Evaluating facial pores and skin texture after low-energy nonablative fractional 1440-nm laser treatments

Efficacy and Safety of 730-nm Picosecond Laser for the Treatment of Acquired Bilateral Nevus of Ota-like Macules

BACKGROUND

The effectiveness and safety of 730-nm picosecond laser for treating acquired bilateral nevus of Ota-like macules remain uncertain.

OBJECTIVE

This study aims to evaluate the potential benefits and risks of using the 730-nm picosecond laser for ABNOM removal.

METHODS

This is a retrospective review of patients who were presented to the clinic between January 2020 and January 2024 for the treatment of ABNOM with 730-nm picosecond laser alone. The efficacy of the laser was assessed based on the Quartile Improvement Scale, using high-resolution photographs evaluated by blinded dermatologists.

RESULTS

A total of 72 Chinese participants with Fitzpatrick skin types III to IV were included in the study. The overall effective rate of the treatment was 75%, achieved after an average of 2.42 ± 0.75 sessions. A subgroup analysis of 41 patients who completed 3 treatment sessions showed statistically significant differences in outcomes across the sessions. The mean improvement scores for sessions 1, 2, and 3 were 1.63 ± 1.04, 2.66 ± 1.22, and 3.29 ± 1.17, respectively ( p < .01). No cases of hypopigmentation were observed. The incidence of postinflammatory hyperpigmentation was 5.56%.

CONCLUSION

The 730-nm picosecond laser is a safe and effective treatment for ABNOM in Chinese patients.

Comparison of Intense Pulsed Light With Nonablative Fractional Laser and Picosecond Alexandrite Laser With Diffractive Lens Array for Noninvasive Facial Rejuvenation

BACKGROUND

Both nonablative fractional (NAFL) laser combined with intense pulsed light (IPL) and picosecond alexandrite laser (PSAL) with diffractive lens array (DLA) have been documented for their efficacy in facial rejuvenation.

OBJECTIVE

To observe the safety and efficacy of PSAL-DLA and IPL-NAFL in the rejuvenation of Chinese individuals.

METHODS

Each subject (n = 18) received three treatments on half of their face, with 1-month interval between treatments. One side of the face was randomly treated with PSAL-DLA, and the other side with IPL-NAFL. Quantitative data of wrinkles, pores, brown spots, and red areas were calculated using the VISIA-CR imaging system 3 months after the final treatment. Secondary outcomes included a 10-point VAS for patient-rated pain sensation, incidence of post-inflammatory hyperpigmentation (PIH), erythema and edema, and overall satisfaction. Adverse events were recorded after each treatment and at each follow-up.

RESULTS

A total of 17 Chinese female patients aged 28.2 ± 4.3 years completed the study and the 3-month follow-up. The IPL-NAFL side showed a statistically significant improvement in pores compared to baseline (p < 0.05); the PSAL-DLA side showed a statistically significant improvement in brown spots compared to baseline (p < 0.01). Compared to PSAL-DLA, the improvement in enlarged pores was better for IPL-NAFL (81.8 ± 128.1 vs. 20.8 ± 132.4, p < 0.01). In terms of pain, IPL-NAFL was more painful than PSAL-DLA (6 ± 1 vs. 4 ± 1, p < 0.01), a longer recovery time for erythema and edema (5 ± 1 vs. 2 ± 1, p < 0.001), and a higher incidence of PIH (58.8% vs. 23.5%, p < 0.05). Patient satisfaction was higher for PSAL-DLA than for IPL-NAFL (3 ± 1 vs. 4 ± 0.5, p < 0.01).

CONCLUSION

Our study results indicated that both IPL-NAFL and PSAL-DLA could improve the photoaging, but within the same number of treatments, IPL-NAFL was slightly more effective for enlarged pores than PSAL-DLA, while PSAL-DLA was more effective for brown spots than IPL-NAFL. Patients were more satisfied with PSAL-DLA, with a shorter postoperative recovery period and a lower incidence of PIH.

The History and Advancement of Light, Lasers, and Energy-Based Devices in Dermatologic Surgery

BACKGROUND

From the theoretical foundations of laser and energy-based applications for the skin to the development of advanced medical devices, the field of dermatologic surgery has undergone transformative changes.

OBJECTIVE

To review the scientific and clinical advancement of laser and energy-based therapies within dermatologic surgery.

MATERIALS AND METHODS

A literature search was conducted to identify important scientific advancements and landmark studies on light, laser, and energy-based devices within the field of dermatologic surgery.

RESULTS

Since the introduction of selective photothermolysis principles in the 1980s, numerous laser and energy-based devices have been developed to effectively treat vascular lesions, target pigmentation, remove tattoos, rejuvenate the skin, and remove hair. Beyond aesthetic applications, photodynamic therapy was introduced to treat various neoplastic and inflammatory conditions. Lasers have also been employed to enhance transcutaneous drug delivery, and new lasers continue to emerge for treating common inflammatory conditions, such as acne. These innovations have contributed to a paradigm shift toward safe and effective, but less invasive, procedure-based treatment in addressing medical and aesthetic concerns in dermatology.

CONCLUSION

Dermatologists have consistently led the way in the continuous development and innovative application of laser and energy-based devices to effectively address a variety of skin conditions.

Nonablative Fractional Diode Laser Resurfacing (1440 nm and 1927 nm) for Photoaged Skin

BACKGROUND

Nonablative lasers treat photoaged skin and stimulate new collagen formation while sparing epidermal damage.

