Laser Resurfacing Research Articles

Laser and Energy Treatments for Acne Scarring: A Review of Clinical Trials.

Acne scarring can have a detrimental impact on quality of life, making early and effective treatment essential. Lasers and energy-based treatment are the preferred treatment modality, yet a clear consensus on the ideal laser selection is lacking in the literature. This review article aims to describe the therapeutic potential of lasers for acne scarring with a focus on clinical trials involving atrophic facial acne scars. A search was conducted in PubMed with keywords such as "acne scars", "laser resurfacing", "fractional laser", "nonfractional laser", "ablative laser", "nonablative laser", with attention to clinical trials completed between 2018 to 2022; results were summarized in narrative format. Improvement in acne scarring is seen from a variety of lasers, with ablative lasers offering the most significant improvement combined with a longer downtime as compared to nonablative lasers. Laser treatment can be combined with a variety of other therapies, including platelet-rich plasma, to increase efficacy. The choice of laser is highly individualized and relies on shared decision-making between the patient and physician. This study presents an overview of clinical trials in laser treatment for acne scarring between 2018 through 2022. Overall, ablative lasers offered the most significant improvement in acne scars. Laser selection is a patient-centered process that requires attention to the type of scarring present, the patient's goals, and the advantages and disadvantages unique to each laser. J Drugs Dermatol. 2024;23(12):1058-1062. doi:10.36849/JDD.8195.

Therapeutic Potential of Extracellular Vesicles (Exosomes) Derived From Platelet-Rich Plasma: A Literature Review.

There are exciting advances in the field of exosomes research as a potential regenerative therapy. Platelet-rich plasma represents an abundant source of exosomes. To present evidence on the use of platelet-rich plasma-derived exosomes in dermatology and discuss current technical limitations. A literature search was conducted using Embase (Ovid), Web of Science, and ClinicalTrials.gov in June 2024. Platelet-rich plasma-derived exosomes contain a myriad of growth factors, genetic materials, and lipids that mediate paracrine signaling. Several preclinical studies have demonstrated their potential in wound healing. This includes faster wound contraction in diabetic animal models, as well as enhanced angiogenesis, increased cell proliferation and migration, and protection against hyperglycemic conditions invitro. A case study reported a topical platelet-derived exosome product tried successfully in a patient with persistent scalp wounds. In contrast, there is scarce information on the use of platelet-rich plasma-derived exosomes in hair growth and skin rejuvenation. Isolation techniques, activation methods, and methods of delivery have not been optimized, which warrants further research. Novel delivery methods, such as hydrogel-based preparations, may enable the topical application of exosomes. Exosomes derived from platelet-rich plasma have demonstrated therapeutic potential. More research is needed to standardize its use.

Therapeutic Effectiveness of Microneedling Radio Frequency in Different Areas of Periorbital Static Wrinkles: A Self-Controlled Study.

Periocular static wrinkles, which are common cosmetic concerns, lack an established effective treatment. Microneedling radio frequency (MNRF) has shown promise in skin rejuvenation; however, there is limited objective information on its long-term effectiveness with regard to periocular static wrinkles. This study aimed to evaluate the clinical efficacy and safety of MNRF treatment for periocular static wrinkles. Eighteen participants with moderate to severe wrinkles were enrolled in this study. MNRF treatment was applied to the periocular skin using MicroRF9 microneedles, which have a depth of 0.5-1.5 mm and a pulse width of 200-300 ms. MNRF treatment was administered twice with a 1-month interval, and the participants were followed up for 6 months. The evaluation included four areas, namely the outer canthi, lower eyelid, inner canthi, and upper eyelid, by using clinical assessments and Antera 3D measurements by digitalized images and grading by clinicians. The results showed significant improvement in all four areas assessed. Participants expressed high satisfaction with the treatment, and any adverse events, such as mild pain and redness, were temporary and resolved within a week. These findings confirm that MNRF is a safe and effective method for reducing periocular static wrinkles.

