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The use of high energy light sources [laser, intense pulsed light (IPL)] is booming in aesthetic surgery. A trend, especially concerning usage of photoepilation in cosmetic institutes, is detectable. Photoepilation works through selective photothermolysis, by heating the chromophore melanin within the hair follicles. We present a case impressionably demonstrating that high-energy light demands profound knowledge of its mechanism of action, and can cause severe harm in absence of basic knowledge. Photoepilation is a balancing act between maximal therapeutic effect and minimal side effect risk. Nevertheless, complications have to be clearly distinguished from professional errors. The latter are rising especially with IPL devices, mainly because its use depicts a legal grey area in most of the countries and is not bound to physicians' supervision. Due to its worse risk-benefit profile as compared with that of laser therapy, we advise against the use of IPL devices and claim for stricter regulation of its use, similar to laser devices.

Regardless of the amount of tissue removed, no main risk factor for complications could be identified. A complication-free course and good outcome can be best achieved with careful patient selection and preoperative planning.

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Metoidioplasty represents a viable option for female-to-male transsexual patients seeking gender reassignment surgery. The aim of this procedure is to create a microphallus with lengthening of the urethra to the tip of the hypertrophied and released clitoris. However, fistula formation and urethral obstruction might occur in the long term and reconstruction represents a challenging problem in this setting. In this report, we present the tubed superficial inferior epigastric artery perforator island flap as an option for urethral reconstruction after failed metoidioplasty in a female-to-male transsexual patient. In a 26-year-old transsexual patient a combination of urethral fistula, urethral stenosis, and disintegrated distal neourethra had developed as a consequence of postoperative hematoma formation. Metoidioplasty was reconstructed by means of a tubed, pedicled superficial inferior epigastric artery perforator flap from the left lower abdomen. The long-term result was stable with pleasing genital appearance, adequate functional outcome, and satisfactory donor site morbidity. In our opinion, this procedure may represent a viable alternative for urethral reconstruction in thin patients.

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The reconstruction of paranasal defects remains a challenge; nevertheless, the growing toolbox of reconstructive instruments facilitates a perfect reconstructive result.