Fractional CO₂ laser treatment of post-surgical nasal scars: a retrospective analysis on 8 patients

Surgical scars of the nasal region following basal cell carcinoma (BCC) excision often present aesthetic and functional challenges, particularly the "trap-door" deformity related to flap reconstruction. Fractional CO₂ laser represents a promising therapeutic option to improve scar quality through collagen remodeling and dermal reorganization. This retrospective study analysed eight patients (six males and two females, mean age 71 ± 10 years) with nasal post-surgical scars after BCC excision and flap reconstruction. All patients underwent two sessions of fractional CO₂ laser in Deep Pulse or High Pulse modes, with a two-month interval between treatments. Clinical outcomes were evaluated using the Patient and Observer Scar Assessment Scale (POSAS) and three-dimensional profilometry with the Antera 3D system before treatment and two months after the last session. A statistically significant improvement was observed in both patient-reported (overall opinion p = 0.0007; thickness p = 0.03) and observer-reported parameters (vascularity p = 0.007; thickness p = 0.005; pliability p = 0.02; overall opinion p = 0.00004). Antera 3D analysis showed a mean reduction in scar depression of 23.5% (p = 0.01). All patients developed transient erythema and edema that were resolved within a week. Fractional CO₂ laser proved to be a safe and effective method to improve nasal post-surgical scars, enhancing texture, vascularity, and contour.