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Hair Removal Treatment Using 1064 Nm Long-Pulsed Nd: YAG Laser in Auricular Post Reconstruction of Microtia Patient: Two Case Reports

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Hair Removal Treatment Using 1064 Nm Long-Pulsed Nd: YAG Laser in Auricular Post Reconstruction of Microtia Patient: Two Case Reports Dermatology Reports 2019; volume 11(s1):8076 Hair removal treatment using of the complex anatomy of the external ear, 1,064 nm long-pulsed Nd:YAG towards the necessity to provide good pro- Correspondence: Erika Dewi Essary, jection and symmetry.1 Unwanted hair is Department of Dermatology and Venereology, laser in auricular post apparent in microtia patients with a low Faculty of Medicine, Universitas Padjadjaran reconstruction of microtia hairline after auricular reconstruction pro- - Dr. Hasan Sadikin Hospital, Bandung 40161 patient: Two case reports cedure.2 In addition, the majority of patients Indonesia. have a low retroauricular hairline. Although Tel.: +62222032426 ext. 3449. E-mail: [email protected] 1 ear reconstruction technology has been Kartika Ruchiatan, 3 1 1 highly developed in techniques and results Acknowledgments: The authors would like to Erika Dewi Essary, Reti Hindritiani, 4 1 of surgeries, hair growth on the reconstruc- extend our gratitude to the staff of the RM Rendy Ariezal Effendi, tion ear has plagued both surgeons and 2 1 Department of Dermatology and Venereology, Rani Septrina, Hendra Gunawan, patients.3 Unwanted hair growth of the 1 Faculty of Medicine, Universitas Padjadjaran Oki Suwarsa reconstructed ears of microtia patients can who contributed to this work. 1Department of Dermatology and cause cosmetic problems,4 physiological 5 Venereology, Faculty of Medicine, distress, and known to be a therapeutic Key words: Auricular reconstruction; hair 6 Universitas Padjadjaran - Dr. Hasan challenge. There is a need for an effective, removal; microtia; Nd:YAG; unwanted hair safe, and non-invasive treatment modality Sadikin Hospital, Bandung 40161, West Contributions: All the authors contributed Java; 2Department of Plastic Surgery, capable of removing hairs on a longterm 7 equally. Faculty of Medicine, Universitas basis. Lasers known for its long-term Padjadjaran - Dr. Hasan Sadikin results, non-invasive nature, minimal treat- Conflict of interests: the authors declare no ment discomfort, and the speed and ease Hospital, Bandung 40161, West Java, potential conflict of interest. with which procedures can be performed.8 Indonesia Therefore, lasers are now viewed as the Funding sources: None gold standard for hair removal.2 A variety of laser systems with varying wavelengths, Receivedonly for publication: 1 February 2019. Abstract pulse durations, spot size, and energy flu- Accepted for publication: 20 February 2019. ences are currently used for hair removal. Microtia is a congenital anomaly of the This work is licensed under a Creative Successful hair removal treatment require external and middle ear with various Commons Attribution-NonCommercial 4.0 light to penetrate deep into the skin because degrees of severity. The hair growth on the International License (CC BY-NC 4.0). it is necessary to obliterate the entire folli-use reconstructed auricle causes aesthetic prob- cle.8 Hair removal treatment using 1,064 nm lems. We describe two cases about the suc- ©Copyright K. Ruchiatan et al., 2019 long-pulsed neodymium: ytrium-alumuni- Licensee PAGEPress, Italy cessful epilation of unwanted hair in um-garnet (LP Nd:YAG) laser combined Dermatology Reports 2019; 11(s1):8076 postauricular reconstruction of microtia doi:10.4081/dr.2019.8076 patients using 1,064 nm long-pulsed the wavelength advantage of the Nd:YAG neodymium: ytrium-alumunium-garnet (LP and the longer pulse duration advantage of 9 Appropriate parameters were chosen in Nd:YAG) laser in Fitzpatrick skin type IV the other long-pulsed systems. The aim of accordance with Fitzpatrick skin type IV. A patients, using 6x6 mm tip, 35 J/cm2 flu- these two case reports were to show the suc- spot size of 6x6 mm, a fluence of 35 J/cm2, ence, 10 ms pulse, and 1 Hz frequency with cessful hair removal treatment using 1,064 a pulse duration of 10 ms, and 1 Hz fre- burnt of hair as an endpoint. On the follow nm LP Nd:YAG laser in auricular postre- quency with burnt of hair as an endpoint. up day 11 of case one and day 7 of case two, construction microtia patients. The observation of epilation was performed the hair reductions on treated auricles were at 11 days after the irradiation (Figure 1C). 