A punch biopsy specimen was obtained from the frontal cicatricial scalp of patient 1, and immunohistochemical staining, using anti-human CD31 antibody (BD Pharmingen, San Jose, Calif), showed poor vascular density in sclerotic tissue (Figure 2A). Two designated frontal alopecic regions were selected; one was pretreated with a carbon dioxide laser (hereinafter, pretreated area), and the other was left untreated as a control area. To create thermal injury in 3-dimensional patterns, round serial 1.0-mm holes were created by ablation using a collimated handpiece, about 3 to 5 mm deep into the skin, with a high-energy, ultrapulse carbon dioxide laser (model 1000U; SNJ Co, Seoul, South Korea). A continuous-wave beam with a pattern density spacing of 5-mm hole-to-hole distance and a pulse energy of 400 mJ was delivered for all applications at a frequency of 100 Hz. Clinical relevance was assessed at 1-month intervals. Two months later, the pretreated area became pinkish, with widened dimples resulting from the previously laser-drilled holes (Figure 3A). Immunohistochemical analysis of a subsequent biopsy sample showed a marked increase in vasculature (Figure 2B).