Radiosurgical Excision of Rhinophyma Letter to the Editor: I am writing to comment on “Radiosurgical Exci-
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چکیده
They state that “Alternative methods including electrocauterization and CO2 [carbon dioxide] laser, via vaporization improve hemostasis but result in scarring and poor cosmesis.” There is no citation for this statement, so I assume it represents the authors’ opinions. Although I am a big proponent of 4.0-MHz radiowave surgery, I also use the CO2 laser to treat rhinophyma (frequently concomitantly with radiowave excision) and have to disagree that scarring and poor cosmesis are a given with laser rhinophyma excision. As all laser surgeons know, it is not the modality that causes the damage but rather the inability to control the degree of lateral thermal damage during the procedure. The laser so frequently takes the blame for untoward results, when in reality most problems are from operator error or inexperience. Although excellent for hemostasis, the main problem in using the CO2 laser to ablate rhinophyma is that it is a slow process (as the authors point out and otherwise previously documented. That being said, if the thermal damage is controlled, the CO2 laser produces excellent results in debulking rhinophyma and sculpting a smooth surface, and I have been using the laser for this purpose since 1997.
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