Laser Skin Resurfacing Research Articles

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.

Effective and durable repigmentation for stable vitiligo: A randomized within-subject controlled trial assessing treatment with autologous skin cell suspension transplantation

BackgroundVitiligo lesions are often challenging to repigment with conventional medical therapies. Surgical autologous melanocyte transfer methods can be utilized for stable vitiligo but demand specialized skills and equipment. A point-of-care autologous cell harvesting device was designed enabling simple preparation of autologous skin cell suspension (ASCS) containing melanocytes, keratinocytes, and fibroblasts providing a straightforward approach for cellular transplantation. ObjectiveTo evaluate the safety and effectiveness of ASCS for repigmentation of stable vitiligo lesions among adults. MethodsA US multicenter, randomized, within-subject controlled trial compared ASCS to NB-UVB only (Control) in similar vitiligo lesions. ASCS was applied after laser skin resurfacing and followed by NB-UVB treatment. The primary effectiveness endpoint was the proportion of lesions achieving ≥80% repigmentation at week-24. Repigmentation durability was assessed at week-52. ResultsAmong 25 subjects, 36% of ASCS-treated lesions achieved ≥80% repigmentation at week-24 compared to 0% for Control (p<0.025), with durability through week-52. The safety profile of ASCS was acceptable, with favorable patient- and investigator-reported outcomes. LimitationsStudy sample size limited robust subgroup analyses. ConclusionApplication of ASCS is a safe and effective treatment for repigmentation of stable vitiligo lesions with the potential to improve health-related quality of life and reduce burden of disease.

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

Nonablative lasers treat photoaged skin and stimulate new collagen formation while sparing epidermal damage. 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. 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. 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. Nonablative combination laser skin resurfacing treatment was well tolerated and significantly improved measures of photodamage in photoaged skin across diverse skin types.

Scope of practice of oculofacial plastic and reconstructive surgeons: a public perception survey

ABSTRACT Purpose The purpose of this study is to determine the public’s perception of the scope of practice for oculofacial plastic and reconstructive surgeons (OFPRS). Methods A 49-question survey was distributed by QualtricsⓇ to a panel similar to the US demographic composition. Responses collected underwent bivariate statistical analysis. Result A total of 530 responses were obtained, with most respondents being white, female, over the age of 35, from the Midwest, and with at least a college education or above. Most respondents did not think ophthalmologists or optometrists were surgeons, and only 158 people (29.8%) knew the primary specialty of OFPRS was ophthalmology. Board certification was preferred by 98.87% of respondents, and 95.28% preferred ASOPRS-trained OFPRS. Conclusions Our study highlights the gap in knowledge about OFPRS as a field, the qualifications and training required, and the scope of practice. Notably, even for OFPRS-specific procedures, PRS remained the leading subspecialist chosen for interventions such as orbital decompression (58.5% vs. 71.5%), orbital reconstruction (57.9% vs. 74.2%), enucleation/evisceration (48.1% vs. 53.4%), optic nerve-related surgery (39.8% vs. 43.4%), orbital cancer resection (42.8% vs. 46.8%), and tear duct surgery (41.9% vs. 52.5%). Additionally, most respondents did not feel that facial fillers, laser skin resurfacing, eyelid cancer removal, or cataract surgery were within the OFPRS scope of practice.

Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern

BackgroundLaser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for “cosmetic” procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices.Case presentationA 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient’s right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar.ConclusionWhen utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.

Evidence-Based Medicine for Nonsurgical Facial Rejuvenation.

Options for nonsurgical facial rejuvenation treatment have increased significantly in both availability and popularity over the past two decades. However, there remains a paucity of clinical practice guidelines and evidence-based recommendations for these procedures. The purpose of this article is to assess the presence of current high-level research for various methods of nonsurgical facial rejuvenation using the Oxford Centre for Evidence-Based Medicine. Botulinum toxin injections remain the best-studied method, with several randomized controlled trials guiding recommendations for safety and efficacy. Several studies on injectable fillers document complications and recommendations to avoid these, but sample sizes are small and many are noncomparative. Deoxycholic acid has been well examined and Food and Drug Administration approved to address submental fat but has not been studied in other areas of the face. Although chemical peels, laser skin resurfacing, energy-based facial rejuvenation, microneedling, and platelet-rich plasma have a variety of facial rejuvenation applications with minimal side effect profiles, there is significant variability with treatment protocols, outcomes measures, and randomized controlled trials with extended follow-up to develop clinical practice guidelines.

