Microneedling-Associated Procedures to Enhance Facial Rejuvenation

Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis. The benefits of microneedling, associated procedures, indications for use, technical considerations, and potential complications are discussed.

Laser emission at 675 nm: In vitro study evidence of a promising role in skin rejuvenation

Light-based therapies have been proven to influence and perhaps reverse skin ageing at clinical, molecular and histologic levels. Laser technology decreases photodamage by promoting collagen type I and III synthesis and enhancing the expression of heat shock protein. Aims: This study aims to assess different doses of 675 nm irradiation on human dermal fibroblast cells to evaluate the potential therapeutic effects on the rejuvenation process. Methods: This study employed a laser system that emits 675 nm wavelength: 260, 390, 520 and 650 J/cm² doses were tested on adult human dermal fibroblast cells. Cellular viability, proliferation, and synthesis of type I and III collagen were studied. Results: No dose tested showed effects on cell viability and proliferation at 24 and 48 h from the irradiation. Doses of 260 and 520 J/cm² causes a significant decrease in type I collagen fluorescence intensity, while 390 J/cm² elicits a significant increase in type III collagen expression. Conclusions: Our results showed that 675 nm laser irradiation does not affect cell viability while modulating cell proliferation and collagen synthesis in human adult cultured fibroblasts in vitro. These findings suggest that 675 nm laser irradiation potentially plays a role in skin rejuvenation.

Systematic review and meta-analysis of randomized clinical trials comparing efficacy, safety, and satisfaction between ablative and non-ablative lasers in facial and hand rejuvenation/resurfacing

Skin aging inevitably begins from the very early days of life. The lasers used in skin rejuvenation are mainly of two types: ablative and non-ablative. This meta-analysis aimed at comparing ablative with non-ablative lasers in terms of their efficacy and safety in skin rejuvenation. Articles published by March 15, 2020 in Embase, Medline (PubMed), Scopus, Cochrane, and clinicalTrials.gov were searched. The inclusion criteria included randomized controlled clinical trials (RCTs) in English using ablative and non-ablative lasers and comparing their safety and efficiency in wrinkle improvement and photoaging therapy. Out of 1353 extracted articles, 11 were selected for qualitative synthesis and of these, 4 were quantitatively analyzed. Different modes of various lasers were implemented; the ablative lasers included Erbium: yttrium-aluminium-garnet (Er:YAG) and CO₂, besides the non-ablative lasers, comprised Ytterbium/Erbium, Erbium: Glass, neodymium: yttrium-aluminum-garnet (Nd:YAG), and alexandrite. Pooled analyses on 124 participants showed insignificant differences between ablative and non-ablative lasers in the likelihood of excellent improvement with an odds ratio of 0.83 (95% CI: 0.24, 2.83). The analyses also showed good improvement with an odds ratio of 0.88 (95% CI: 0.44, 1.78), fair improvement with an odds ratio of 1.13 (95% CI: 0.56, 2.26) and side effects with an odds ratio of 0.82 (95% CI: 0.43, 1.56). The efficacy and safety of ablative laser were not higher than those of non-ablative laser in skin rejuvenation. Given the small samples of the included articles, it is recommended that further high-quality RCTs be conducted using larger samples to confirm this conclusion.

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.

Chemical Peel (Deep, Medium, Light)

With modern medicine increasing both the average life span and quality of life, there has been a greater demand for treatment of age-related skin changes. As many new options in skin resurfacing are developed annually, it is chemical peeling that has withstood the trials of time and scrutiny. The different variations of chemoexfoliation have been used for rhytids, actinic damage, lentigos, and dyschromias. This article describes the most recent knowledge about chemical peeling, and exposes previously accepted yet incorrect dogmas. Chemical peeling, when practiced with knowledge and good technique, can yield excellent results in skin rejuvenation.

Nonablative and Hybrid Fractional Laser Skin Rejuvenation

In the 2000s, there was a significant expansion in technology that was described as "nonablative." These devices featured several different wavelengths and technologies. What they shared in common was the goal of delivering improvement in skin appearance while minimizing downtime and complications. Most of the "less-invasive" devices relied on the advent of fractional technology. This was the design feat of having multiple very small laser pulses delivered in a gridlike fashion and allowed for a mosaic of treated and untreated skin. With islands of healthy skin next to treated skin, the healing process was thought to be more rapid.

A novel method of facial rejuvenation using a 2940-nm erbium:YAG laser with spatially modulated ablation: a pilot study

The objective of this study was to determine the efficacy and safety of a novel method of facial rejuvenation using a 2940-nm erbium:YAG laser with Spatially Modulated Ablation™. A pilot study was performed in 16 women with moderate to severe signs of facial aging relative to chronological age, who underwent two treatment sessions with an Er:YAG laser coupled to the RecoSMA™ technology (Linline, Minsk, Belarus). The whole face was treated in all patients. Clinical efficacy, tolerance, adverse effects, complications, and histological changes due to the treatment were evaluated. Clinical photographs and biopsies were taken before treatment and 3 months after the second treatment session. All patients completed the study and presented no significant complications. Histological changes in the epidermis and dermis as a result of treatment were found. Fine lines, wrinkles, and overall facial aging improved significantly (p < 0.0001). The mean reduction of fine lines and wrinkles was 59 % (r = 40-75 %). The mean improvement of overall facial aging was 74 % (r = 55-90 %). After showing the patients the comparative photographs before and after treatment, 75 % of women stated that they were satisfied or very satisfied and would recommend the treatment. Preliminary results show an excellent safety/efficacy profile for this novel technology, which, based on observed results, can be considered to have advantages over other methods of facial rejuvenation with lasers.

Evidence-Based Medicine in Laser Medicine for Facial Plastic Surgery

In the setting of rapidly changing technology tone must make a decision on whether he or she places a premium on being an "early adopter" of technology or delay purchasing decisions until there is adequate proof that a particular technology is useful. Laser devices are a significant capital expenditure, and therefore members of the second group who base their purchasing decisions on evidence-based medicine may be able to avoid deploying capitol into a purchase that becomes obsolete as quickly as it appeared.