International Medical Case Reports Journal (Jan 2022)
Hypertrophic Scar Following Excisional Surgery and Full-Thickness Skin Grafting Due to Rhinophyma Treated with 1064 nm Q-Switched Neodymium:Yttrium Aluminum Garnet Laser
Abstract
Kartika Ruchiatan,1 Reti Hindritiani,1 Diah Puspitosari,1 Gabriela Reginata,1 Rani Septrina2 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia; 2Department of Plastic Surgery and Reconstruction, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Kartika RuchiatanDepartment of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, IndonesiaTel +62811247932Email [email protected]: Rhinophyma is characterized by progressive enlargement of the nasal skin, which is considered to be an advanced stage of phymatous rosacea. Esthetic disfigurement makes surgical treatment necessary for this condition. Hypertrophic scars are the consequence of alterations in the skin’s healing process following surgical interventions. Laser may be the treatment of choice in hypertrophic scars. We reported a case of hypertrophic scars following excisional surgery and full-thickness skin grafting due to rhinophyma in an 18-year-old male who was consulted from the Department of Plastic Surgery and Reconstruction. The 1064 nanometer (nm) Q-switched Neodymium: Yttrium Aluminum Garnet (QS Nd:YAG) with 4 mm spot size, 1.5 J/cm2 and 1 Hz was applied to the hypertrophic scars for three sessions within one month interval. Clinical improvement was observed as indicated by the patient’s Vancouver scar scale score and spectrophotometry result, and no side effects were found. Nd:YAG laser is a non-ablative device that targets hemoglobin, water, and melanin. Any thermal effects on dermal tissue containing blood vessels could result in reduced blood flow through the capillaries in the dermal papillae. QS Nd:YAG-induced selective photothermolysis was responsible for collagen breakdown and reduced collagen production in hypertrophic scars. The 1064 nm QS Nd:YAG laser gave good results in this case although more treatment sessions may be recommended and a longer follow-up is necessary in order to assess the stability of the result.Keywords: hypertrophic scar, rhinophyma, QS Nd:YAG laser