OBJECTIVE

To evaluate the effectiveness and safety of nonablative fractional diode combination laser skin resurfacing treatment (1440 and 1927 nm) in mild-to-moderate photoaged skin.

MATERIALS AND METHODS

The entire face was treated with both 1440-nm and 1927-nm wavelengths per treatment, with a total of 4 treatments spaced 1 month apart. Follow-up occurred at 1 and 3 months post-treatment. Outcomes were improvement in the appearance of ≥1 measure of photodamage (rhytides, skin texture, dyschromia/pigment, skin radiance, pore size, and overall appearance) at the 3-month (primary) and 1-month (secondary) follow-up visits. Safety was monitored throughout the study.

RESULTS

Participants ( N = 28; 89% female; mean age, 40 years) experienced significant mean improvement from baseline in all measures of photodamage with combination laser treatment at 1 and 3 months post-treatment (all p < .001). No serious adverse events occurred. Post-treatment erythema and edema were minimal, and pain levels remained consistent throughout treatment. Most participants (96.4%) considered their overall appearance as improved and expressed satisfaction with treatment outcomes.

CONCLUSION

Nonablative combination laser skin resurfacing treatment was well tolerated and significantly improved measures of photodamage in photoaged skin across diverse skin types.

Application of integrated skincare in medical aesthetics: A literature review

Integrated skincare combines clinically proven skincare products with professional medical aesthetics to provide a comprehensive solution for beauty pursuers. Studies have demonstrated that a combination of medical aesthetic procedures and maintenance therapies is more effective than either treatment alone. This review outlines the current applications of integrated skincare, including different regimens of energy-based aesthetic devices and active ingredients in cosmeceuticals or chemical peels. Additionally, the benefits and limitations of integrated skincare are discussed. Lastly, this review highlights the potential for improved satisfaction and long-term maintenance of the desired outcomes through appropriate integrated skincare procedures.

Evaluation of 755-nm Picosecond Alexandrite Laser With a Focus Lens Array for the Treatment of Enlarged Facial Pores

OBJECTIVES

This study aims to evaluate the use of 755-nm picosecond alexandrite laser with a focus lens array to treat facial pores.

METHODS

Laser treatment was performed on 129 patients between January 2021 and October 2022. VISIA imaging system was used for photographic assessments, the total average number and pore index was calculated, the physicians' assessment score and patient satisfaction score were collected, and the incidence of disadvantage effects was also documented.

RESULTS

The mean patient age was 35.2±6.4 years (21-45 y). The total average number of facial pores was 1614.1±412.8, and the total average number decreased to 1262.6±356.2 three months after the last treatment. The pretreatment baseline of pore index was 26.1±4.5, while the pore index was 21.3±3.7 three months after the last treatment. The physicians' assessment score was 2.7 on the 0-to-4 scale, and patient satisfaction score was 3.5 on the 1-to-5 scale. There were no adverse events, such as hyperkeratosis, scarring, and hypo-or hyperpigmentation.

CONCLUSIONS

755-nm picosecond alexandrite laser with a focus lens array was safe and effective in the treatment of facial pores with relatively few unanticipated adverse events.

LEVEL OF EVIDENCE

Level IV-observational study without controls.

The mechanism and application of computer-assisted full facial skin imaging systems

Computer-assisted full facial imaging systems are currently among the most widely used skin analysis instruments in dermatology and medical cosmetology. These systems offer objective quantitative evaluation of facial skin conditions, and as they are non-invasive, play an important role in assessing dermatological conditions such as pigmentation, inflammation, vascular diseases, skin texture, the severity of ageing, and therapeutic follow-up. Although computer-assisted full facial imaging systems enable quantitative analysis in the scope of medical treatment and cosmetic evaluation, their results may considerably vary because of the influence of environmental and postural factors for improper operation. Furthermore, manual observation is sometimes necessary for experimental work for more accuracy, and familiarity with the imaging principles and application points is necessary to best apply this technique. This report aims to discuss and interpret these systems' imaging mechanisms and explore the primary issues with their application.

Neck and chest rejuvenation with fractional 1440 and 1927-nm low-powered diode laser

OBJECTIVES

Ultraviolet light and infrared radiation exposure to the chest and neck can result in photoaging changes, such as rhytids, skin roughness, and dyschromia, which can be treated with nonablative fractionated lasers. The low-powered fractionated 1440 and 1927-nm diode lasers have been shown to safely reduce facial photodamage. This study was conducted to investigate the safety and efficacy of a low-powered 1440 and 1927-nm nonablative fractionated diode laser in addressing photoaging symptoms, such as rhytids, skin roughness, and dyschromia, of the neck and chest.

METHODS

In a prospective, single-arm, nonrandomized study, a cohort of 24 adult female patients with photodamage to their neck and chest received four treatments to these areas, administered at 4-week intervals. Treatments consisted of four passes on high settings with the 1440 nm handpiece followed by four passes with the 1927 nm handpiece. Photographs were taken at each study visit. Study investigators graded wrinkle severity, texture, and mottled pigmentation of the treated area at baseline and follow-up visit, 3 months after the fourth treatment. Subjects also rated clinical improvement of their neck and chest, along with overall appearance. Blinded evaluators used baseline and follow-up photographs to quantify improvements of rhytids and hyperpigmentation of the neck and chest using a 6-point improvement scale.

