In order to reach a higher level of accuracy in simulation of port wine stain treatment, we propose to discard the typical layered geometry and cylindrical blood vessel assumptions made in optical models and use imaging techniques to define actual tissue geometry. Two main additions to the typical 3D, weighted photon, variable step size Monte Carlo routine were necessary to achieve this goal. First, optical low coherence reflectometry (OLCR) images of rat skin were used to specify a 3D material array, with each entry assigned a label to represent the type of tissue in that particular voxel. Second, the Monte Carlo algorithm was altered so that when a photon crosses into a new voxel, the remaining path length is recalculated using the new optical properties, as specified by the material array. The model has shown good agreement with data from the literature. Monte Carlo simulations using OLCR images of asymmetrically curved blood vessels show various effects such as shading, scattering-induced peaks at vessel surfaces, and directionality-induced gradients in energy deposition. In conclusion, this augmentation of the Monte Carlo method can accurately simulate light transport for a wide variety of nonhomogeneous tissue geometries.