Resolution of Treatment-Refractory Papulopustular Rosacea With Combined Light Source Photodynamic Therapy Using Pre-incubation Nonablative Fractionated Laser Resurfacing

Resolution of Treatment-Refractory Papulopustular Rosacea With Combined Light Source Photodynamic Therapy Using Pre-incubation Nonablative Fractionated Laser Resurfacing

Granulomatous Reactions From Microneedling: A Systematic Review of the Literature.

Microneedling is a common minimally invasive procedure for skin rejuvenation. Granulomatous reactions after microneedling have been rarely reported. To systematically review the literature for granulomatous reactions from microneedling. A systematic review of the Medline, Scopus, Google Scholar, and Cochrane databases was performed for articles describing granulomatous reactions to microneedling. Thirteen studies were selected for inclusion after full-text review, which described 15 patients (26-74 years old) with non-necrotizing granulomatous inflammation postmicroneedling. Motorized microneedling pen use and topical Vitamin C application were implicated in a majority of cases. Although delayed-type hypersensitivity was commonly proposed as the underlying etiology, patch testing or further workup was rarely performed. Improvement or clearance occurred inconsistently with myriad treatment options, including topical steroids, oral antibiotics, and systemic anti-inflammatory medications. Granulomatous reactions to microneedling and microneedling-mediated transepidermal drug delivery can rarely occur and may be treatment-resistant.

Non-Facial Skin Rejuvenation of the Neck, Chest, and Hands. Part One: Using Injections.

The demand for aesthetic procedures aimed at restoring and preserving a youthful appearance is growing. While numerous non-surgical facial rejuvenation techniques are available, there is a need for a comprehensive review of clinic-based procedures targeting non-facial body parts. This review aims to describe and evaluate clinic-based techniques for rejuvenating the neck, chest, and hands, focusing on various types of fillers and other non-invasive procedures. In this first part of this review, we conducted an extensive literature review on PubMed, reporting the effectiveness of different fillers, detailing their preparation, required volume per area, injection methods, durability, and any associated side effects. We also discuss the use of mesotherapy, microneedling, chemical peeling, and Profhilo in these specific body areas. The review synthesizes the latest data on the effectiveness and safety of these procedures, highlighting the advancements in filler technology and the growing popularity of non-invasive techniques for body rejuvenation. This article serves as a valuable resource for practitioners and patients interested in non-surgical body rejuvenation, providing insights into the best practices.

Nonfacial Skin Rejuvenation of the Neck, Chest, and Hands. Part Two: Using Laser Techniques.

Interest in aesthetic procedures that help maintain a youthful look is on the rise. While many nonsurgical techniques focus on facial rejuvenation, there is a need for a detailed review of treatments, specifically for nonfacial areas. This review explores various clinic-based methods for revitalizing the neck, chest, and hands, with a particular emphasis on different laser treatments. For this second part of the review, we conducted a comprehensive search on PubMed to evaluate the effectiveness of various laser treatments. The review covers treatment parameters such as wavelength, fluence, and pulse, along with outcomes, follow-up care, and potential side effects. A discussion on the role of sclerotherapy in treating these areas was also included. This article compiles recent findings on the safety and effectiveness of these treatments, showcasing progress in laser technologies and the growing trend of noninvasive body rejuvenation. It offers practical insights for both practitioners and patients looking for reliable options in nonsurgical body treatments.

