What are the recommended CO2 (carbon dioxide) laser settings for treating Rhinophyma using a Candela device?

CO2 Laser Settings for Rhinophyma Treatment with Candela Device

For treating rhinophyma with a CO2 laser Candela device, use settings of 35-50 J/cm² with a 10-ms pulse duration for patients with Fitzpatrick skin types I-III, and 25-40 J/cm² with a 20-ms pulse duration for patients with skin types IV-VI. 1

Optimal Treatment Parameters

• For continuous mode CO2 laser treatment (often used for debulking larger rhinophymas), use 10-20 W with a defocused 2-3 mm beam 2
• For scanner-assisted treatment (used for reshaping nasal contours), use a 4-7 mm spot at 20-40 W 2
• When using fractional ablative CO2 laser for milder cases, aggressive parameters of up to 70 mJ and 70% density with 16-18 passes have shown good results 3
• Target endpoint should be delayed post-treatment perifollicular erythema and/or edema for effective tissue ablation 1

Treatment Approach Based on Severity

• For mild rhinophyma:

  • Consider fractional CO2 laser treatment with settings of 70 mJ, 70% density, and multiple passes (16-18) 3, 4
  • This approach offers faster healing times with fewer adverse events while still providing good cosmetic outcomes 3

• For moderate to severe rhinophyma:

  • Use continuous mode CO2 laser for initial debulking (10-20 W, defocused 2-3 mm beam) 2
  • Follow with scanner mode for reshaping and contouring (4-7 mm spot, 20-40 W) 2
  • Consider multiple sessions for optimal results in severe cases 5

Treatment Protocol

• Administer appropriate anesthesia (1% lidocaine with epinephrine for regional perinasal nerve block) 3
• Consider HSV prophylaxis with acyclovir 400 mg TID or valacyclovir 500 mg BID 3
• Begin treatment with the appropriate mode based on severity assessment 2
• For optimal results, include a margin of approximately 1 cm of normal skin in the treatment field 1
• Allow re-epithelialization to occur naturally (typically 4-7 days) 3

Expected Outcomes and Follow-up

• Expect complete re-epithelialization within 4-7 days post-treatment 3
• Self-limited edema and erythema are normal in the immediate post-treatment period 3
• Schedule follow-up at 3 months to assess results 2
• Scanner-assisted CO2 laser treatment has shown only 1.1% recurrence in long-term follow-up studies 6

Potential Complications and Considerations

• Main complications include pain during anesthetic injection, scarring, hypopigmentation (in approximately 3% of patients), and visible open pores 2
• Traditional CO2 resurfacing may result in a shiny, scarred appearance with patulous pores and loss of pigmentation; fractional approaches may reduce these risks 3
• For patients with significant telangiectasia, consider combination therapy with pulsed dye laser after CO2 treatment for optimal cosmetic results 7