fatty residues, etc., to reduce the psychological burden of the child and parents due to aesthetic and functional problems. Since the completion of the regression of hemangioma is mostly after 9 years old, the best time for plastic surgery is 8 to 12 years old. As for laser, although certain scholars have different opinions and recommend its use after 15 months, the treatment program should be completed at the age of 3.5 years. At this time, the child’s body image begins to develop and there is a risk of ridicule from other children.