RESULTS

Of the original cohort, 20 subjects completed all four treatments and 3-month follow-ups. The mean rhytid scores improved by 0.7 ± 1.0 for both neck and chest. Meanwhile, texture scores improved by 1.2 ± 0.4 for the neck and 1.4 ± 0.7 for the chest, with pigment scores improving by 0.5 ± 0.6 for the neck and 0.67 ± 0.7 for the chest. Statistical analysis using paired t-tests, performed on all pre- and posttreatment scores, revealed significant differences (p < 0.05) in wrinkle severity, skin texture, and pigmentation of the neck and chest posttreatment. The degree of improvement was consistent for both the neck and chest areas. Blinded evaluators graded clinical improvements in rhytids and pigmentation at 0.6 ± 1.0 and 0.8 ± 1.2 respectively, corresponding to mild improvement of both neck and chest.

CONCLUSIONS

A series of treatments with the nonablative low-energy fractional 1440 and 1927-nm diode laser appears to be safe and effective for improving rhytids, skin texture, and hyperpigmentation of the neck and chest.

Skin pore imaging using spectral-domain optical coherence tomography: a case report

Sebum is an important component of the skin that has attracted attention in many fields, including dermatology and cosmetics. Pore expansion due to sebum on the skin can lead to various problems. Therefore, it is necessary to analyze the morphological characteristics of sebum. In this study, we used optical coherence tomography (OCT) to evaluate facial sebum areas. We obtained the OCT maximum amplitude projection (MAP) image and a cross-sectional image of skin pores in the facial area. Subsequently, we detected the sebum in skin pores using the detection algorithm of the ImageJ software to quantitatively determine the size of randomly selected pores in the proposed MAP images. Additionally, the pore size was analyzed by acquiring images before and after facial sebum extraction. According to our research, facial sebum can be morphologically described using the OCT system. Since OCT imaging enables specific analysis of skin parameters, including pores and sebum, skin analysis employing OCT could be an effective method for further research.

Evaluation of 30% supramolecular salicylic acid followed by 1565-nm non-ablative fractional laser on facial acne and subsequent enlarged pores

The treatment of acne vulgaris and enlarged pore remains challenging. The 30% supramolecular salicylic acid (SSA) is a newly developed form of SA which affects pathogenic factors of acne. Non-ablative fractional laser (NAFL) promotes remodeling and decreases sebum excretion with minimal side effect. The current study was aimed to evaluate the sequential modality with 30% SSA followed by 1565-nm NAFL on facial acne and subsequent enlarged pores. A 20-week-duration prospective study was performed. Consecutive 4 sessions of 30% SSA treatment were conducted, at 2-week intervals. Two weeks after the last session of 30% SSA, 3 sessions of 1565-nm NAFL treatment were applied, at 4-week intervals. The noninvasive devices measured scores of red areas and pores, cuticle moisture, and sebum secretion. The main subjective evaluation was global acne grading system (GAGS). The side effects were recorded. Compared to baseline, the scores of red areas and pores, sebum secretion, and GAGS significantly decreased after series sessions of 30% SSA treatments (P < 0.05). The sequential application of 1565-nm NAFL maintained the good results (P < 0.05, comparing to baseline) and even further decreased the sebum secretion (P < 0.05, comparing to SSA). The cuticle moisture remained unchanged during whole period, and side effects including tingling sensation, pain, erythema, and edema were quickly reversible and acceptable. The significant improvements of acne and pores were produced by 30% SSA, and 1565-nm NAFL inhibited the sebum secretion and maintained the efficacies of 30% SSA. The sequential modality of 30% SSA followed by 1565-nm NAFL was an alternative choice for acne vulgaris companied with enlarged pores.

"The efficacy and adverse effects of treatment options for facial pores: A review article"

INTRODUCTION

Skin pores are enlarged openings of the pilosebaceous follicles that can be affected by age, gender, genetics, exposure to UV light, ethnicity, and sebum secretion. Many treatment modalities reduce facial pores' count and area, including oral and topical medications as well as different wavelengths of lasers. Finding a safe and cost-effective treatment protocol is necessary since facial pores are one of the main reasons for cosmetic complaints.

AIM

This review compares available treatment options for reducing facial pores' number and area according to the published clinical trials.

METHODS

A search on PubMed and Google Scholar was performed. Nineteen published clinical trials regarding treatment options for facial pores were included and reviewed based on the authors' clinical experience.

RESULTS

A total number of 591 cases (83.7% female) aged 18-80 years were included. Three assessment methods including digital imaging, physician assessment, and patient' satisfaction were used in the studies to evaluate the therapeutic efficacy of each modality. Furthermore, combining different modalities increased the efficacy of reducing pores' size and number. Mild, reversible burning and erythema were common side effects.

CONCLUSION

Multiple sessions and combination therapies improve facial pores' area and number. In young patients, the focus should be on controlling sebum production, while in older patients, the focus should be on rejuvenation in addition to the control of sebum production.

Treatment of striae albae with 1,550 nm Er: Glass vs. CO2 fractional laser: A self-controlled study

Objective

The objective of this study was to compare the efficacy and safety of fractional CO₂ laser and 1,550 nm Er: glass laser in the treatment for the patients with striae albae.

Methods

The female adults with striae albae in the abdomen for at least 12 months were recruited. After informed consent obtained, the patient received three treatments at 2-month intervals. The lesions on the left abdomen were treated with 10,600 nm CO₂ fractional laser and right side treated with 1,550 nm Er: glass fractional laser. The pictures were taken before each visit and 3 months after the final treatment. The criteria for the evaluations using a quartile grading scale were excellent (76-100%), good (51-75%), fair (26-50%), poor (1-25%), and no improvement (0%). The safety and efficacy of the two lasers were independently evaluated using before and after photographs by two dermatologists. In addition, the self-reports to investigate the pain and satisfaction from patients were also recorded.