A clinical case of skin lymphocytoma in a young woman

A 25-year-old woman came to consult a dermatovenerologist. The woman complained of a rapidly progressing painless lump on the right wing of her nose which developed after photo-rejuvenation treatment and the development of herpetic infection.in the place of a previous lipoma removed by radio wave surgery. The clinical picture was characterized by a solitary disc-shaped plaque, 2 cm in size, bluish-reddish-brownish in color, of a doughy consistency, significantly protruding above the skin surface, with clear borders and a smooth, shiny surface. There was a complex differential diagnostics, the final diagnosis was confirmed by the results of a histological examination, which revealed changes characteristic of lymphocytoma. The patient was treated with aminoquinoline preparations and topical glucocorticosteroids and rapid positive dynamics with complete regression of the skin pathological process was observed. A clinical case of skin lymphocytoma that occurred after several successive trigger factors such as lipoma formation and removal, photo rejuvenation procedures, and herpes infection is presented in the article. This is a fairly rare disease that does not have a pathognomonic clinical picture, so it is difficult to differentiate and diagnose it. The results of a pathomorphological examination are essential for the diagnosis. A positive effect with a complete regression of skin changes can quickly occur if treated correctly.

Delayed vascular occlusion following hyaluronic acid-based skin booster – A rare case report

Hyaluronic acid (HA) based skin boosters used for treating fine lines and for enhancing the quality of skin are quite popular as they help by drawing water under the dermis (hydrofilling effect), helping in prolonged hydration of the skin. They are also considered safe due to the superficial plane of injection and low volumes injected. The patient came to the clinic for skin hydration and rejuvenation treatment. After detailed discussion and informed consent, a non-animal origin HA-based skin booster with a concentration of 20 mg/mL was chosen for facial rejuvenation. As per protocol, 2 mL of the product was injected by micropuncture technique with the automated click technology, delivering 0.01 mL per point in the mid dermis all over the cheeks, chin, and forehead. The patient tolerated the procedure well and presented to us 48 hours post-injection with persisting redness and pain on the central forehead. The redness appeared to be in a triangular pattern, with the apex at the left eyebrow and the base toward the hairline. Diagnosis of vascular compromise was made, and the patient was immediately treated with pulsed doses of hyaluronidase. The entire area healed without any sequelae. We hereby report a rare case of delayed vascular occlusion following skin booster treatment, which was successfully managed by hyaluronidase treatment. Skin boosters are the most sought after treatments for skin hydration and are generally considered safe; this is the first case report with delayed vascular occlusion reported following skin booster injections. Because of the high risk associated with glabella and forehead areas for fillers, one should be mindful in this area even with the skin boosters.

Microfocused Ultrasound in Regenerative Aesthetics: A Narrative Review on Mechanisms of Action and Clinical Outcomes.

Microfocused ultrasound with visualization (MFU-V) is widely used in aesthetic medicine for skin tightening and rejuvenation. However, its role in regenerative aesthetics and its precise mechanism of action are not fully understood. This narrative review aims to contextualize and articulate the mechanism of action of MFU-V, evaluate its role in regenerative aesthetics, and assess its effectiveness based on existing clinical, histological, and skin-mechanical studies. A comprehensive literature search was performed to collect and analyze studies on MFU's biological mechanisms, clinical outcomes, and impact on extracellular matrix (ECM) regeneration. The review integrates findings from clinical trials, histological analyses, and biomechanical assessments to provide a cohesive understanding of MFU-V's role in aesthetic medicine. MFU-V emits focused ultrasound energy that penetrates multiple skin layers and the superficial musculoaponeurotic system, creating localized thermal coagulation points. These points initiate biological responses that recruit fibroblasts and stimulate the production of new collagen and elastin fibers. Enhanced ECM protein synthesis leads to significant improvements in skin biomechanics and quality, reducing skin laxity and enhancing appearance. Clinical studies support these findings, showing improvements in skin firmness and texture following MFU-V treatment. Through analyzing the underlying biological mechanisms and the observable clinical outcomes, this narrative review sets the stage for a comprehensive understanding of the mechanism of action and role of MFU-V in regenerative aesthetics.

