Treatment of periorbital and perioral wrinkles with fractional Er:YAG laser: What are the effects of age, smoking, and Glogau stage?

Ablative Laser Therapy of Skin

Laser skin rejuvenation was introduced in the mid-1990s. Early ablative laser devices relied on scanner technology that provided significant ablation and longer time on tissue treatments. These early treatments provided significant improvement in the appearance of the skin, but because of the longer treatment times and in some cases excessive treatment, complications such as scarring and hypopigmentation were significant. More recent advances in skin resurfacing technology have now minimized these risks providing certain key principles are observed. These parameters are reviewed in detail to improve the reader's ability to propose and execute proper skin resurfacing treatments.

Novel, Validated, 5-Point Photonumeric Scales for Assessment of the Perioral Region

BACKGROUND

The use of validated scales is still considered the gold standard for evaluating the severity of an aesthetic facial condition.

OBJECTIVES

The aim of this investigation was to create and validate 5-point photonumeric scales for the assessment of perioral lines and marionette lines.

METHODS

A medical team created 2 different novel 5-point photonumeric scales for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation.

RESULTS

For the Croma Static Perioral Lines-Assessment Scale, the digital interrater intraclass correlation coefficients (ICCs) were 0.88 (95% CI, 0.85-0.91) in the first rating and 0.87 (95% CI, 0.83-0.90) in the second rating. The digital intrarater ICCs were 0.90 (95% CI, 0.87-0.92). In the live rating, the interrater ICCs were 0.89 (95% CI, 0.85-0.93) in the first rating and 0.91 (95% CI, 0.87-0.93) in the second rating with an intrarater ICC of 0.91 (95% CI, 0.88-0.95). For the Croma Marionette Lines-Assessment Scale, the digital rating interrater ICCs were 0.85 (95% CI, 0.81-0.89) in the first rating and 0.87 (95% CI, 0.84-0.90) in the second rating with an intrarater ICC of 0.89 (95% CI, 0.88-0.91). In the live rating, the interrater ICCs were 0.73 (95% CI, 0.54-0.83) in the first rating and 0.79 (95% CI, 0.65-0.87) in the second rating with an intrarater ICC of 0.88 (95% CI, 0.83-0.94).

CONCLUSIONS

The Croma Static Perioral Lines-Assessment Scale and the Croma Marionette Lines-Assessment Scale have exceptional inter- and intrarater agreements that justify their use in clinical and study settings for all ethnic groups.

LEVEL OF EVIDENCE: 5

Human dermal fibroblast-derived extracellular matrix reduces postinflammatory hyperpigmentation after fractional carbon dioxide laser facial resurfacing in Asians

BACKGROUND

Extracellular matrix (ECM) components promote the development of skin wounds by providing biological scaffolds and regenerative microenvironments.

AIMS

To evaluate the beneficial effects of human dermal fibroblast-derived ECM after fractional carbon dioxide laser resurfacing in Asians.

PATIENTS/METHODS

In this double-blind, randomized, vehicle-controlled, split-face study, 15 participants with features of facial skin aging were treated with a single session of fractional carbon dioxide laser, followed by the application of either ECM (ECM group) or placebo (control group). In vivo skin parameters were measured at baseline and after 4 and 12 weeks of treatment using the Antera 3D®, Cutometer® MPA580, Dermascan®, and Tewameter®.

RESULTS

A total of 14 participants (mean age 45.1 ± 9.7 years) completed the study. The change in melanin level was significantly lower in the ECM group than in the control group at week 12 (p < 0.05). Transient increase in erythema level was observed at week 4 in the control group, and the change in the erythema level was greater in the control group than in the ECM group (p = 0.014). Though the ECM group showed improvements in the dermal density, texture, transepidermal water loss, marionette lines (volume, maximum depth, and average depth), and nasolabial folds (volume, maximum depth, and length), no significant differences were found between the two groups. Treatment-related adverse events were not reported.

CONCLUSIONS

We suggest that human dermal fibroblast-derived ECM may be used as adjunctive therapy after fractional carbon dioxide resurfacing to prevent postinflammatory hyperpigmentation in Asians.