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Clinical Application of Intense Pulsed Light Depilation Technology in Total Auricular Reconstruction

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Clinical Application of Intense Pulsed Light Depilation Technology in Total Auricular Reconstruction Lasers Med Sci DOI 10.1007/s10103-017-2255-1 ORIGINAL ARTICLE Clinical application of intense pulsed light depilation technology in total auricular reconstruction Ying Guo1 & Jing Shan2 & Tianyu Zhang2 Received: 27 March 2015 /Accepted: 5 June 2017 # Springer-Verlag London Ltd. 2017 Abstract Although ear reconstruction technology has been pulsed light depilation technology is a reasonable complemen- highly developed in recent years, hair growth on the recon- tary approach to total auricular reconstruction. And preopera- structed ear has plagued both surgeons and patients. In this tive depilation is recommended over postoperative depilation. paper, the authors introduce a clinical application of intense The non-invasive modern photonic technology can resolve the pulsed light depilation in total auricular reconstruction. From problem of postoperative residual hair on the reconstructed August 2012 to August 2013, 27 patients (28 ears) suffering auricle, improving auricular shape and increasing patient sat- from congenital microtia were treated by intense pulsed light isfaction. In addition, an adequately set preoperative hair re- depilation (650–950-nm filter, initial fluence of 14–16 J/cm2 moval area can provide surface skin that is most similar to and gradually increased, pulse width of 30–50 ms, spot size of normal auricle skin for auricular reconstruction. 20 × 30 mm2, intervals of 6–8 weeks, a total of four sessions) either before or after auricular reconstruction. According to Keywords Intense pulsed light . Hair removal . Congenital the treatment situation at diagnosis, the patients were divided microtia . Auricular reconstruction into two groups: the preoperative group and the postoperative group. There were no differences between the two groups in terms of age or initial fluence for hair removal; however, there Introduction were less treatments in the former than in the latter group (preoperative group 4.1 ± 0.3, postoperative group 4.7 ± 0.7, Total auricular reconstruction has long been a challenge for F =9.10,P = 0.006), and the maximum fluence used for hair orthopedists and otologists. Successfully reconstructing the removal was lower in the former than in the latter group (pre- external ear not only requires a precise cartilage framework operative group 18–20 J/cm2, postoperative group 19–22 J/ to outline its special contours but also must be covered with cm2, F =22.31,P < 0.001). After follow-up for ≥4–6months, normal skin. To resolve the problem of skin covering, skin the effective rate was 100% in the preoperative group, and the grafting or using a postauricular tissue expander [1, 2]toex- effective rate was 80% in the postoperative group. Intense pand the skin flap is commonly used; however, a skin graft can only resolve the problem of quantity while introducing an issue of skin color difference. In particular, the front part of the Ying Guo and Jing Shan contributed to the work equally and should be auricle often shows an uneven spotty color, which is unaccept- regarded as co-first authors. able to the patients. In addition, the majority of patients have a low retroauricular hairline. Even with the use of a * Tianyu Zhang [email protected] postauricular tissue expander, adequate skin cannot be provid- ed within a few months to cover the total auricle, especially 1 Department of Laser Plastic Surgery, EYE and ENT Hospital of the skin of supra-auricular tissue [3]. Fudan University, Shanghai, China In the Department of Otolaryngology at our hospital, the 2 Department of Otolaryngology-Head and Neck Surgery, EYE and modified Nagata technique commonly requires a portion of ENT Hospital of Fudan University, 83 Fenyang Road, the postauricular or supra-auricular scalp tissue to bury an Shanghai 200031, China auricular framework during the first stage of the operation. Lasers Med Sci Both patients and surgeons are not pleased with the cosmetic For eligible patients, the involved ear was compared with appearance of the auricle with hairs present. In 2012, the in- the normal ear. CT (SOMATOM Definition Edge, Siemens, tense pulsed light (IPL) technique was used to remove un- Germany) data were combined to build a model to further wanted hair from these regions for adjunctive therapy on 27 determine the location and size of the reconstructed ear. The patients before or during total auricular reconstruction. The contour of the auricle was marked with a red line, then ex- difference of treatment results between the preoperative group panded by 1.5–2.0 cm and remarked on the supra-auricular and the postoperative group was discussed in the study. It will and postauricular parts. The area within the expanded contour help to improve the treatment process of total auricular was defined as the hair removal treatment area (Fig. 2). reconstruction. Before hair removal, the