Results

Totally, 27 cases were recruited, and 25 patients completed the treatments and follow-up. The excellent and good results (improvement of 51-100%) were achieved on the right abdomen in 84% of the patients, while 48% on the left site (p < 0.05). Hyper-pigmentation was seen in 20% of the patients assessed on the left abdomen and only in 8% on the right abdomen. During the treatments, average score of the pain on the right abdomen was 5.41 ± 2.13, which was higher than that on the left (4.19 ± 2.12) (p < 0.001). No permanent hyper-pigmentation was found on the both sides. Considering the whole treatments, the patients favored the modality used on the right side (80 vs. 68%, p < 0.05).

Conclusion

Compared with CO₂ fractional laser, 1,550 nm Er: glass fractional laser therapy provides the significantly better clinical outcomes and fewer side effects in the treatment of striae albae.

Limitations

The sample size and follow-up time were limited.

Low-fluence treatment with a novel fractionated 2,910-nm fiber laser improves photodamage

BACKGROUND

Facial rejuvenation by lasers that target water has been a mainstay of esthetic laser treatments for decades. Modern lasers more commonly treat a fraction of the skin surface using ablative, semi-ablative, or nonablative pulses.

METHODS

Twenty subjects with visible evidence of chronic photoaging on the face were enrolled in this study. All subjects received two full-face, single-pass treatments spaced 2 months apart with the superficial mode of a 2910 nm fiber laser with an estimated penetration depth of 10 μm, 25% coverage, delivered in a 15 mm × 15 mm square microbeam pattern. A blinded comparison of pretreatment and 3-month post-treatment images was performed. Evaluation of biopsy samples for laser-tissue effects was performed on three separate subjects and biopsies were harvested 1-day post-treatment, 1-week post-treatment, and 2-weeks post-treatment.

RESULTS

Blinded evaluation of digital images revealed an average improvement score of 25.1 ± 14.5 (mean ± SEM) or 25.1%, using an 11-point scale evaluating overall improvement in photoaging (p < 0.001). Post-treatment effects were limited to mild-to-moderate erythema and edema, and the pain was rated a 1.9 out of a maximum of 10. Histology demonstrated superficial changes in the stratum corneum and epidermis with dermal inflammation present at 1-day post-treatment and 1-week post-treatment, with a return to baseline at 2 weeks.

CONCLUSIONS

The 2910 nm fiber laser is safe and effective for improving mild photodamage, with minimal discomfort and downtime. Dermal inflammation results from very superficial epidermal injury and may contribute to clinical improvement.

Adverse Events of Nonablative Lasers and Energy-Based Therapies in Subjects with Fitzpatrick Skin Phototypes IV to VI: A Systematic Review and Meta-Analysis

BACKGROUND

Although there is an abundance of literature on nonablative laser and energy-based therapies for the management of skin conditions, adverse events are inconsistently addressed and range widely across studies. Fitzpatrick skin phototypes (SPTs) IV to VI are believed to be at higher risk.

OBJECTIVES

The aim of this study was to determine the types and rates of adverse events in nonablative laser and energy-based therapies among patients with SPTs IV to VI.

METHODS

Articles addressing nonablative laser and energy-based therapies for skin rejuvenation and acne scarring in patients with SPTs IV to VI that provided data on adverse events were included. The pooled prevalence of each adverse event was calculated. To determine whether age, treatment indication, SPT, and device type influenced incidence, subgroup and meta-regression analyses were performed. Heterogeneity was evaluated with the I2 statistic.

RESULTS

Forty-three studies were included in the meta-analysis. The sample size was 1654, and the median age of subjects was 39.4 years. The most common adverse events were postinflammatory hyperpigmentation (PIH) (rate, 8.1%) and prolonged erythema (rate, 0.6%). The rate of PIH was significantly higher for diode and erbium-doped lasers compared with intense pulsed light and radiofrequency. PIH correlated positively with SPT, laser density, and total energy delivered.

CONCLUSIONS

Although the overall rate of adverse events in nonablative laser and energy-based therapies for SPTs IV to VI is low, the incidence of PIH is not insignificant. Certain lasers, such as diode, Q-switched Nd:YAG, and erbium-doped lasers, tend to have higher rates of PIH, whereas intense pulsed light and radiofrequency have minimal risk. Higher SPTs and higher energy deliverance correlate positively with the incidence of PIH.

LEVEL OF EVIDENCE: 4

Quantitative assessment of the long-term efficacy and safety of a 1064-nm picosecond laser with fractionated microlens array in the treatment of enlarged pores in Asians: A case-control study

Background

Enlarged facial pores are one of the common skin signs of photoaging that patients seek treatment for. However, objective data and long‐term assessment on the efficacy and safety of therapeutic procedures for this condition are limited.

Objective

To objectively evaluate the efficacy and safety of a 1064‐nm picosecond laser with microlens array (MLA) for pore tightening.

Methods

Twenty‐five patients with enlarged pores received three treatments with a 1064‐nm picosecond laser coupled with MLA at 4‐week intervals. Patients were evaluated using objective (measurement of pore volume using three‐dimensional photography) and subjective (clinical evaluation by two blinded dermatologists) assessments at baseline and at the 1‐, 3‐, and 6‐month follow‐ups. Adverse effects were also recorded during each visit.

