Combined Nonablative Fractional Laser and Surgical Debulking for Facial Hidradenitis Suppurativa

To report a novel, multimodal approach using nonablative fractional laser (NAFL) therapy followed by surgical debulking to treat disfiguring facial scarring secondary to hidradenitis suppurativa (HS) in a patient with skin of color.

A 33-year-old man with a history of severe HS presented with extensive cribriform scarring involving the bilateral cheeks, temples and mandibular areas. After medical optimization, he underwent 3 monthly sessions of 1540 nm NAFL (Palomar Starlux) followed by conservative surgical debulking of residual hypertrophic tissue.

At 1-month follow-up, the patient demonstrated marked clinical improvement in scar texture, pigmentation, and contour with no adverse effects. Compared to baseline, there was a notable reduction in hypertrophy, flattening of papillomatous lesions, and improved cosmesis overall. Importantly, the patient also reported a significant improvement in pain and quality of life.

This case illustrates the safety and efficacy of NAFL in combination with surgical debulking for scar remodeling in HS, particularly in patients with skin of color, for whom laser therapies are often underutilized out of concern for post-treatment dyspigmentation.