[page 142] [Dermatology Reports 2019; 11(s1):8076] Hair removal treatment using 1,064 nm long-pulsed Nd:YAG laser in auricular post reconstruction of microtia patient: Two case reports Kartika Ruchiatan, 1 Erika Dewi Essary, 1 Reti Hindritiani, 1 RM Rendy Ariezal Effendi, 1 Rani Septrina, 2 Hendra Gunawan, 1 Oki Suwarsa 1 1 Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung 40161, West Java; 2 Department of Plastic Surgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung 40161, West Java, Indonesia Abstract Microtia is a congenital anomaly of the external and middle ear with various degrees of severity. The hair growth on the reconstructed auricle causes aesthetic prob- lems. We describe two cases about the suc- cessful epilation of unwanted hair in postauricular reconstruction of microtia patients using 1,064 nm long-pulsed neodymium: ytrium-alumunium-garnet (LP Nd:YAG) laser in Fitzpatrick skin type IV patients, using 6x6 mm tip, 35 J/cm 2 flu- ence, 10 ms pulse, and 1 Hz frequency with burnt of hair as an endpoint. On the follow up day 11 of case one and day 7 of case two, the hair reductions on treated auricles were 46% and 58%, respectively, with no adverse effects. Minimal 6 repeated sessions are recommended for optimal result. In these case reports, LP Nd:YAG laser treatment is considered effective for the unwanted hair growth on the reconstructed auricle in dark skin type patients with minimal risk of adverse effect. Introduction Microtia known as a congenital malfor- mation that is characterized by unorganized cartilage remnants and a malpositioned lob- ule, with the various degrees of severity from mild structural abnormalities to the complete absence of the external and mid- dle ear. The prevalence varies among coun- tries from 0.83 to 17.4 per 10,000 births, and males are more often affected than females. Auricular reconstruction is a chal- lenging reconstructive procedure, because of the complex anatomy of the external ear, towards the necessity to provide good pro- jection and symmetry. 1 Unwanted hair is apparent in microtia patients with a low hairline after auricular reconstruction pro- cedure. 2 In addition, the majority of patients have a low retroauricular hairline. Although ear reconstruction technology has been highly developed 3 in techniques and results of surgeries, 4 hair growth on the reconstruc- tion ear has plagued both surgeons and patients. 3 Unwanted hair growth of the reconstructed ears of microtia patients can cause cosmetic problems, 4 physiological distress, 5 and known to be a therapeutic challenge. 6 There is a need for an effective, safe, and non-invasive treatment modality capable of removing hairs on a longterm basis. 7 Lasers known for its long-term results, non-invasive nature, minimal treat- ment discomfort, and the speed and ease with which procedures can be performed. 8 Therefore, lasers are now viewed as the gold standard for hair removal. 2 A variety of laser systems with varying wavelengths, pulse durations, spot size, and energy flu- ences are currently used for hair removal. Successful hair removal treatment require light to penetrate deep into the skin because it is necessary to obliterate the entire folli- cle. 8 Hair removal treatment using 1,064 nm long-pulsed neodymium: ytrium-alumuni- um-garnet (LP Nd:YAG) laser combined the wavelength advantage of the Nd:YAG and the longer pulse duration advantage of the other long-pulsed systems. 9 The aim of these two case reports were to show the suc- cessful hair removal treatment using 1,064 nm LP Nd:YAG laser in auricular postre- construction microtia patients. Case Reports Case #1 A 37-year-old male who had congenital microtia of the right ear was referred to our department, with a complaint of excessive hair growth on the right ear two months after the second ear reconstruction surgery. The surgery using the skin of the scalp and the groin as donor sites. He was clinically examined and photo-documented before receiving the first laser treatment (Figure 1A). The physical examination showed unwanted hair growth on reconstructed auricular region (the right auricle). Dermoscopy examination revealed 147 vel- lus and terminal hairs (Figure 1B). Hairs were trimmed using a scissor immediately prior to laser therapy. The therapy session took place under topical anesthesia on the therapeutic area. A LP Nd:YAG with a wavelength of 1,064 nm was used. Appropriate parameters were chosen in accordance with Fitzpatrick skin type IV. A spot size of 6x6 mm, a fluence of 35 J/cm 2 , a pulse duration of 10 ms, and 1 Hz fre- quency with burnt of hair as an endpoint. The observation of epilation was performed at 11 days after the irradiation (Figure 1C). The post-treatment region was examined by dermoscopy and showed 46% reduction rate of unwanted hair (Figure 1D). There were no side effects such as inflammation, oedema, ulcer, scar, and folliculitis of the epilated skin after irradiation. Case #2 A 18-year-old female complaint with an excessive hair growth on the left ear. The patient had undergone stage I-II auricular reconstruction using the Nagata technique, with obvious hair growth in helix area of the reconstructed auricle two weeks after the surgery. She was referred to our department for opinion regarding hair removal at this unusual site. The skin of the scalp was used as a donor site. The physical examination of the left ear showed long, thick, and coarse hairs (Figure 2A). Dermoscopy examina- tion revealed 152 vellus and terminal hairs (Figure 2B). The patient had Fitzpatrick Dermatology Reports 2019; volume 11(s1):8076 Correspondence: Erika Dewi Essary, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung 40161 Indonesia. Tel.: +62222032426 ext. 3449. E-mail: dr.erika1@gmail.com Acknowledgments: The authors would like to extend our gratitude to the staff of the Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran who contributed to this work. Key words: Auricular reconstruction; hair removal; microtia; Nd:YAG; unwanted hair Contributions: All the authors contributed equally. Conflict of interests: the authors declare no potential conflict of interest. Funding sources: None Received for publication: 1 February 2019. Accepted for publication: 20 February 2019. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). ©Copyright K. Ruchiatan et al., 2019 Licensee PAGEPress, Italy Dermatology Reports 2019; 11(s1):8076 doi:10.4081/dr.2019.8076 Non-commercial use only