Non-ablative laser skin rejuvenation by targeting indigenous chromophores

Three pulsed laser systems: 980 nm semiconductor diode laser, 1064 nm Nd: YAG laser and long pulse- fractional 2940 nm pulsed Er: YAG were used to treat some non-ablative skin rejuvenation applications. These three wavelengths can target the three main indigenous chromophores (melanin, hemoglobin and water) of the skin to treat different skin disorders. The efficacy of these lasers was assessed in the treatment of age spots, enlarged veins and wrinkles. The chromophore type and location of a specific disorder was taken into consideration when working out, in advance, the required laser fluence. The absorption of laser photons and the reabsorbed photon scattering were calculated and used to work out the temperature rise in the targeted tissue. The results indicated very good outcome of age spots with 980 nm laser, excellent clearance of the varicose veins with the use of 1064 nm laser and very good smoothing of fine lines wrinkles on forehead. Advances may involve conducting wavelengths or developing customizable protocols for different skin types. Long-term studies on patient outcomes to help establish standardized protocols and improve efficacy in clinical uses.

Regenerative Skincare Technologies Derived From Human Fibroblasts: Growth Factors and Exosomes for Transformative Outcomes.

Since the early 2000s, human fibroblast conditioned media (HFCM) has been used in topical growth factor skincare to support skin regeneration and skin rejuvenation. Human fibroblast conditioned media contains the fibroblast secretome including growth factors as well as exosomes. The potential benefits of topically applied exosomes are gaining interest in the medical aesthetic field. This article aims to summarize the preclinical and clinical data available on regenerative HFCM-based topical skincare with a focus on studies investigating products applied to improve overall facial skin rejuvenation and/or after in-office cosmetic procedures. In addition, available data on fibroblast-derived exosomes will be covered. A focused literature review was conducted to provide an overview of evidence on HFCM-based topical skincare. Human fibroblast conditioned media-based skincare significantly reduces signs of skin aging including photodamage, coarse lines and wrinkles, and sagging. After in-office cosmetic procedures, HFCM-based skincare can stimulate skin recovery and reduce downtime as well as provide skin quality benefits to enhance overall treatment outcomes. Application of purified exosomes from HFCM also demonstrated significant improvements in multiple skin aging parameters. Human fibroblast conditioned media combines naturally secreted fibroblast-derived growth factors and exosomes that stimulate skin regeneration and rejuvenation as evidenced by a variety of assays and assessments including in vitro preclinical studies, clinical investigator grading, instrumentation measurements, biopsy analyses, and patient-reported outcomes.

Energy-Based Skin Rejuvenation: A Review of Mechanisms and Thermal Effects.

Energy-based photoelectric and ultrasonic devices are essential for skin rejuvenation and resurfacing in the field of plastic surgery and dermatology. Both functionality and appearance are impacted by factors that cause skin to age, and various energy types have variable skin penetration depths and modes of transmission. The objective is to advise safe and efficient antiaging treatment while precisely and sensitively controlling and assessing the extent of thermal damage to tissues caused by different kinds of energy-based devices. A literature search was conducted on PubMed to review the mechanisms of action and thermal effects of photoelectric and ultrasonic devices in skin remodeling applications. This paper reviews the thermal effects of energy-based devices in skin resurfacing applications, including the tissue level and molecular biochemical level. It seeks to summarize the distribution form, depth of action, and influencing factors of thermal effects in combination with the mechanisms of action of various types of devices. Accurate control of thermal damage is crucial for safe and effective skin remodeling treatments. Thorough investigation of molecular biochemical indicators and signaling pathways is needed for real-time monitoring and prevention of severe thermal injury. Ongoing research and technological advancements will improve the accuracy and control of thermal damage during treatments.