Ablation Method of Grinding a Leather Split under the Influence of Laser Radiation

Using scanning electron microscopy, the surface morphology of a split leather sample was studied under the action of laser radiation from the front and backsides. It has been established that the effect of laser skin resurfacing is achieved in the range of input energies of 40 J and exposure times of 40 sec. It was found that laser exposure from the front and backsides leads to polishing of splits. Skin resurfacing from the front and leather split starts at different input energies from the front side from the split, which is associated with a looser structure of the leather from the split and its lower absorption of radiation.

Synergistic Sequential Emission of Fractional 10.600 and 1540 nm Lasers for Skin Resurfacing: An Ex Vivo Histological Evaluation.

Background: Fractional ablative and non-ablative lasers are useful treatments for skin rejuvenation. A procedure that provides the sequential application of fractional ablative followed by non-ablative laser treatment may reduce patients’ downtime and deliver better cosmetic results than with either laser alone. Objective: The purpose of the current study was to demonstrate the ameliorative and therapeutic effects in skin remodeling of the synergistic use of the two laser wavelengths (fractional ablative CO2 and non-ablative 1540 nm) with three different types of pulse shapes, S-Pulse (SP), D-Pulse (DP) and H-Pulse (HP), through which the CO2 laser can emit, performing an ex vivo histological evaluation. Methods: In this prospective study, ex vivo sheep inner thigh skin was chosen due to its similarity to human skin tissue, and a histological evaluation was performed. Three irradiation conditions, using all of the three CO2 pulse shapes (alone or averaged), were investigated: (1) 10.600 nm alone, the sequential irradiation of the two wavelengths in the same perfectly controlled energy pulses (DOT) for the entire scan area; ((2) 10.600 nm followed immediately by 1540 nm; and (3) 1540 nm followed immediately by 10.600 nm). Results: When comparing ablative to sequential irradiations, the synergy of the two wavelengths did not alter the typical ablative pulse shape of the 10.600 nm laser alone. With the same CO2 pulse shape, the lesion depth did not vary with the synergy of the two wavelengths, while thermal lesion width increased compared to CO2 alone. The ablation rate was achieved, while the total thermal lesion coverage in the scanning area of CO2 − 1540 lasers was greater than when using CO2 alone and then the other sequential irradiation. Conclusions: This study provides important preclinical data for new and early uses of the novel 10.600/1540 nm dual-wavelength non-ablative fractional laser. The synergy of the two wavelengths enhanced all the benefits already available when using CO2 laser systems both in terms of tone strengthening, thanks to a greater shrinking effect, and in terms of stimulation and collagen remodeling thanks to a greater volumetric thermal effect.

Does Tixel® hit the technology treatment sweet spot?

Tixel® is a fractional thermomechanical skin resurfacing device that is suitable for treating most skin indications, including uneven skin tone, elevated scarring and fine lines and wrinkles. It is both non-laser and non-ablative. At lower settings, it produces similar results to laser skin resurfacing without the risks of possible skin or eye damage. It safe and effective on all skin types and can be used around the delicate eye area, causing very little pain or downtime.

Knowledge, Attitudes, and Practice of Cosmetic Procedures among Population of Majmaah, Saudi Arabia, 2019-2020

