There were always stares.
Billie Cline did her best to avoid them in high school, wearing her thick red hair long and straight while most of the other girls sported short bouncy ponytails.
Later, with her hair cropped closer, the Los Alamos woman would feel the eyes of strangers on her blemished neck and face. They would take a look, she said, then turn away.
The children in her Lompoc elementary school classes did not try to hide their curiosity. Every year a new group would come in with an old question. They would ask her how she got burned.
It wasn't a burn, she would patiently tell them. She was born with it.
But Cline and her birthmark have largely parted ways, separated after 38 years by the tiny pulsating beam of a yellow laser. No more questions, no more stares. "It's really nice," she said.
Cline and more than a dozen other people have had their reddish blemishes--known commonly as "port-wine stains"--gradually faded through a laser treatment pioneered in Santa Barbara.
For many of them, it has ended a lifetime of taunts and tears. One man's criminal rehabilitation has been credited, in part, to greater self-esteem triggered by the removal of a large stain on his face.
One woman felt confident enough after her laser work to pursue a dream of becoming a model.
Those external successes do not always bring internal healing, however. Many patients still will not talk openly about their birthmarks.
Aid for Children
That's why doctors say the laser's biggest plus is that it can be used on children, removing the stains before too many questions and too many stares bring deep psychological scarring.
Lasers, long the weapons of science fiction heroes, have been applied to medicine in recent years with increasing frequency and dramatic results. They are used now, for example, to treat tumors and glaucoma, to detect lung cancer and to clear airways.
Doctors also are hopeful that lasers, coupled with a drug that reacts to the light beam, may prove successful in treating various cancers. Other research is aimed at seeing if lasers might break up blood clots and help heal skin wounds.
For more than five years, doctors have used argon lasers to treat port-wine stains and other blemishes. The blue-green light, in many cases, successfully stopped the flow of blood to the vessels that caused the stain.
But there were also complications.
Some studies showed that about 20% of the patients exhibited scarring; the red mark was replaced by a blanched one. Scarring was most common in children, so treatment was available only to those older than 17.
The laser also could not be used in sensitive skin areas, such as around the nose.
In Santa Barbara, physician Gregory Keller and biomedical engineer Daniel Doiron began experimenting with lasers, attempting to fine-tune wavelengths and the timing of the light pulses.
Building on research done by others, they found that a dye laser tuned to yellow could fade the birthmarks without the complications of the earlier models.
"The blue-green laser was more of a brute-force method," Keller said. "You burned the vessels out." But at the same time, he added, much of the surrounding skin was also burned.
Keller and Doiron said the yellow light is more easily absorbed by the blood vessels. When the beam is directed at the stain and "shot" in rapid doses, it coagulates the vessel without harming the nearby tissue.
"Selectivity is the key," said Keller, a head and neck surgeon with more than a decade of experience in laser medicine. "You can pick out the vessel you want."
Doiron and Keller founded the Western Institute for Laser Treatment in 1983, and under its auspices run one of only three yellow-laser operations in the world. The $100,000 machine is located at Goleta Valley Community Hospital.
The private, nonprofit institute has gained an international reputation for its laser advances, despite its tiny headquarters and staff. It trains doctors, does treatment and research, develops new systems and raises money to provide hospitals with sophisticated lasers.
Doiron, who did his doctoral thesis on lasers at the University of California, Santa Barbara, tunes the equipment in the hospital's special laser room before each treatment. Keller then uses a small pen-like silver wand to guide the highly concentrated light beam.
When the light strikes the skin, the reaction looks like a tiny explosion as the tissue briefly bubbles, then contracts. Cline says it feels like a pin prick.
Most patients report only minor discomfort, although some require an anesthetic for particularly sensitive regions. Unlike with the blue-green laser, there is no itchy scabbing after treatment, the patients say.
Only a small portion of the stain is treated at a time. Some areas are treated again to further bleach the blemish.
Because of its selectivity and sensitivity, the laser also can be used on children. Keller said that is the treatment's most encouraging benefit, because "kids are kids. They make fun of each other, and those with blemishes get self-conscious."
The advances here have attracted wide attention. Last month, a group of doctors from Japan came to the Goleta hospital to watch Keller work on a patient--a woman who had traveled from Texas for removal of a facial stain.
Cline, who had been undergoing treatment with an argon laser, found out about the newer process four years ago from her dermatologist in Santa Maria. She said it took her nine months to make up her mind about seeing Keller.
"I hate to think about doing things in vain," the second-grade teacher at Clarence Ruth School said. "I'd had it (the birthmark) for 35 years, so I'd learned to live with it quite a bit. But I thought, it's (the treatment) available, so why not?"
She is pleased with the results, saying that the spots that require further treatment can be covered in the meantime with makeup. "People don't even notice anymore," she said.
"I've always been kind of embarrassed by it," she added. "But when my friends say, 'Billie, it looks great,' that makes me feel better."
Cheryl Simmen, executive director of the laser institute, said other patients have reported similar successes. One of them is Leonard Andrews, who was an inmate at the federal prison in Lompoc when he heard about the treatment.
Effects of Feelings
Doctors at the prison linked Andrews' criminal background to feelings of shame about his port-wine stain, and they suggested that the laser might turn things around for him.
Andrews has been receiving treatments for more than a year, and the doctors report a significant change in his attitude. He is out of prison now.
Jordis Cleaveland, the patient from Texas, had received radium treatments on her birthmark, located above her top lip, when she was 12. They thinned the mark, but didn't remove it.
At age 60, she had given up hope of getting rid of it. But then she heard about the laser institute's work and came from her San Antonio home for a test.
That small patch has healed, leaving no trace of the stain, and now she would like to see the whole thing disappear.
Growing up with the birthmark, she said, "was horrible. We all know children are cruel. I was super-sensitive about it, although it was easier on a little girl because it was OK for me to cry. Later, I could use makeup.
"But it was most unpleasant. I can't think of anything worse than having something on your face. My lifelong desire has been to look like everyone else, to not feel so different.
"I can't wait."