Results

After three treatments, there was a significant reduction of pore size from baseline (p < 0.001). The improvement in pore size appearance significantly continued from the 1‐month to the 6‐month follow‐up visits (p = 0.013). The total average pore size was 1.15652 ± 0.614322 and 0.8087 ± 0.50515 at baseline and at 6 months after the final treatment, respectively, resulting in an average of 30% reduction in pore size. No cases of dyspigmentation, textural alteration, or scarring were documented.

Conclusion

Fractional 1064‐nm picosecond laser appears to be effective and safe for reducing pore size in Asians with minimal transient side effects.

Fractional carbon dioxide laser versus carbon-assisted Q-switched Nd: YAG laser in the treatment of dilated facial pores

BACKGROUND

The treatment of dilated facial pores is difficult, and the ideal modality is not established yet. Different ablative and nonablative lasers have been used in the treatment of dilated pores with variable outcomes.

AIM

To evaluate and compare the efficacy of fractional CO2 laser versus carbon-assisted Q-switched Nd: YAG laser in dilated facial pores.

METHODS

The study included 80 patients with dilated pores divided into two groups each containing 40 patients. Group (A) had fractional CO2 laser treatment, and group (B) received Q-switched Nd: YAG laser treatment after the application of a carbon solution on the face. The treatment was repeated monthly for a total of 3 sessions. Objective and subjective assessments of the clinical outcome were performed.

RESULTS

Both modalities significantly improved the dilated pores; however, the clinical response was statistically higher and the improvement was maintained for a longer duration of time in the factional laser group compared with the carbon-assisted Q-switched Nd: YAG laser group (p = 0.01). The downtime was significantly lower in the Q-switched Nd: YAG laser group, and the patients' satisfaction rates were comparable in both groups.

CONCLUSION

The two laser systems appear to be effective, safe, and well-tolerated in the treatment of dilated pores. The fractional CO2 laser was associated with a significantly higher and more prolonged clinical response.

Helium plasma dermal resurfacing: VISIA CR assessment of facial spots, pores, and wrinkles-Preliminary findings

Objectives

Effects of low energy, single‐pass helium plasma dermal resurfacing (PDR) treatment on brown spots, enlarged pores, and wrinkles—preliminary findings.

Methods

Twenty two subjects (64.6 ± 6.6 years) with Fitzpatrick Wrinkle and Elastosis Scale score (FWS) of ≤2 and seeking improvement of facial appearance were included in this subanalysis. All subjects received a single, one‐pass, full face, and low power helium PDR treatment. Standard digital images were collected using the VISIA‐CR (Canfield Scientific Inc.) at baseline and 3 months after treatment with images assessed for improvement in FWS and for improvements in brown spots, enlarged pores, and wrinkles by proprietary automated image processing algorithms.

Results

Nearly all subjects demonstrated ≥1‐point improvement in FWS and also reported improvement per modified Global Aesthetic Improvement Scale query. The numbers of brown spots and enlarged pores decreased by 45.1% and 28.3%, respectively. Stratification of brown spots data by presence or absence of post‐inflammatory hyperpigmentation revealed paradoxically conflicting data. The improvement detected in wrinkle area and mean wrinkle thickness was less pronounced with overall reductions of 13.4% and 4.8%, respectively. 37 Non‐serious adverse events (AEs) in 22 subjects were reported with most resolving within 14 days or less, and no serious AEs were observed.

Conclusions

While longer‐term follow‐up is needed, these early study results show that one single‐pass, low energy helium PDR treatment improves facial skin appearance both qualitatively and quantitatively. Studies evaluating higher energy levels and multiple treatment passes are ongoing.

Three-Year Results of Facial Photoaging in Asian Patients After Alexandrite 755 nm Picosecond Laser With Diffractive Lens Array: A Split-Face, Single-Blinded, Randomized Controlled Comparison

BACKGROUND AND OBJECTIVE

The long-term efficacy of a picosecond alexandrite laser (PSAL) with a diffractive lens array (DLA) for the treatment of photoaging is absent. To observe the long-term efficacy of PSAL for the treatment of photoaging.

STUDY DESIGN/MATERIALS AND METHODS

Each patient (n = 10) received 10 treatments at 2-week intervals. One side of the face was randomly selected for treatment. At 1, 3, 6, and 36 months after the final treatment, two blinded physicians evaluated photographs with four clinical indicators of photoaging (dyschromia, skin texture, skin laxity, and rhytids). A quartile scale was used.

RESULTS

At baseline, there were no significant differences in dyschromia, skin texture, facial laxity, or rhytids between the treated and control sides (P > 0.05). Picosecond laser-treated side showed 0.85 and 1.05 (both P < 0.05) better for dyschromia at 3- and 6-month follow-up, and 0.6 (P < 0.05) better for skin texture at 6-month follow-up. At 36-month follow-up, the degree of photoaging is intensified on the control side while the rejuvenation efficacy maintained on the treated side, with 1.4, 0.75, and 0.8 (all P < 0.05) better for dyschromia, skin texture, and rhytids relative to the control side measures.

CONCLUSION

Our results demonstrate the long-term efficacy and safety of PSAL with DLA for the treatment of facial photoaging.