Introduction: Cosmetic procedures have been growing recently among men and women. Cosmetics procedures refer to both surgical and non-surgical procedures. For example, rhinoplasty (nose surgery), surgical face-lifts, abdominoplasty (tummy tuck), and liposuction, etc. referred to surgical procedures. In contrast, procedures such as chemical peels, filler, and botulinum toxin injections, laser skin resurfacing, vein removal, and laser hair removal are collectively referred to as non-surgical procedures. In recent years cosmetics surgeries have decreased while people have moved towards non-invasive cosmetic procedures. Objective: Knowledge, Attitude, and Practice of Cosmetic procedure among the population of Al-Majmaah, Saudi Arabia, 2019-2020. Methodology: This is an observational cross-sectional study targeted Al- Majma’ah population. Half of the participants were asked to complete an electronic questionnaire and the remaining completed a paper-based questionnaire. The questionnaire was divided into four parts: Socio-Demographic Data, Knowledge, Attitude, and Practice of cosmetic procedures. Data were analyzed by using SPSS v.25. In addition, Pearson Chi-square tests applied to determine associations between qualitative variables. Results: Most of the participants were aged between 18-25 years. The majority were female. All of them have heard about cosmetic procedures. Social media was the most common source of information. More than half of the participants recognized different types of cosmetic procedures. More than two-thirds of them believed low self-esteem affects decisions about cosmetic procedures. Only 146 reported undergoing cosmetic procedures, where most of them underwent liposuction and hair removal. Personal desire was the primary source of motivation.,Whereas self satisfaction was the commonest cause for not considering such procedures. 244 of the participants reported their relatives had undergone cosmetic procedures Conclusion: Most of the participants had poor to moderate levels of knowledge regarding Cosmetic procedures. Most of the participants had a positive attitude regarding such a procedure. The prevalence of cosmetic procedures is somewhat uncommon as about one-third of the participants underwent surgical and non-surgical procedures. Keywords: Cosmetic Procedures, Knowledge, Attitudes, Practice, Majmaah, Saudi Arabia

Knowledge, Attitudes, and Practice of Cosmetic Procedures among Population of Majmaah, Saudi Arabia, 2019-2020

Introduction: Cosmetic procedures have been growing recently among men and women. Cosmetics procedures refer to both surgical and non-surgical procedures. For example, rhinoplasty (nose surgery), surgical face-lifts, abdominoplasty (tummy tuck), and liposuction, etc. referred to surgical procedures. In contrast, procedures such as chemical peels, filler, and botulinum toxin injections, laser skin resurfacing, vein removal, and laser hair removal are collectively referred to as non-surgical procedures. In recent years cosmetics surgeries have decreased while people have moved towards non-invasive cosmetic procedures. Objective: Knowledge, Attitude, and Practice of Cosmetic procedure among the population of Al-Majmaah, Saudi Arabia, 2019-2020. Methodology: This is an observational cross-sectional study targeted Al- Majma’ah population. Half of the participants were asked to complete an electronic questionnaire and the remaining completed a paper-based questionnaire. The questionnaire was divided into four parts: Socio-Demographic Data, Knowledge, Attitude, and Practice of cosmetic procedures. Data were analyzed by using SPSS v.25. In addition, Pearson Chi-square tests applied to determine associations between qualitative variables. Results: Most of the participants were aged between 18-25 years. The majority were female. All of them have heard about cosmetic procedures. Social media was the most common source of information. More than half of the participants recognized different types of cosmetic procedures. More than two-thirds of them believed low self-esteem affects decisions about cosmetic procedures. Only 146 reported undergoing cosmetic procedures, where most of them underwent liposuction and hair removal. Personal desire was the primary source of motivation.,Whereas self satisfaction was the commonest cause for not considering such procedures. 244 of the participants reported their relatives had undergone cosmetic procedures Conclusion: Most of the participants had poor to moderate levels of knowledge regarding Cosmetic procedures. Most of the participants had a positive attitude regarding such a procedure. The prevalence of cosmetic procedures is somewhat uncommon as about one-third of the participants underwent surgical and non-surgical procedures. Keywords: Cosmetic Procedures, Knowledge, Attitudes, Practice, Majmaah, Saudi Arabia

A саsе of effective treatment of acne in patient with secondary immune deficiency of the first degree

Acne is an urgent problem in modern dermatology. The management of this disease is a complex, lengthy and multi-step process that requires a combination of different treatment methods and an individualized approach.&#x0D; Objeсtive — to demonstrate a clinical case of effective treatment of acne in a patient with secondary immune deficiency of the first degree.&#x0D; Materials and methods. A clinical case is presented of treatment of a 23-­year­-old man suffering from papulopustular form of moderate acne developed on the background of secondary immune deficiency of the first degree. The disease had a chronic course and resistance to the therapy used. The retinoid drug isotretinoin was used for treatment with a gradual increase and then decrease in its daily dose; antibiotic therapy; the drug Propes as an immunomodulator; as well as a set of cosmetic measures — chemical peelings and laser skin resurfacing. After the onset of dryness of certain areas of the skin, as a side effect of isotretinoin, emollients were locally intended.&#x0D; Results and discussion. At the end of the seventh month of treatment, the inflammatory rash on the skin completely stopped. The phenomenon of postacne was eliminated. During the control immunogram 2 months after the start of complex therapy, there was complete normalization of its parameters. In addition, during the first month of taking the drug isotretinoin , the patient did not have the exacerbation of the inflammatory process on the skin which was usual for this stage of treatment.&#x0D; Conclusions. The success in the treatment of the patient with acne who had secondary immune deficiency of the first degree as concomitant pathology, in our opinion, is due to a well­chosen comprehensive treatment which included antibacterial therapy, systemic retinoid isotretinoin in an appropriate for this clinical stage dose, Propes medication of the defensins group as an immunomodulatory agent, as well as the use of a complex of cosmetic measures.

