Many people are born with birthmarks, which are generally defined as a visible mark on the skin that is unique to the individual and does not quickly go away. Birthmarks can take on a wide variety of coloring, shapes and sizes. Most birthmarks are small, not noticeable, or unlikely to show outside of clothing. However, others can take a more prominent appearance, and some can pose an eventual health risk. For these reasons, some people go to cosmetic surgeons for birthmark removal procedures.

There are three main types of birthmarks:

• Pigmentation birthmarks refer to the type of birthmark where the skin has too much coloring or pigment. This includes some moles, brownish or cream-colored spots, and "Mongolian spots" which usually fade away by age 8.

• Macular stains (often called salmon patches) are flat and usually light pink patches of skin often on the neck and eyelids. Sometimes these marks fade, particularly those on children's eyelids, while many on the neck do not.

• Vascular malformations include one of the most common birthmarks, called port-wine stains, and can be found anywhere on the body. These birthmarks do not fade or go away and can be located in very visible areas such as the face.

Always make sure your or your child's physician is aware of any of these types of birthmark, as well as any skin discoloration or abnormality in case they are signs of, or could lead to, more serious medical problems.

If you or your child has any of the above, you might be considering cosmetic birthmark removal surgery. Over the past few years, the technology in this area has advanced and become safer and more effective. For example, laser therapy can now be used to shrink or eliminate some birthmarks that are close to the surface, such as port-wine stains. You cosmetic surgeon can evaluate the type, size, and location of your birthmark and then recommend an appropriate type of treatment. There are more forms of treatment than can possibly be discussed here.

Many potential cosmetic surgery patients are concerned with risks and or pain associated with birthmark removal. There is no simple answer to these questions, as each surgery is as different as each birthmark. There is usually a limited amount of pain, such as a slight burning sensation with laser treatment for example. As far as risk, there is always the potential with any skin surgery of infection and scarring. If you are having the surgery for purely cosmetic reasons, you should definitely inquire about the risk for scarring as you would not want replace one blemish with another.

Any qualified cosmetic surgeon who does birthmark removal should be able to give you an estimate of the costs. Almost all HMOs do not cover the cost of birthmark removal that is done for cosmetic reasons. However, many cosmetic clinics do offer payment plans and discounts. The surgeon should also be able to give you a specific prediction of what that area of skin will look like after the procedure, how long the procedure will take, and what follow up will be necessary. As with most major purchases, you may want to get a few estimates, check references, and see actual results.

It will be important for you to share information regarding allergies and medical conditions you have with your cosmetic surgeon. Many people downplay these because they feel this surgery is not potentially harmful, or because they do not want to be turned down. Finding a qualified cosmetic surgeon, hearing enough so that the procedure and its risks and benefits are completely clear, and asking her or him every question you have, is a vital step toward possibly removing your birthmark.