LIMITATION

Small sample size and the lack of objective evaluation. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

The effect of lyophilized platelet rich-plasma on skin aging: a non-randomized, controlled, pilot trial

Platelet-rich plasma (PRP) showed positive results in the improvement of skin aging. Lyophilized PRP can be interesting in clinical practice due to the facility to obtain many samples in a single blood collection and can be used in multiple injections. To evaluate the effect of lyophilized PRP in the treatment of skin aging, through a Phase II pilot study. Nineteen women (54 years ± 7 years) with Glogau photoaging II and III types were select for this non-randomized, split-face controlled study. They received monthly intradermal injections of lyophilized PRP and saline solution (as control) into the facial skin, during a period of 2 months. The evaluation was performed by imaging method, histological techniques, and multiphoton microscopy. Although lyophilized PRP presented 10 times the platelet baseline value (P < .0001) and growth factors in adequate levels, only saline solution showed an increase of dermis thickness (p = .0009). Collagen pre and post-application remained the same for both types of treatments. The use of lyophilized PRP by mesotherapy showed no improvement on skin aging. TRIAL REGISTRATION APPROVAL: RBR-3n9wxw, UTN U1111-1226-6093-retrospectively registered.

Microbotox for the treatment of wide facial pores: A promising therapeutic approach

BACKGROUND

Microbotox is the injection of multiple microdroplets of diluted onabotulinum toxin A into the upper dermis. It has been previously used in one study only to decrease pore size and to improve skin texture.

AIMS

To evaluate the efficacy and safety of microbotox in the treatment of wide facial pores.

METHODS

Thirty-five patients with wide facial pores received a single session of microbotox. Objective measurements regarding improvement of pore size (0-4 scale) were recorded by two-blinded dermatologists. The improvements were confirmed by dermoscopic examination. Patient satisfaction was measured by Likert satisfaction scale (1-5 scale). Follow-up of the patients was done for 1 year.

RESULTS

After a single treatment session, the total average of improvement was 87.2%. The average improvement of pore size was 3.7 (0-4 scale). The average patient satisfaction after the end of therapy was 4.7. Dermoscopic evaluation confirmed the reduction in the size and number of pores. There were no serious or long-term side effects.

CONCLUSIONS

A single treatment session of microbotox appears to be safe and effective for the reduction of facial pore size. Improvement of skin texture and oiliness was also observed.

Efficacy of non-ablative fractional 1440-nm laser therapy for treatment of facial acne scars in patients with rosacea: a prospective, interventional study

Acne scarring is one of the most common facial skin disorders. The appropriate treatments for acne scars in patients with rosacea have not been studied. This study was designed to evaluate the efficacy and safety of non-ablative fractional 1440-nm laser (1440-nm NAFL) therapy for treatment of atrophic acne scars in patients with rosacea. In this prospective, interventional study, 32 patients with rosacea and acne scars underwent three sessions of 1440-nm NAFL therapy. Therapy efficacy, epidermal barrier function, and side effects were evaluated. Thirty patients completed and the median acne scar scores significantly reduced from 45 (30, 50) to 15 (15, 30) after three treatments (P < 0.001). The improvement score of acne scars was 2.7 ± 0.7; 22 (73.3%) were satisfied or highly satisfied. The rosacea erythema scores changed from 2.1 ± 0.4 to 1.9 ± 0.5 (P = 0.326), and flushing, burning, and stinging were not worse. The oil content after treatments was significantly reduced (P < 0.001), while there was no significant difference in other indicators of skin barrier function. The quality-of-life score decreased from 17.5 ± 3.8 to 14.1 ± 3.0 (P < 0.001). No serious side effects were observed. The 1440-nm NAFL therapy is effective in the treatment of acne scaring in patients with rosacea with little damage to the skin barrier.

The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types

BACKGROUND

The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery.

OBJECTIVE

To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III-V.

METHODS

Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment.

RESULTS

Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator-assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted.

CONCLUSION

The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III-V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ.

Sequential facial skin rejuvenation with intense pulsed light and non-ablative fractionated laser resurfacing in fitzpatrick skin type II-IV patients: A prospective multicenter analysis

Background

While skin aging is triggered by multiple factors and typically presents with multiple manifestations, conventional treatment regimens deploy a single treatment modality. Typical approaches exploit ablative techniques, which involve considerable patient discomfort and downtime and can induce adverse events. Non‐ablative fractionated laser (NAFL) resurfacing promotes neocollagenesis, with significantly fewer complications and discomfort. At the same time, intense pulsed light (IPL) therapies have a marked impact on skin tone, with an effect on collagen deposition. This study evaluated the combined effect of same‐day, sequential IPL‐NAFL treatment on photoaging of the face.

Design

In this prospective study, 30 patients presenting Fitzpatrick skin types II–IV, elastosis scores 3–6 and mild to moderate pigmentation, underwent three sessions, of full‐face IPL therapy, followed immediately by NAFL treatment, conducted at 4–6 weeks intervals. Wrinkle/elastosis and skin qualities were scored at 1, 3, and 6 months after the last treatment session. Immediate responses were evaluated up to 30 min following treatment and adverse events were monitored throughout the study period.

Results

Wrinkle/elastosis scores gradually improved over the treatment period, with 59% of patients presenting a ≥1‐point improvement in FES scores by the 1‐month follow‐up session, which persisted also at the 6 months follow‐up visit. Good to excellent pigmentation responses were recorded for ≥63% and improvements in texture, brightness, and tightness were recorded for ≥80% of patients throughout the follow‐up period. Over 90% of the treated patients exhibited improved or much improved overall appearance. Patient scorings and satisfaction level reflected physician assessments. Treatments were well tolerated and the social downtime observed was of 1.5 ± 0.25 days.

Conclusion

The same‐day combined IPL‐NAFL regimen proved safe and elicited a significant skin rejuvenating effect, in a similar manner to that shown in other same‐day combined therapies, without prolonging downtime of each individual modality. Lasers Surg. Med. 51:141–149, 2019. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Analysis of the number of enlarged pores according to site, age, and sex

BACKGROUND

Increasing the number of enlarged pores causes cosmetic problems. The difference in the number of enlarged pores according to facial site, age, and sex is unclear.