Improvement in the Youthfulness of Facial Skin after a Single Treatment with Platelet Rich Plasma

Objective: Platelet rich plasma (PRP) is an autologous substance widely used to stimulate dermal collagen synthesis. This study aimed to investigate the efficacy of a single PRP treatment for facial rejuvenation. Materials and Methods: This study was conducted at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from August 2020 to March 2021. Enrolled patients underwent a single intradermal injection treatment of 0.1 mL PRP at 30 locations on the face. Outcomes were assessed at 1, 2, and 4 weeks post-intervention using the patient-perceived age visual analog scale (VAS), FACE-Q assessment, and elasticity index (EI) with a Cutometer. Results: Forty Thai patients with an average age of 36.4 years, Fitzpatrick skin type 3-4 were enrolled. The mean Patient-perceived Age VAS significantly decreased one month after treatment (-2.71±2.42, p<0.001). FACE-Q satisfaction with facial skin was 74.29±14.49, and satisfaction with the outcome was 73.41±16.26 (scale 0-100). The PRP significantly affected skin EI, with the peak improvement observed at 1-2 weeks post-injection, predominantly at the cheek, crow’s feet, and perioral area (all p<0.05). All patients had an overall improvement in satisfaction scores throughout the study. Conclusion: A single treatment of PRP injection resulted in overall satisfaction in facial skin rejuvenation as measured by patient-perceived age VAS and FACE-Q assessment. The PRP showed positive outcomes in EI with peak performance at 1-2 weeks post-treatment.

Injectable "Skin Boosters" in Aging Skin Rejuvenation: A Current Overview.

Aging-related changes in the skin, such as dullness, dehydration, and loss of elasticity, significantly affect its appearance and integrity. Injectable "skin boosters," comprising various biological materials, have become increasingly prominent in addressing these issues, offering rejuvenation and revitalization. This review offers a comprehensive examination of these injectables, detailing their types, mechanisms of action, and clinical uses. It also evaluates the evidence for their effectiveness and safety in treating age-related skin alterations and other conditions. The goal is to provide an insightful understanding of injectable skin boosters in contemporary dermatological practice, summarizing the current state of knowledge.

Sulfated galactans ameliorate the cellular senescence in dermal fibroblast cells

Replicative senescence of dermal fibroblast is the primary mechanism of intrinsic skin aging. Recent research has focused on the different properties of sulfated galactans (SG) derived from the red seaweed Gracilaria fisheri. Therefore, we aimed to investigate the potential impact of SG on anti-aging skin. This study used a validated replicative senescent human dermal fibroblast (HDF) model. We observed that replicative senescent HDF cells exhibited remarkable changes in cell morphology, decreased cell proliferation, retarded migrating activity, and reduced extracellular matrix (ECM) production. Additionally, the replicative senescent HDF cells exhibited increased expression of cell cycle inhibitors p16 and p21. Our results demonstrated that SG is safe and effective in reversing these morphological and molecular alterations in senescent HDF cells. SG mediated enhanced ECM synthesis, including collagen, elastin, and hyaluronic acid (HA), and promoted cell migration by upregulating TGF-β1 and TLP gene expression. SG also reduced the expression of ECM breakdown enzymes MMP-1, MMP-2, MMP-3, and MMP-9 while increasing MMP inhibitors TIMP-1 and TIMP-2. These results indicate that SG effectively restores fibroblast function, contributing to decelerating the aging processes, supporting its potential as a therapeutic agent for skin rejuvenation and anti-aging treatments.

INDIVIDUALIZED MICROCURRENT FREQUENCIES: A NEW FRONTIER IN WELLNESS

Individualized microcurrent frequencies are a breakthrough in wellness, offering personalized health solutions through low-level electrical impulses. This therapy activates natural healing processes, providing benefits such as accelerated recovery, pain relief, improved circulation, stress reduction, and skin rejuvenation. It represents a shift towards personalized care, enhancing overall well-being.