treatment area was trimmed with scissors (YYJ-PT160, Cofoe®, Hunan, China) and shaved using a disposable scraper blade (74-C, Flying Eagle®, Shanghai, China). Anesthesia was unnecessary. Materials and methods All patients were treated using the Harmony™ Multi- Application Laser System (Alma Lasers, Ltd., Caesarea, From August 2012 to August 2013, 27 patients suffering from Israel, 650–950-nm filter, with spot size of 20 × 30 mm2). congenital microtia visited our department (Department of Patients wore protective goggles (YL800W Safety Eye Plastic Surgery) for hair removal either before or after auricu- Guard, Alma Lasers, Ltd., Caesarea, Israel) or had their eyes lar reconstruction. The age of the patients ranged 6 to 26 years, covered with wet gauze (7.5 × 7.5 cm2-8P, Winner®, Hubei, with an average age of 12.85 years. The patients in the study China). Young children were accompanied by a family mem- had Fitzpatrick skin types III or IV. Based on the treatment ber (also wearing protective goggles). The patients were set in situation at diagnosis, the patients were divided into the fol- a supine position; the head was turned to the healthy side to lowing two groups: (1) the preoperative group (17 patients, 18 expose the involved ear. A cold-set gel was applied to the skin involved ears, 15 males, 2 females) were those who needed to surface within the treatment area, and normal skin as well as undergo total auricular reconstruction but had a lower periotic the hairy site were covered with a white light-shielding plate. hairline; these patients were asked not to consider the surgery Appropriate parameters were chosen in accordance with before one course of hair removal treatment was completed; Fitzpatrick [4] skin type and character of hairs. Fitzpatrick (2) the postoperative group (10 patients, 10 involved ears, 8 skin type of Asian was type III or IV. Initial fluence was often males, 2 females) were those patients who had undergone at 14–16 J/cm2 and gradually increased. The recommended stages I–II auricular reconstruction using the Nagata tech- initial pulse width was 50 ms, which could be changed to 30– nique, with obvious hair growth in a partial area of the recon- 40 ms since the second treatment. Because the skin was cov- structed auricle (Fig. 1). ered with too many hairs, it was hard to confirm the Fig. 1 The inclusion and exclusion of participants for various selected surgical groups Lasers Med Sci of 6–8 weeks for a total of four sessions. During each treat- ment, the skin area was photographed (Digital Still Camera, DSC-F707, Sony®, Japan) and the hair conditions as well as treatment parameters were recorded. Data were compared using a continuous data statistical description and analysis of variance with SPSS (Chicago, ILL, USA). The continuous variables were presented as mean ± SD (standard deviation) when they were distributed normally. Analysis of variance (ANOVA) was used to com- pare the differences between preoperative and postoperative groups. A P value <0.05 was considered statistically signifi- cant. With the sample size in this study, and the mean of the times of treatment, the estimated power of the comparison was 83–95%. Results Fig. 2 The area within the expanded contour was defined as the hair removal treatment area After hair removal treatment, the patients were followed from 4 to 6 months for comparative analysis of hair removal treat- Fitzpatrick skin type in the first treatment. Longer initial pulse ment parameters and results between the two groups. The width was chosen to reduce complications, such as empyrosis. curative effect of hair removal was ranked into four levels: Since the second treatment, with hairs decreased, appropriate cured, markedly effective, effective, and ineffective. Cured: parameters could be chosen in accordance with Fitzpatrick hair density per square centimeter decreased by ≥90% and skin type and character of hairs. In general, the end point hairs mostly or completely disappeared; the patient is very was when the patient felt pain, the skin became reddish, or satisfied. Markedly effective: hair density per square centime- the perifollicular edema and erythema were evident; residual ter decreased by 60–89% and new hairs become thinner, hair roots then shed over the next few days. The treatment area softer, and lighter; the patient is satisfied. Effective: hair den- was scanned once according to the size of the light spots. sity per square centimeter decreased by 30–59%, and new There had to be a 20% area of overlap between two spots so hairs become thinner, softer, and pale; the patient is generally as to cover the edge, but normal skin was protected from satisfied. Ineffective: hair density per square centimeter de- repeated irradiation. creased by ≤29% and thick hairs continue to grow; the patient In the postoperative group, because the auricular frame- is unsatisfied. work was already reconstructed, the treatment area had irreg- All the patients had accepted the treatment and index as- ular morphologies and the hairy area was generally located at sessment.
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