Skin Stories

Skin Story: Behind the Spot - My Experience with "Café Au Lait"

Exploring a decision to remove a café au lait spot

Woman outside with hair over her face
Credits: "Fade Qu at Unsplash.com"
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"What's that thing on your face? Did something happen to you?" a boy asked me as he pointed at the light brown colored birthmark under my eye. I immediately tried to cover the spot with my hair and replied faintly, "No, it's a birthmark." Throughout middle school and early high school, I was frequently asked questions like these. My birthmark didn’t bother me until people started pointing it out. Since it was so highly visible I started feeling self-conscious about my appearance, wondering why no one else had similar spots on their face. Although my parents tried being supportive of my birthmark, calling it a unique beauty mark, I just wanted it to be gone. 

I decided to take a trip to the dermatologist with my mom and we discovered that the spot on my face was called a café au lait spot. Collections of melanocytes can produce these in the epidermis of the skin, causing a pigmented spot on the surface. My dermatologist explained that the spots are typically permanent and may grow in time, but there were still treatment options. I noticed how empathetic she was and I appreciated that she asked how I felt about having the café au lait on my face and what I wanted to do as far as treatments. I told her my biggest concern was other people always pointing it out and making me feel embarrassed and disfigured. She understood and gave me the option of laser removal.

Laser treatments are used frequently for café au lait removal but results are variable and the spots may come back after treatment. The thought of a laser alone was daunting at first, and all I could think about was my skin sizzling off and leaving me scarred. My dermatologist reassured me by telling me it was minimal pain that wouldn’t last long, so I went forward with the treatment. 

The day of my treatment, I walked in hoping that this would help get rid of the spot on my face, but I knew in the back of my mind that all of these efforts may just be useless. I was sat down next to a huge laser as my dermatologist prepared an anesthetic cream. She placed it on the area under my eye and then sat down next to me and covered my eye with a metal goggle. Zap! I could hear the skin sizzle under the bright light and it felt like needles poking my skin, but the pain was tolerable and lasted about a minute. 

Afterward, my birthmark was puffy and red but after several days it began to scab. From there, my birthmark peeled off, just as a scab would. I held it in my hand and thought it was strange how the physical birthmark came off my face. The area under my eye was sensitive for the next few days, and as my skin came back to normal I could see that the birthmark was significantly lighter this time. It wasn’t 100% clear but now that it was lighter I felt that it no longer defined me. It amazed me that a few zaps of a laser changed how I felt about myself, even though my spot didn’t clear entirely.

Looking back on my own experience, I am appreciative of my results and that my dermatologist was able to guide me to a solution to my skin concern. I know that having a skin imperfection or disorder can cause a great amount of distress or lack of confidence and it is sometimes difficult to find effective treatments. However, by keeping a positive outlook and telling your dermatologist how you feel physically, mentally, and emotionally, can help with proper treatment of your skin and more importantly, improve the overall quality of life. I am grateful that my birthmark is still faintly on my face because although others might not always notice it, I have accepted it as a beautiful imperfection. 

Here are before and after shots of my café au lait spot:

Cafe Au Lait Spot Before and After

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