ORIGINAL ARTICLE Laser hair removal following forehead flap for nasal reconstruction Cheng-I Yen 1 & Cheng-Jen Chang 2 & Chun-Shin Chang 1 & Hung-Chang Chen 1 & Mei-Hua Chien 3 & Yen-Chang Hsiao 1 Received: 20 May 2019 /Accepted: 12 January 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020 Abstract The forehead flap is a dependable option for nasal reconstruction owing to its reliability and anatomic likeness to nasal skin. For patients with low hairlines, the vertical design of the paramedian forehead flap can intrude into the scalp, thus incorporating hair into the nasal reconstruction. The inadequate length of the forehead flap or shift to an oblique design may result in eyebrow elevation and asymmetry. Therefore, laser hair removal (epilation) on the forehead flap has been proposed to improve esthetic results. An alexandrite laser (755 nm, 10 to 20 ms, 18-mm spot size) with a Dynamic Cooling Device ™ (DCD ™ ) cooling system was used for hair removal in 22 patients (16 male and 6 female patients) after nasal reconstructions using forehead flaps from December 2011 to September 2016. All patients received cryogen spray cooling laser treatment (CSC-LT). The mean follow-up period was 24 months, with a range between 18 and 50 months. The average duration of treatment was 1.8 months (range, 1– 5 months). The energy density ranged from 14 to 18 J/cm 2 with an average of 17.2 J/cm 2 . The number of treatments ranged from 2 to 4 (mean 2.8). Patients had satisfactory esthetic results over 11.1 months (range, 8–18 months). Residual white hairs were observed in 3 patients, and 4 patients had tiny black residual hairs without deteriorating cosmesis. Using an alexandrite laser to remove hair on the forehead is safe and reliable in nasal reconstruction with superior recipient site cosmesis. Keywords Laser . Hair removal . Epilation . Forehead flap . Nasal reconstruction Introduction The nose is a psychologically significant and central facial structure with intricate esthetic and functional features. Nasal reconstruction can be a challenge for the plastic surgeons. The forehead is a dependable option for dorsal resurfacing because of its reliability and anatomic likeness to nasal skin [1–5]. However, extending the paramedian forehead flap to the lower nose and columella is challenging in numerous patients, particularly in those with low hairlines or long noses with more distal defects [4, 6, 7]. For patients with a vertically short forehead, the vertical design of the paramedian forehead flap can sometimes intrude into the scalp, thus incorporating hair into the nasal reconstruction [4, 6, 7]. Persistent hair growth may lead to unfavorable esthetic outcomes and potential psy- chosocial consequences; it is traditionally considered a thera- peutic challenge [4, 6–8]. When possible, it is preferable to avoid the transposition of terminal scalp hairs to the nose. Therefore, some surgeons are hesitant to utilize an adequate length of the forehead or shift to using an oblique or cross- midline design that will result in difficulties in donor site clo- sure or elevation and asymmetry of the eyebrows [6]. The persistent hair growth can be bothersome to patients. We tried to remove the hair at every operation but some patients still have to remove or trim the hair on the reconstructed nose every 4–6 weeks, which causes pain and inconvenience. Laser epilation is an efficient method of hair removal for hir- sutism and hypertrichosis, but it has rarely been reported in reconstructive surgery [8, 9]. Only a few applications in intraoral flaps following head and neck cancer reconstruction as well as microtia reconstruction have been demonstrated in the literature [8–12]. In this article, we report for the first time Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10103-020-02965-9) contains supplementary material, which is available to authorized users. * Yen-Chang Hsiao b8301063@gmail.com 1 Department of Plastic and Reconstructive Surgery, Chang Gung Aesthetic Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan 2 Department of Surgery, School of Medicine, College of Medicine, and Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan 3 Burn Center, Chang Gung Memorial Hospital, Linkou, Taiwan Lasers in Medical Science https://doi.org/10.1007/s10103-020-02965-9