Safety of laser skin resurfacing in immunocompromised and diabetic patients

Safety of laser skin resurfacing in immunocompromised and diabetic patients

The Rise of Physician Assistants and Nurse Practitioners in Medically Necessary, Noninvasive Aesthetic Procedures for Medicare Beneficiaries.

Physician assistants and nurse practitioners have a vital role in a successful plastic surgery practice, often executing multiple essential tasks. These include wound care, floor management, follow-up care, and even procedures. While the role of physician assistants and nurse practitioners in noninvasive surgical care has been explored in other specialties (e.g., urology), the extent of their involvement in noninvasive aesthetic procedures is unknown.1 This study elucidates trends in the role of physician assistants and nurse practitioners in performing plastic surgery procedures for Medicare beneficiaries. A retrospective review of common noninvasive aesthetic procedures performed by physician assistants and nurse practitioners was conducted.2 These procedures were extracted from the 2019 American Society of Plastic Surgeons Statistics Report.3 Percentage changes in the number of procedures performed from 2010 to 2018 were recorded. In addition, compound annual growth rates were calculated from 2010 to 2018 for both number of procedures and total payment value. In 2018, a total of 7,561,309 noninvasive aesthetic procedures, amounting to $433,788,296, was performed by nurse practitioners (n = 2,825,274, $140,786,303) and physician assistants (n = 4,735,936, $293,001,993) (Table 1). From 2010 to 2018, there was a 24 percent increase in the number of procedures performed by nurse practitioners, a 19 percent increase in those performed by physician assistants, and a 21 percent increase for the combined cohort. By total payment amount, there was an increase in compound annual growth rates of 22 percent for nurse practitioners, 20 percent for physician assistants, and 20 percent for the combined cohort. Botulinum toxin type A had the highest percentage increase (4431 percent), followed by soft-tissue fillers (990 percent), chemical peel (484 percent), laser hair removal (467 percent), laser tattoo removal (353 percent), intense pulsed light treatment (346 percent), laser treatment of leg veins (316 percent), laser skin resurfacing (254 percent), microdermabrasion (120 percent), and sclerotherapy (44 percent) (Fig. 1). Table 1. - Nurse Practitioners and Physician Assistants in Noninvasive Aesthetic Procedures for Medicare Beneficiaries in 2018 Characteristic Overall Nurse Practitioners Physician Assistants Combined Total no. of noninvasive cosmetic services (2018) 2,825,274 4,735,936 7,561,309 CAGR of noninvasive cosmetic services (2010–2018) 24% 19% 21% Total noninvasive cosmetic payments (2018) $140,786,303 $293,001,993 $433,788,296 CAGR of noninvasive cosmetic payments (2010–2018) 22% 20% 20% CAGR, compound annual growth rate. Fig. 1.: Percent change in the top 10 medically necessary aesthetic procedures performed by nurse practitioners and physician assistants from 2010 to 2018.Our results confirm the prominence of physician assistants and nurse practitioners in performing noninvasive aesthetic procedures. Moreover, physician assistants performed the majority of procedures (62 percent), whereas nurse practitioners maintained a higher compound annual growth rate (24 percent) from 2010 to 2018. This is likely a reflection of the larger census of physician assistants relative to nurse practitioners in plastic surgery; nonetheless, such trends suggest a growing potential for nurse practitioners to engage in procedural-based care.4,5 To further explain these finding, future studies could assess how clinical responsibilities and reimbursements have evolved for nurse practitioners and physician assistants. Furthermore, of all procedures, botulinum toxin injections represented the highest growth over time. This could be attributed to a combination of factors, including patient demand, procedural ease, and increased clinical exposure.3 This study has a couple of limitations that warrant consideration. First, only the top 10 highest-volume aesthetic procedures were included. In doing so, we excluded other common procedures in our analyses. Second, we examined Medicare beneficiaries, and therefore did not analyze data from healthier or younger patients perhaps better suited to receive these types of procedures. Thus, our study likely underestimates the engagement of advanced practice providers in “medically necessary” aesthetic procedures. With the increasing demand of aesthetic surgery among older patients, the role of physician assistants and nurse practitioners may be crucial in order to ensure adequate access to care. Future studies should further explore their engagement in aesthetic medicine, with respect to quality, patient satisfaction, and educational training. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work.

