Multispectral Imaging and OCT-Guided Precision Treatment of Rhinophyma with CO₂ and Dye Lasers: A Comprehensive Diagnostic and Therapeutic Approach

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is an interesting study, using novel and expensive modalities to tailor-treat rinophyma. Optical coherence tomography (OCT) is a non-invasive optical imaging technique that uses low-power infrared laser light to image up to 2 mm beneath the skin surface. OCT is used to determine the primary vascular or fibrous component of rhinophyma, then dye or CO2 laser is applied. 

Overall, I like the study and the results. Figures 9-11 convey little information and might be omitted. A limitations section is notably missing from the discussion. Availability of OCT, dye and CO2 laser is not common in dermatology departments even in developed countries. Rhinophyma is a rare disorder; presented results are promising; but to obtain the modalities in any dermatology department is costly. Then referring rhinophyma patients to more distant departments that would have the means used herein, would also be a concern, given the benign character of the disease. 

Author Response

The lines discussing rosacea have been removed, as well as Figures 9 and 10, and certain sections have been omitted to streamline the manuscript. The wavelengths of the different lasers have been added at the beginning of the document. In the Materials and Methods section, an explanation has been included on when the fractional mode is used, along with the parameters applied. Additionally, the manufacturer’s name, city, and country for the various devices have been provided. Regarding conscious sedation, ECG, and arterial monitoring, these measures are essential for safety during nasal pyramid ablation, as removing several centimeters of tissue can involve significant pain and bleeding. For these reasons, these monitoring methods are crucial for ensuring patient safety.

Reviewer 2 Report

Comments and Suggestions for Authors

This is a nicely done study to analyze and document real time changes in skin after PDL/CO2 lasers

I suggest following:

 Remove paragraph on page 2, Line 72-79. The manuscript is about treatment of Rhinophyma and not medical management of Rosacea

Overall manuscript is too long and repetitive. It can be shortened

Please add manufacturer’s name, city and country of all the devices and products used

In the beginning of the manuscript add wavelengths of PDL, CO2 lasers

Was CO2 laser always used in Fractional/pulsed mode, or it was also used in CW/full ablative mode? Please add CO2 laser parameters, spot size, rep rate, number of passes, etc.

Why was it necessary to use conscious sedation, ECG and arterial monitoring?

Page 13, Line 363: Also add full ablative CO2 laser treatment of Rhinophyma

Author Response

The lines discussing rosacea have been removed, as well as Figures 9 and 10, and certain sections have been omitted to streamline the manuscript. The wavelengths of the different lasers have been added at the beginning of the document. In the Materials and Methods section, an explanation has been included on when the fractional mode is used, along with the parameters applied. Additionally, the manufacturer’s name, city, and country for the various devices have been provided. Regarding conscious sedation, ECG, and arterial monitoring, these measures are essential for safety during nasal pyramid ablation, as removing several centimeters of tissue can involve significant pain and bleeding. For these reasons, these monitoring methods are crucial for ensuring patient safety.