46% and 58%, respectively, with no adverse The post-treatment region was examined by effects. Minimal 6 repeated sessions are Case Reports dermoscopy and showed 46% reduction recommended for optimal result. In these Case #1 rate of unwanted hair (Figure 1D). There case reports, LP Nd:YAG laser treatment is A 37-year-old male who had congenital were no side effects such as inflammation, considered effective for the unwantedNon-commercial hair microtia of the right ear was referred to our oedema, ulcer, scar, and folliculitis of the growth on the reconstructed auricle in dark department, with a complaint of excessive epilated skin after irradiation. skin type patients with minimal risk of adverse effect. hair growth on the right ear two months after the second ear reconstruction surgery. Case #2 The surgery using the skin of the scalp and A 18-year-old female complaint with an the groin as donor sites. He was clinically Introduction excessive hair growth on the left ear. The examined and photo-documented before patient had undergone stage I-II auricular Microtia known as a congenital malfor- receiving the first laser treatment (Figure reconstruction using the Nagata technique, mation that is characterized by unorganized 1A). The physical examination showed with obvious hair growth in helix area of the cartilage remnants and a malpositioned lob- unwanted hair growth on reconstructed reconstructed auricle two weeks after the ule, with the various degrees of severity auricular region (the right auricle). surgery. She was referred to our department from mild structural abnormalities to the Dermoscopy examination revealed 147 vel- for opinion regarding hair removal at this complete absence of the external and mid- lus and terminal hairs (Figure 1B). Hairs unusual site. The skin of the scalp was used dle ear. The prevalence varies among coun- were trimmed using a scissor immediately as a donor site. The physical examination of tries from 0.83 to 17.4 per 10,000 births, prior to laser therapy. The therapy session the left ear showed long, thick, and coarse and males are more often affected than took place under topical anesthesia on the hairs (Figure 2A). Dermoscopy examina- females. Auricular reconstruction is a chal- therapeutic area. A LP Nd:YAG with a tion revealed 152 vellus and terminal hairs lenging reconstructive procedure, because wavelength of 1,064 nm was used. (Figure 2B). The patient had Fitzpatrick [page 142] [Dermatology Reports 2019; 11(s1):8076] Case Report skin type IV. Before hair removal, the treat- ment area was trimmed with scissor (Figure 2C). The patient was set in a supine position and the head was turned to expose the involved ear. The 1,064 nm LP Nd:YAG laser was used under topical anaesthesia. A spot size of 6x6 mm, a fluence of 35 J/cm2, a pulse duration of 10 ms, and 1 Hz fre- quency with burnt of hair as an endpoint. A significant reduction of unwanted hair (58% reduction hair amount) was observed 7 days after only one session compared to that observed before the treatment (Figure 2D). No adverse effects occured during the treat- ment. Discussion A two-step auricular reconstruction was planned in microtia patients. The first stage, the ipsilateral coatal cartilages are harvested to construct all anatomical segments. The second stage is generally carried out 6 months after the first1 and skin grafting commonly used.3 Although the techniques only and results of surgeries for microtia have improved, microtia patients with low hair- lines have aesthetic problems of hair growth when scalp skin is usually used for ear use reconstruction.4 Unwanted hair may only Figure 1. Clinical appearance. A. Before therapy. B. Dermoscopy examination before become apparent in the later stages of a therapy. C. Day 11 after therapy. D. Dermoscopy examination day 11 after therapy. reconstruction, sometimes hair begins to grow on the rim after a second stage release, and sometimes a full thickness graft from the groin begin to grow hair when a child progresses beyond puberty. The cells that responsible for hair growth are not actually located in the bulb but located in the the buldge zones. Thus, grafts with a substantial dermal component will grow hair.2 Our cases showed that the use of skin graft taken from scalp and groin skin can lead to the undesired side effect of unwanted hair growth. A variety of conventional methodsNon-commercial are available for hair removal, such as shaving, plucking, waxing, chemicals,3,6 and elec- trolysis6 which provide temporary effects3,6 and often involve adverse reactions.3 Lasers are now viewed as the gold standard for hair removal,2 and considered as the most effi- cient method for the reduction of unwanted hair.5 Lasers have been used both to treat hairs prior to reconstruction and to treat the ears after reconstruction.2 Laser hair removal systems are typically grouped into the following 3 categories on the basis of the type of laser or light source each uses: red light systems (694 nm ruby), infrared light systems (755 nm alexandrite, 800 nm diode, and 1,064 nm Nd:YAG), and intense 10 Figure 2. Clinical appearance. A. Before therapy. B. Dermoscopy examination before pulsed light sources (590 to 1200 nm). therapy. C. Trimmed area before therapy. D. Day 7 after therapy. Lasers require an effective fluence, appro- [Dermatology Reports 2019; 11(s1):8076] [page 143] Case Report priate spot size for the area being treated for less invasive and safer than other surgical Auricular reconstruction of congenital the successful treatment without complica- flap reconstructions and good cosmetic microtia: a personal experience in 225 5 tion.
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