Effect of Oil-Phase Volume Fraction on Rheological Properties of Pistacia Lenticus Fruit Oil-in-Water Emulsion Intended for Healing Wounds

Oil-in-water emulsions with different internal phase concentrations of Pistacia lentiscus fruit oil (PLFO) were investigated. These emulsions could be useful as a cream for healing wounds after laser skin resurfacing. Microscopic analysis and rheological measurements were employed to assess the effect of PLFO content on the emulsion properties for 24 hours and one year of storage in the refrigerator. Three emulsions were prepared with 5, 10, and 20% of PLFO. An increase in the internal phase concentration led to an increase in the size of oil droplets (from 1.07 to 2.24 µm) and their concentration in the aqueous phase, which significantly influenced the viscosity and stability of emulsions. However, the high content of PLFO (20%) led to a non-homogeneous distribution of the droplet size, which decreased the viscosity and stability of the emulsion. Furthermore, the creep-recovery tests were carried out to analyze the viscoelastic behavior of emulsions. The Burger model was applied for simulations using a function of PLFO concentration. The elastic character corresponds to the gel internal network structure of emulsion. The elasticity increased with the oil concentration, indicating that the strengthening of the structure of emulsion. The elastic behavior retains in time, suggesting that PLFO influences the emulsion stability. However, high oil concentration resulted in a weakening of the structure. One of the most significant findings of this study is that the emulsion containing 10% was most stable with time and can easily be transformed into liquid, which makes it useful for the skincare formulations due to release the active compounds.

The 3-step Greek protocol of neck skin rejuvenation inspired by a case of pseudoxanthoma elasticum: combination of laser skin resurfacing, collagen booster and PRP

Aim: The physiological ageing process causes significant changes in the extracellular matrix (ECM) of the neck skin, which are the first signs of ageing witness for women. We are inspired by a young woman, who suffers from a rare genetic disorder called pseudoxanthoma elasticum (PXE), which manifests irregular, thickened, fragmented and haphazardly orientated elastic fibers. We herein present a combination of three different therapies (laser skin resurfacing, type I horse collagen boosters and platelet rich plasma)as an approach to ameliorate neck skin sagging. Methods: A 28-year-old Roma woman with a clinically diagnosed PXE, verified by ophthalmologic evidence and skin biopsy, underwent 3 sessions of this combined protocol every 3 weeks. One month after the last treatment session, a new biopsy was taken. During this period, the patient was encouraged for daily topical application of collagen mousse and vitamin C combined with sun block SPF50, along with limited exposure to sunlight. Results: Clinical assessment supported by photographic documentation was performed at each session. Severe changes in hydration and tightening of the neck skin were obvious 3 weeks after the second session, although the verification of the results was substantiated with the pathology of the post treatment skin biopsy obtained 1 month following the completion of the protocol. The elastic fibers in the mid-dermis were dense, non-fragmented and parallel oriented. The aesthetic performance was evident until the final follow-up visit. Conclusions: Nowadays, the primary goal of aesthetic medical research is oriented to the dermis bio-reconstruction, where specific treatments try to improve the dermis quality from the inside to repair imperfections of skin ageing. The key of success is attributed to the best possible treatment combination capable of fibroblast stimulation.