OBJECTIVE

To analyze the distribution of the number of enlarged pores according to facial site, age, and sex.

METHODS AND MATERIALS

We analyzed the number of the enlarged pores and the percentage of wrinkles in the nose, forehead, and cheek from 434 polarized images. The measurement results were analyzed according to site, age, and sex. Relationship between enlarged pore counts and wrinkle severity was also analyzed. The study was conducted by using DermaVision,™ which can take cross-polarization, parallel polarization, and ultraviolet light images.

RESULTS

The enlarged pores of the nose and forehead were more prominent than in the cheeks. Pore counts were increased with age, and the increment was significant between the 30's and 40's. There was no significant difference by gender. Enlarged pore counts were related to wrinkle severity.

CONCLUSIONS

The number of enlarged pores differs depending on body site and increased with age. The enlarged pore counts correlate with wrinkle severity and the correlation varies depending on the body site.

A Single-Center, Randomized, Double-Blind, Placebo-Controlled Clinical Trial of the Effectiveness of ANT1 Soybean Extract Cream on Skin Recovery After Nd: YAG Laser Treatment

Nd:YAG laser has been used extensively for its versatility in treating many common aesthetic problems, but numerous adverse effects are often complained by recipients of Nd:YAG laser. This study introduces the ANT1 soybean extract cream, which was formulated to alleviate adverse effects after laser therapy. This study explores whether ANT1 enhances the repair mechanism of the postlaser skin, decreases laser-induced complication, and shortens recovery time. The study also aims to pinpoint the ANT1 concentration that is most effective in improving the skin condition after Nd-YAG laser therapy.

MATERIALS AND METHODS

This study was a single-center, randomized, double-blind, placebo-controlled trial. Patients eligible for the study were Asian women, aged 25 to 40 years, who were free of dermatological diseases and allergic reaction. There were a total of 45 subjects. Each subject received a session of Nd-YAG laser therapy every 2 weeks, totaling 3 sessions. Facial skin assessment was achieved via VISIA complexion analysis. VISIA complexion analysis quantitatively assessed the skin condition and tracked the recovery progress of each subject at baseline, immediately after all 3 laser sessions, and a week after the final laser treatment.

RESULTS

Skin condition was evaluated by VISIA complexion analysis. Skin condition was recorded in aspects of pigmented spots, wrinkles, texture, pores, and red area. After Nd-YAG laser therapy, postlaser inflammation was observed in all subjects. Throughout the laser sessions and the outpatient follow-up clinic, the adverse effects of laser therapy, such as redness, spots, wrinkles, pores, and textures, decreased with the use of ANT1 cream. There has been a marked effect in wrinkle reduction in the patients who received a higher concentration of ANT1 cream (P ≤ 0.05). Statistically significant improvement in spots and pores is also seen (P ≤ 0.05).

CONCLUSIONS

Through this study, the results suggest that the application of ANT1 soybean extract cream ameliorates the complications and enhances the cosmetic effects of Nd-YAG laser therapy. A higher concentration of the ANT1 cream significantly reduces wrinkles and redness after laser. All in all, this study proves that the ANT1 soy extract cream may be a useful addition to postlaser care for an overall enhancement in skin condition and recovery.

Comparison of two kinds of skin imaging analysis software: VISIA® from Canfield and IPP® from Media Cybernetics

BACKGROUND

Skin imaging analysis, acting as a supplement to noninvasive bioengineering devices, has been widely used in medical cosmetology and cosmetic product evaluation. The main aim of this study is to assess the differences and correlations in measuring skin spots, wrinkles, vascular features, porphyrin, and pore between two commercially available image analysis software.

MATERIALS AND METHODS

Seventy healthy women were included in the study. Before taking pictures, the dermatologist evaluated subjects' skin conditions. Test sites included the forehead, cheek, and periorbital skin. A 2 × 2 cm cardboard was used to make a mark on the skin surface. Pictures were taken using VISIA^® under three kinds light conditions and analyzed using VISIA^® and IPP^® respectively.

RESULTS

(1) Skin pore, red area, ultraviolet spot, brown spot, porphyrin, and wrinkle measured with VISIA^® were correlated with those measured with IPP^® (P < .01). (2) Spot, wrinkle, fine line, brown spot, and red area analyzed with VISIA^® were correlated with age on the forehead and periorbital skin (P < .05). L-value, Crow's feet, ultraviolet spot, brown spot, and red area analyzed with IPP^® were correlated with age on the periorbital skin (P < .05). (3) L-value, spot, wrinkle, fine line, porphyrin, red area, and pore analyzed with VISIA^® and IPP^® showed correlations with the subjective evaluation scores (P < .05).

CONCLUSIONS

VISIA^® and IPP^® showed acceptable correlation in measuring various skin conditions. VISIA^® showed a high sensibility when measured on the forehead skin. IPP^® is available as an alternative software program to evaluate skin features.

Evaluating photographic scales of facial pores and diagnostic agreement of tests using latent class models

BACKGROUND

Ordinal severity scales illustrated by photographs have been widely developed to help dermatologists in evaluating skin problems or improvements. Numerous scales have been published, and none of them were used for assessing facial pores.

METHODS

A five-point photographic scale of facial pores was formulated, and photographs of pores on nasal ala from 128 female volunteers were acquired. Five dermatologists with similar experiences rated the 128 photographs independently using the reference photographs. Latent Class Models (LCM) were used to analyze the data. Firstly, we hypothesized that the conditional probabilities of the five dermatologists were identical to build the first LCM and without the restriction to formulate the second LCM. Conditional probability and posterior probability were also calculated.

