Reduction of thickened flap using fractional carbon dioxide laser

Background and Objective The paramedian forehead flap is an excellent choice when repairing a large nasal defect. However, even when carefully thinned, the flap may develop a bulky appearance, an ill-fitting contour, or trap door deformity. When on the face, these suboptimal results can be quite distressing. Surgical and non-surgical options for improvement exist. Surgical options include additional debulking and reorientation of the flap. Non-surgical options include intralesional corticosteroids or 5-flourouracil, dermabrasion, and ablative and non-ablative laser resurfacing. Each option has limited benefit as well potential side effects. Study Design/Materials and Methods Case report. Results In this report, we present dramatic improvement of a thickened paramedian forehead flap using the Fraxel Re:pair, a fractional carbon dioxide (CO ₂) laser (Solta Medical, Inc. Hayward, CA). Conclusion To our knowledge, this is the first case in the literature demonstrating successful reduction of a bulky flap using a fractional ablative laser.