Nonablative laser skin resurfacing for periorbital wrinkling—A case series of 16 patients

Many modalities have been described for the treatment of periorbital wrinkling. The purpose of this study is to quantify the improvement of periorbital wrinkling achieved by current nonablative modalities, using a fractional 1565nm Er:glass fiber laser. Our study is a retrospective two-center case series including 16 patients treated with nonablative laser for periorbital wrinkling at the Tel-Aviv Sourasky Medical Center in Israel and Laserplast Aesthetic Medicine Center in Italy between 2017 and 2019. Patients were assessed for objective and subjective improvement, patient satisfaction, side effect profile, and downtime. Improvement in average Fitzpatrick Wrinkle Scale scores (from 4.3 to 2.7 by ranking physician 1 and 3.8 to 2.4 by ranking physician 2, P<.001) was observed after 8weeks. Global Assessment Improvement Scale scores were 2.6 (physician 1) and 2.2 (physician 2) on average. This correlated to mild-moderate subjective sense of improvement by patients. Side effects and downtime were minimal. Our study suggests that current nonablative laser skin resurfacing technology offers a mild-moderate improvement in periorbital wrinkling.

Wound Healing Treatments After Ablative Laser Skin Resurfacing: A Review.

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario. J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386.

Assessment of Laser Effects on Skin Rejuvenation.

Laser skin resurfacing has changed the approach of facial skin rejuvenation over the past decade. This article evaluates the laser effects on skin rejuvenation by the assessment of laser characteristics and histological and molecular changes, accompanied by the expression of proteins during and after laser-assisted rejuvenation of skin. It is important to note that different layers of skin with different cells are normally exposed to the sun's UV radiation which is the most likely factor in aging and damaging healthy skin. To identify the expression of proteins, using validated databases and reviewing existing data could reveal altered proteins which could be analyzed and mapped to investigate their expression and their different effects on cell biological responses. In this regard, proteomics data can be used for better investigation of the changes in the proteomic profile of the treated skin. Different assessments have revealed the survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases (MMPs) and heat shock proteins (HSPs) as a result of different low-power laser therapies of skin. There are a wide range of biological effects associated with laser application in skin rejuvenation; therefore, more safety considerations should be regarded in the application of lasers in skin rejuvenation.

First Assessment of a Carbon Monoxide Laser and a Thulium Fiber Laser for Fractional Ablation of Skin.

A recent generation of 5,500 nm wavelength carbon monoxide (CO) lasers could serve as a novel tool for applications in medicine and surgery. At this wavelength, the optical penetration depth is about three times higher than that of the 10,600 nm wavelength carbon dioxide (CO2 ) laser. As the amount of ablation and coagulation is strongly influenced by the wavelength, we anticipated that CO lasers would provide extended coagulation zones, which could be beneficial for several medical applications, such as tissue tightening effects after laser skin resurfacing. Untilnow, the 1,940 nm wavelength thulium fiber (Tm:fiber) laser is primarily known as a non-ablative laser with an optical penetration depth that is eight times higher than that of the CO2 laser. The advantage of lasers with shorter wavelengths is the ability to create smaller spot sizes, which has a determining influence on the ablation outcome. In this study, the ablation and coagulation characteristics of a novel CO laser and a high power Tm:fiber laser were investigated to evaluate their potential application for fractional ablation of the skin. Laser-tissue exposures were performed using a novel CO laser, a modified, pulse-width-modulated CO2 laser, and a Tm:fiber laser. We used discarded ex vivo human skin obtained from abdominoplasty as tissue samples. Similar exposure parameters, such as spot size (108-120 μm), pulse duration (2 milliseconds), and pulse energy (~10-200 mJ) were adjusted for the different laser systems with comparable temporal pulse structures. Laser effects were quantified by histology. At radiant exposures 10-fold higher than the ablation threshold, the CO laser ablation depth was almost two times deeper than that of the CO2 laser. At 40-fold of the ablation threshold, the CO laser ablation was 47% deeper. The ablation craters produced by the CO laser exhibited about two times larger coagulation zones when compared with the CO2 laser. In contrast, the Tm:fiber laser exhibited superficial ablation craters with massive thermal damage. The tissue ablation using the Tm:fiber laser was very superficial in contrast to the CO laser and the CO2 laser. However, higher etch depths should be obtainable when the radiant exposure is increased by using higher pulse energies and/or smaller spot sizes. At radiant exposures normalized to the ablation threshold, the CO laser was capable of generating deeper ablation craters with extended coagulation zones compared with the CO2 laser, which is possibly desirable depending on the clinical goal. The effect of deep ablation combined with additional thermal damage on dermal remodeling needs to be further confirmed within vivo studies. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.