RESULTS

The five-point scales were ambiguous as the raters actually had difficulties in distinguishing between some adjacent categories. Adjacent categories were pooled for reanalyzing, and the model fitted well.

CONCLUSIONS

The newly developed photographic scale of Chinese facial pores should be redefined to improve their quality and reproducibility in future studies. Standardized scales for the measurement of aging and response to cosmetic therapy were essential for assessing diagnostic experiment. The LCM can effectively deal with diagnostic test of agreement and reproducibility.

Fractional resurfacing in the Asian patient: Current state of the art

BACKGROUND AND OBJECTIVE

Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient.

METHODS

A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO₂ ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors.

CONCLUSION

Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.

The role of lasers and intense pulsed light technology in dermatology

The role of light-based technologies in dermatology has expanded dramatically in recent years. Lasers and intense pulsed light have been used to safely and effectively treat a diverse array of cutaneous conditions, including vascular and pigmented lesions, tattoos, scars, and undesired hair, while also providing extensive therapeutic options for cosmetic rejuvenation and other dermatologic conditions. Dermatologic laser procedures are becoming increasingly popular worldwide, and demand for them has fueled new innovations and clinical applications. These systems continue to evolve and provide enhanced therapeutic outcomes with improved safety profiles. This review highlights the important roles and varied clinical applications that lasers and intense pulsed light play in the dermatologic practice.

Objective assessment of facial skin aging and the associated environmental factors in Japanese monozygotic twins

Twin studies, especially those involving monozygotic (MZ) twins, facilitate the analysis of factors affecting skin aging while controlling for age, gender, and genetic susceptibility. The purpose of this study was to objectively assess various features of facial skin and analyze the effects of environmental factors on these features in MZ twins. At the Osaka Twin Research Center, 67 pairs of MZ twins underwent medical interviews and photographic assessments, using the VISIA(®) Complexion Analysis System. First, the average scores of the right and left cheek skin spots, wrinkles, pores, texture, and erythema were calculated; the differences between the scores were then compared in each pair of twins. Next, using the results of medical interviews and VISIA data, we investigated the effects of environmental factors on skin aging. The data were analyzed using Pearson's correlation coefficient test and the Wilcoxon signed-rank test. The intrapair differences in facial texture scores significantly increased as the age of the twins increased (P = 0.03). Among the twin pairs who provided answers to the questions regarding history differences in medical interviews, the twins who smoked or did not use skin protection showed significantly higher facial texture or wrinkle scores compared with the twins not exposed to cigarettes or protectants (P = 0.04 and 0.03, respectively). The study demonstrated that skin aging among Japanese MZ twins, especially in terms of facial texture, was significantly influenced by environmental factors. In addition, smoking and skin protectant use were important environmental factors influencing skin aging.

Facial skin pores: a multiethnic study

Skin pores (SP), as they are called by laymen, are common and benign features mostly located on the face (nose, cheeks, etc) that generate many aesthetic concerns or complaints. Despite the prevalence of skin pores, related literature is scarce. With the aim of describing the prevalence of skin pores and anatomic features among ethnic groups, a dermatoscopic instrument, using polarized lighting, coupled to a digital camera recorded the major features of skin pores (size, density, coverage) on the cheeks of 2,585 women in different countries and continents. A detection threshold of 250 μm, correlated to clinical scorings by experts, was input into a specific software to further allow for automatic counting of the SP density (N/cm²) and determination of their respective sizes in mm². Integrating both criteria also led to establishing the relative part of the skin surface (as a percentage) that is actually covered by SP on cheeks. The results showed that the values of respective sizes, densities, and skin coverage: 1) were recorded in all studied subjects; 2) varied greatly with ethnicity; 3) plateaued with age in most cases; and 4) globally refected self-assessment by subjects, in particular those who self-declare having “enlarged pores” like Brazilian women. Inversely, Chinese women were clearly distinct from other ethnicities in having very low density and sizes. Analyzing the present results suggests that facial skin pore’s morphology as perceived by human eye less result from functional criteria of associated appendages such as sebaceous glands. To what extent skin pores may be viewed as additional criteria of a photo-altered skin is an issue to be further addressed.

Reduction of conspicuous facial pores by topical fullerene: possible role in the suppression of PGE2 production in the skin

Background

Conspicuous facial pores are therapeutic targets for cosmeceuticals. Here we examine the effect of topical fullerene on conspicuous facial pores using a new image analyser called the VISIA^® system. Ten healthy Japanese females participated in this study, and they received applications of 1% fullerene lotion to the face twice a day for 8 weeks.

Findings

Fullerene lotion significantly decreased conspicuous pores by 17.6% (p < 0.05, Wilcoxon signed-rank test) after an 8-week treatment. A self-administered questionnaire indicated that this reduction achieved cosmetically appreciable effects. In addition, to investigate the mechanism of effect of fullerene, we examined its effect on UVB-induced prostaglandin E₂ (PGE₂) production in reconstructed human epidermis (RhE). The results showed that irradiation of RhE with 1000 mJ/cm² increased PGE₂ production by 62.3% (p < 0.05, Mann-Whitney U-test) and the addition of 28 μM fullerene significantly suppressed the UVB-induced PGE₂ production by 18.3% (p < 0.05).

Conclusions

Fullerene lotion significantly decreases conspicuous facial pores after an 8-week treatment possibly through the suppression of PGE₂ production in the epidermis.