The ‘Gopher Sign’: A Clinical Sign to Determine the Adequate Depth of CO2 Laser Ablation in Rhinophyma

The CO2 lasers are widely used for laser ablation of rhinophyma. For the treatment to be successful, it is essential to control the depth of the epidermal vaporization with limited damage to papillary dermis.1 Poor recognition of adequate depth and inappropriate selection of energy delivered with CO2 lasers can lead to hypertrophic scarring and delayed wound healing.2 In this article we describe the new ‘Gopher Sign’; a clinical sign to assist an operator in determining the adequate depth of CO2 laser treatment of rhinophyma. A case of 80 year old gentleman with moderate rhinophyma is presented and the ‘Gopher Sign’ demonstrated. The patient underwent treatment with CO2 laser (Lumenis, Santa Clara, California) aided by use of the plume evacuator. The main bulk of the rhinophyma was ablated using a 2 mm ‘True Spot’ hand piece on Continuous Wave settings; which started at 12 Watts. A layer by layer technique was used and the energy was progressively lowered to maintain the control and minimize potential of over reduction and scarring. After two or three passes visible expression of the contents of the dilated glands is observed as illustrated in Figure 1.