Non-Surgical Medical Aesthetics and Patient Quality of Life: An Umbrella Review

Abstract Background Non-surgical cosmetic facial procedures have become popular treatment options for individuals seeking aesthetic improvements. Despite a breadth of literature on patient satisfaction with treatment outcomes, there is a lack of information specific to changes in quality of life outcomes. Objectives The objective of this umbrella review was to report the effectiveness of non-surgical facial aesthetic treatments on reported quality of life in cosmetic treatment seeking patients. We also aimed to identify gaps in the literature on measures of quality of life outside of patient satisfaction. Methods We completed a comprehensive, systematic search of review articles across six databases including Medline, CINAHL Plus, EMBASE, APA PsychINFO, Cochrane Reviews and Google Scholar. We included review-level studies examining the change in quality of life measures following treatment. Critical appraisal was completed for each review article included. Results A total of seven reviews included. One review was of strong quality, two moderate, and four were weak. Several non-surgical procedures were evaluated across reviews including injectable neurotoxins, dermal fillers and laser skin resurfacing. The majority of included studies reported increases in measures of quality of life, post treatment in the same patient or compared to controls. The most commonly reported measure was psychological wellbeing, followed by self-perception. There was a lack of measures outside of improvements to aesthetics, including those specific to mental health (e.g., depression). Conclusions Overall, studies that report on non-surgical treatments report increases in overall quality of life. This conclusion should be interpreted with caution as the majority of reviews included were of moderate to weak quality. A major gap in this literature includes mental health outcomes. Future research should focus on increasing the rigour of reporting for systematic reviews.

Poly-D,L-Lactic Acid Filler Attenuates Ultraviolet B-Induced Skin Pigmentation by Reducing Destruction of the Basement Membrane.

Poly-D,L-lactic acid (PDLLA) filler, which increases volume and collagen synthesis, is used for skin rejuvenation. PDLLA filler also increases M2 macrophages and IL-10. Ultraviolet (UV) radiation induces dermal hyperpigmentation by disrupting the basement membrane (BM), allowing melanin to move into the dermis. Therefore, using UV-irradiated macrophages and animal skin, we determined whether PDLLA filler decreased M1 macrophages and skin inflammation, thereby reducing BM destruction and dermal hyperpigmentation. UV radiation increased the M1 macrophage marker CD86 and TNF-α expression, which was inhibited by the treatment of macrophages with PDLLA. In fibroblasts treated with conditioned medium from UV-irradiated macrophages, NF-κB activity, NLRP3 inflammasome components (NLRP3, ASC, and pro-caspase-1), IL-18, MMP2, and MMP9 increased, but all decreased after PDLLA treatment. Similar to the in vitro study, UV-irradiated mouse skin showed increased CD86, NLRP3, ASC, pro-caspase-1, MMP2, and MMP9, which decreased after PDLLA injection. Disruption of the lamina densa of the BM and dermal pigmentation increased after UV irradiation and decreased after PDLLA injection. In conclusion, PDLLA reduced dermal pigmentation by decreasing BM destruction in UV-irradiated skin. PDLLA has the potential to reduce dermal pigmentation by regenerating the BM.

In vitro study of the gel cohesivity and persistence to hyaluronidase degradation of a novel stabilized composition of 26 mg/mL of high molecular weight HA

Aim: Hyaluronic acid (HA) is extensively used in injectable skin quality products due to its documented role in skin rejuvenation. The rapid in vivo degradation of HA by the enzyme hyaluronidase necessitates the development of advanced formulations to ensure the efficacy and longevity of the treatments. In this context, a novel 2.6% high molecular weight HA (H-HA)/3.2% sorbitol composition has been introduced, featuring stabilization through hydrogen bonds rather than traditional crosslinking. Methods: The stabilized composition was evaluated through two in vitro enzymatic degradation tests. In the first test, the efficiency on the gel degradation was followed by rheology and compared with two crosslinked HA products available on the market. In the second test, the effect on the gel structure of a less diluted hyaluronidase dose was followed by rheological and cohesivity measurements. Results: In vitro study demonstrates that, before its complete degradation into a liquid-like state, the stabilized composition exhibits high elasticity and cohesivity during the enzymatic degradation process, surpassing traditional crosslinked HA products. Conclusion: The stabilization provided by the sorbitol in the stabilized composition effectively enhances product properties and protects them during gel degradation. These attributes indicate significant potential for improved clinical outcomes in skin quality treatments.