Photorejuvenation

Evaluation of short-term face rejuvenation effects of non-ablative bipolar radiofrequency treatment performed by Med-RF© device

OBJECTIVE

Skin laxity and wrinkling are common signs of the aging process. This physiological condition of the skin is often accompanied by psychological and social concerns, especially for females, entailing considerable expenses for cosmetics and pharmaceuticals to cease or slow down its advancement. The objective of this study was to evaluate the short-term impact of a new non-ablative radiofrequency device available in the skin face cosmetic field.

METHODS

A randomized study was run on 62 healthy subjects with normal-age related-grade skin laxity, subdivided into two groups. Group 1 received one treatment with Modula RF device (Wavemed, San Cesareo RM, Italy) over the whole face surface. Group 2 received three monthly treatments.

RESULTS

Clinical improvements of the exposed areas were detected by measuring skin parameters, such as total water content, elasticity, and sebum levels at baseline and 1 h after the treatment. Data showed significant effects of Med-RF treatment on skin hydration (p < 0.001), skin elasticity (p < 0.0001), and sebum (p = 0.0009). Moreover, a negative linear correlation was obtained between women's age and hydration.

CONCLUSION

In conclusion, the results of this study suggest that radiofrequency significantly improves the subjective and objective judgment of patients and doctors, supported by the positive results obtained on the skin quality parameters evaluated. These results confirm that Med-RF technology represents an important tool to achieve face rejuvenation in the field of non-invasive procedures.

Efficacy and Safety of Monopolar Radiofrequency for Treatment of Lower Facial Laxity in Asians

INTRODUCTION

Monopolar radiofrequency (MRF) is a valuable modality for tightening and contouring mild-to-moderate facial skin laxity. Few studies have evaluated new-generation MRF devices for lower facial laxity in Asians. This study aims to evaluate the efficacy and safety of MRF for treating lower facial laxity in Asians.

METHODS

This prospective cohort study enrolled 30 volunteers with Fitzpatrick Skin Types III-V and mild-to-moderate skin laxity. Subjects received a single MRF treatment. Self-assessments and adverse events were recorded. Two blinded dermatologists graded improvements (6-point scale) after treatment and 1, 3, and 6 months later.

RESULTS

All subjects completed the study. Treatment energy levels ranged from 2 to 4. The average number of shots was 412 ± 49, delivered in 3-4 passes with 15-30% overlap. All patients reported improvement in lower facial laxity immediately after treatment. Most patients had mild-to-moderate improvement over the 6-month follow-up. Continuous improvement was observed at the 1-, 3-, and 6-month follow-ups (P < 0.01). Significant improvement was seen at the 6-month follow-up compared with the 1-month follow-up (P < 0.01). Subjects tolerated the procedure well: the average pain score was 3.13 out of 10, and no serious adverse events were observed.

CONCLUSIONS

The new-generation MRF device we tested was effective and safe for mild-to-moderate lower facial laxity in Asian skin. The latest MRF technology offers improved safety to prevent complications. Appropriate patient selection, setting, and protocols are mandatory to achieve optimal clinical outcomes.

THE TRIAL REGISTRATION NUMBER

TCTR20210326002.

Quantitative evaluation of collagen and elastic fibers after intense pulsed light treatment of mouse skin

BACKGROUND AND OBJECTIVE

The aging of human skin includes intrinsic aging and photo-aging, which are characterized by a decrease in collagen and the deposition of abnormal elastic fibers. Intense pulsed light (IPL) sources are widely used in medicine to treat various cosmetic problems, including photo-damaged skin. Few studies have examined the microscopic changes produced by IPL. The objective of this study was to quantitatively evaluate the effects of IPL on collagen and elastic fibers in mice.

MATERIALS AND METHODS

Forty female BALB/c mice were divided into four subgroups. Group 1 was the control group (n = 10), and groups 2, 3, and 4 were treatment groups (n = 10 in each group). Group 2 received one treatment, group 3 received two treatments, and group 4 received three treatments every 2 weeks. Skin tissue was obtained from irradiated areas 24 hours after the last treatment in each mouse. Collagen fibers were identified using the picrosirius red method. Elastic fibers were marked by Weigert-oxone stain. All samples were analyzed and quantified by a light microscope using analyzer system images.

RESULTS

Group 4, which received three IPL treatments, showed significant quantitative increases in both collagen fibers (P < 0.05) and elastic fibers (P < 0.01). Collagen fibers demonstrated a better parallel distribution in relation to the epidermis.

CONCLUSION

IPL treatment significantly increased the number of collagen and elastic fibers within the dermis and improved the parallel distribution of collagen fibers in relation to the epidermis. These results were evident after three IPL treatments. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.

Combination Therapy in Midfacial Rejuvenation

BACKGROUND

Facial aging in the midface reflects cumulative results of multiple intrinsic and extrinsic factors over time. Midfacial rejuvenation procedures can make a positive impact on facial attractiveness and patient satisfaction.

OBJECTIVE

To review evidence and clinical experience using combination treatments for midfacial rejuvenation to achieve optimal outcomes.

MATERIALS AND METHODS

This article provides a review of published scientific evidence supporting the use of combination therapy in midfacial rejuvenation. In addition, the authors share their cumulative clinical experience and best practices for combination treatments in the midface.

RESULTS

Clinical experience and evidence shows that combining multiple aesthetic therapies targeting multiple aspects of the aging process provides optimal results, with greater overall efficacy and a higher level of patient satisfaction.

