Few passes of CO₂ laser to aid to remove foreign body under skin

Dear Sir,

CO₂ laser (10600 nm) is considered gold standard for cutaneous resurfacing as it’s absorption is well-suited for water in the skin tissue (70% of total skin tissue contains water). Before the advent of fractional ablation, thermal destruction of tissue was more and leads to scarring and fibrosis.^[1] Now, with newer technology of fractional photothermolysis, we can have magical result with minimum side effects. Cutaneous resurfacing in India is mainly used for photodamaged and acne scarred skin. It is also used to remove many epidermal and dermal lesions.^[2] Although satisfaction with CO₂ laser is high; yet, side effects are also not less. In 1^st weeks, chance of postoperative erythema and infection is high. Chance of scarring, fibrosis, and depigmentation is also raised when increase fluence or higher concentration of fractional CO₂ is used. Depth of penetration and dermal necrosis is also found to be high.^[3]

Here, we report a case of traumatic scar where CO₂ laser used in an interesting way. One male patient of 29 years of age presented to us with a scar tissue of 6 years old over left forehead just above the eyebrow. On examination, it was an elevated, firm, and irregular scar tissue measuring 2.5 cm in largest diameter [Figure 1]. Hence, we decided to perform CO₂ laser (Lumenis, fractional CO₂) with 17.5 j/cm², concentration 5% in a single pass. After 2 sitting in 1 month gap, we have noticed a peculiar thing. On palpation, a foreign body like sensation was felt subcutaneously just above the eye brow. On the 3^rd day of CO₂ laser, a broken glass piece came out on its own [Figures 2 and 3]. An old scar with foreign body, that was impalpable before, become prominent and superficial on resurfacing. By this, we probably avoided an ugly, less cosmetic incision unknowingly.

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Figure 1:

Old scar just above the left eyebrow.

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Figure 2:

Foreign body just after 3^rd CO₂ pass.

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Figure 3:

Foreign body (a broken glass piece).

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Few passes of CO₂ laser may be helpful over a cosmetic area to remove a foreign body from scarred or granulomatous lesion.