Secondary Intention Healing of Extensive Nasal Defects: A Multimodal Approach to Optimize Esthetic Outcomes

Introduction: Secondary intention healing (SIH) in the nasal region yields variable cosmetic results depending on the involved subunit. We report a case of a recurrent sclerodermiform basal cell carcinoma (BCC) resulting in an extensive surgical defect involving multiple subunits of the nose, eyelid, and cheek, traditionally requiring complex multistage flap reconstruction, successfully managed with SIH followed by a combination of laser technologies. Case presentation: A 75-year-old male with recurrent sclerodermiform BCC underwent excision resulting in a large facial defect affecting multiple nasal, eyelid, and cheek subunits. The wound was managed with SIH supported by sequential use of advanced dressings. After several weeks, the patient developed a small hypertrophic scar along the lateral nasal sidewall and malar region. A combined protocol using intense pulsed light (IPL), a fractional ablative erbium laser, and 5-fluorouracil (5-FU) drug delivery resulted in progressive remodeling and complete clinical resolution of the hypertrophic component, yielding a nearly imperceptible scar. Discussion: Early postoperative intervention with a multimodal laser approach may significantly enhance cosmetic outcomes following SIH, even in extensive defects involving multiple facial subunits. This case illustrates the potential of combined laser technologies and 5-FU as a minimally invasive strategy to optimize scarring and reduce the need for complex reconstructive surgery.