Will nonablative rejuvenation replace ablative lasers? Facts and controversies

Since the early 1980s, the field of skin rejuvenation has evolved rapidly. Traditional ablative resurfacing with carbon dioxide and Er:YAG lasers offered dramatic improvement of the skin tone and texture, but prolonged postoperative period and an increased risk for side effects and complications were unacceptable for the majority of patients. It prompted the development of nonablative lasers and non-laser systems, which stimulate dermal neocollagenesis without epidermal disruption, and therefore, produce less adverse effects with little or no healing time. Recently, fractional nonablative and ablative lasers have been introduced, employing a completely new concept of fractional photothermolysis, which ensures high efficacy and fewer risks. Ablative laser resurfacing still remains the gold standard for treating advanced and severe photoaging providing excellent results in experienced hands. Alternatively, ablative fractional resurfacing can be used, with the results, which are comparable to fully ablative lasers with better standard of safety. Nonablative resurfacing is ideal for patients under the age of 50 years with minimal facial sagging, and for those who are unwilling to undergo expensive and demanding ablative procedures. It can be concluded that the key of therapeutic success is in proper patient selection, setting appropriate expectations and combining different rejuvenation technologies with other therapeutic modalities, such as botulinum toxin and fillers.

Expression of p53 protein after nonablative rejuvenation: the other side of the coin

BACKGROUND

Disturbance of p53 expression may play an important role in the pathogenesis of ultraviolet (UV) light-induced skin cancer as well as photoaging.

OBJECTIVES

To objectively evaluate the potential effect of nonablative facial rejuvenation on p53 expression.

PARTICIPANTS AND METHODS

Thirty patients with Fitzpatrick skin type III to IV were divided into five groups. Each group underwent a different nonablative modality: radiofrequency (RF), intense pulsed light (IPL), electro-optical synergy (ELOS) (combined RF and IPL), 1,320-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and 2,940-nm erbium-doped (Er):YAG laser minipeel. Skin biopsies were obtained before treatment, by the end of treatment, and 3 months after treatment. Biopsies were also taken from 30 controls. Quantitative evaluation of p53 was performed using computer image analysis for immunostained tissues.

RESULTS

P53 expression was statistically significantly greater at the end of IPL (p = .02) and ELOS (p = .02) treatments than before treatment but was statistically insignificantly lower (p > .05) 3 months after treatment than at the end of treatment. No significant differences (p > .05) were observed in p53 level after RF, 1,320-nm Nd:YAG, and 2,940-nm Er:YAG mini-peel treatments from baseline.

CONCLUSIONS

The increase in epidermal p53 expression after IPL treatment could increase the risk of skin neoplasia by intense pulsed light-induced DNA damage which may lead to dysregulation of apoptosis and initiation of skin cancer.

Laser light activation of a second-generation photosensitiser and its use as a potential photomodulatory agent in skin rejuvenation

Photodynamic rejuvenation therapy (PDRT) is a growing field in cosmetic dermatology. In this study, different sources of light (a yellow laser, a red laser and ultraviolet A (UVA) lamps) were used to activate a second-generation photosensitiser, hypericin. Uptake of hypericin was monitored over 24 h and efficacy of PDRT was assessed using cell viability and reactive oxygen species (ROS) quantification assays. In addition, we show for the first time, a quantifiable assay for ROS production in human dermal fibroblasts incubated with hypericin and exposed to yellow laser light or UVA lamps. Furthermore, we optimised a protocol with regard to hypericin concentration and irradiation parameters using the XTT cell viability kit. This study showed that this photosensitiser, hypericin, was taken up by the cells in a concentration-dependent manner over 24 h with cell saturation occurring after approximately 16 h. The uptake seemed to be localised to the cell cytoplasm with no hypericin appearing in the nucleus. The levels of ROS increased in the cell when irradiated with the yellow laser (561 nm) however, it did not increase further with the addition of hypericin. Hypericin and UVA showed a significant increase in the amount of ROS produced. The results also show that cell viability is not affected by low power light (2 mW) from the yellow laser irrespective of the dose used. However, an increase to 10 mW power with 5 J/cm(2) light dose, resulted in a significant drop (p < 0.05) in cell viability at both 0.5 (77.53 ± 9.67 %) and 1 μM (48.51 ± 13.27 %) hypericin concentrations. In contrast, a 20 % increase in cell viability was seen with 1 J/cm(2) and 20 mW and 0.25 μM hypericin. Overall, this study highlights an optimised protocol for hypericin-induced photorejuvenative therapy using laser light and proposes that parameters of 0.25 μM hypericin as a photosensitiser activated via a dosage of 1 J/cm(2) yellow laser light produces an effective in vitro outcome to be considered as an important contribution towards optimising PDRT.

Effects of the Nd:YAG 1320-nm laser on skin rejuvenation: clinical and histological correlations

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is a popular non-ablative treatment used for skin rejuvenation. The purpose of this prospective study was to evaluate the clinical effects, coupled with a quantitative assessment, of the histological changes in response to Nd:YAG 1320-nm laser treatment of periocular wrinkles. Six volunteers with Fitzpatrick skin types III and IV and Glogau class I-II wrinkles were subjected to 3 months of Nd:YAG 1320-nm treatment in the periocular area (six sessions at 2-week intervals). Volunteers were photographed, and skin biopsies were obtained at baseline as well as 3 and 6 months after the start of treatments. Quantitative evaluation of total elastin, newly synthesized tropoelastin, collagen types I, III and VII, and newly synthesized collagen was performed using a computerized morphometric analysis. A noticeable clinical and histological improvement was observed after Nd:YAG 1320-nm treatment. Collagen types I, III and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased after treatment. Our data suggest that Nd:YAG 1320 nm is an effective treatment for skin rejuvenation as it stimulates the repair processes, and reverses the clinical, as well as the histopathological, signs of skin aging.