The Z-plasty procedure is composed of a double transposition flap to surgically correct scar orientation, and new lines can be made with Z-plasty in respect to relaxed skin tension lines (1). However, new postoperative scars made by Z-plasty are usually longer in length, and additional new scar lines are inevitably created (Figure 1A). Satisfactory treatment outcomes can be expected only after well-planned and/or mul- tiple Z-plasties by experienced surgeons. In addition, because scars mature spontaneously in the range of 6–12 months, surgical scar revision is usually per- formed more than 3 months following injury.

Scar revision procedures are aimed to optimize the appearance of scars and to improve skin texture. The use of laser devices as a nonsurgical scar revision method allows many scars to be treated during early postoperative periods. In this report, we briefly introduce a nonsurgical scar revision technique, the pinhole method, using a 10,600-nm car- bon dioxide (CO₂) laser for the treatment of poorly oriented scars.

We performed three sessions of CO₂ laser treatments with settings of super pulse mode, 2.0 W in intervals of 4–8 weeks for each case.Topical application of EMLA cream was used for local anesthesia one hour prior to the procedure. Then, multiple holes were made at intervals of 1–3 mm using a CO₂ laser on the poorly oriented scars. Hydrocolloid dressing was applied to the treated areas for one week. Posttherapy transient erythema and crusting are spontaneously resolved along with clinical improvements (Figures 2 and 3).

Figure 1. Poorly oriented scar on the wrist, which developed at the age of 21, in a 33-year-old man (A) before and (B) two months after two sessions of scar revision by the pinhole method using a 10,600-nm carbon dioxide laser.

Figure 2. Poorly oriented scar on the forehead, which developed at the age of 15, in a 34-year-old woman (A) before and (B) two months after two sessions of scar revision by the pinhole method using a 10,600-nm carbon dioxide laser.