Periorbital Wrinkles Research Articles

Evaluation of the effects of a preparation containing asiaticoside on periocular wrinkles of human volunteers

Skin ageing is accompanied by wrinkle formation. In particular, periorbital wrinkle formation is a relatively early sign of skin ageing. We evaluated the effects of a preparation containing asiaticoside on the periorbital wrinkles of a group of volunteers. The effectiveness of the active compound, asiaticoside, in a base-cream preparation for the treatment of temporal periorbital wrinkles was tested on 27 female volunteers as follows: the women applied the cream twice a day to the region of interest for 12 weeks. Same women also applied a vehicle control cream to the periorbital skin around the other eye. Negative replicas were taken of the periorbital skin before treatment and 4, 8, and 12 weeks after application of the cream. The results were evaluated by semi-automated morphometry of the plastic replicas. After 12 weeks of treatment, there was a significant improvement of the periorbital wrinkles in majority of the volunteers who tested the cream. Of the 27 women examined with periocular wrinkles, 65% showed an improvement at the end of the treatment. In three cases, the improvement was 100% (disappearance of the crow's feet), 75% +/- 1.97 and 79% +/- 2.82. On six eyes, there was no significant change after the treatment. With 12 weeks of treatment with the asiaticoside-containing cream, most of the periorbital wrinkles were attenuated to some degree, and some women experienced a significant improvement of the periorbital wrinkles on one of their eyes.

X-Linked Ectodermal Dysplasia With Immunodeficiency Caused by NEMO Mutation

X-linked ectodermal dysplasia with immunodeficiency (XL-EDA-ID) is described in patients with hypomorphic mutations in IKBKG (the inhibitory kappaB kinase gamma gene), which encodes nuclear factor kappaB essential modulator (NEMO). Features include hypohidrosis, dental anomalies, alopecia, and immunodeficiency. Boys with NEMO mutations often present with serious infections, but the NEMO mutations are rarely diagnosed early in infancy. Cutaneous features in these patients are poorly elucidated. A 12-week-old male infant presented with a recalcitrant skin eruption, intertrigo, atopiclike dermatitis, and erythroderma. Alopecia, frontal bossing, and periorbital wrinkling were present, and family history revealed incontinentia pigmenti in his mother. Laboratory evaluation revealed leukocytosis with eosinophilia, low IgG and IgM levels, and absent IgA. Flow cytometry revealed lymphocytosis with elevated CD3(+) and CD4(+) counts and low levels of natural killer cells. Amplification and sequencing of IKBKG revealed insertion of cytosine at nucleotide 1167 (1167-1168insC) in exon 10, with frameshift mutation in the zinc-finger domain. Peripheral blood stem cell transplantation led to initial engraftment and improvement in his skin findings, but his engrafted cell counts diminished, and a second stem cell transplantation was planned. Mutations in NEMO should be considered in male infants with recalcitrant seborrheic or atopic dermatitislike eruptions and intertrigo, especially when features of ectodermal dysplasia are present. Early recognition and diagnosis are desirable, prior to the onset of manifestations of immunodeficiency.

Histologic evidence of new collagen formation using a Q‐switched Nd:YAG laser in periorbital rhytids

Objectives: Non‐ablative laser treatment has been used for improving dermal toning. Laser application to dermis causes new collagen formation in terms of wound healing. We aimed to study mainly histological changes in skin after the use of a Q‐switched Nd:YAG laser in non‐ablative treatment of wrinkles. Methods: The laser was adjusted to a fluency of 7 J/cm2 with a spot size of 3 mm and a pulse rate of 10 Hz to treat periorbital wrinkled areas. None of the patients had received filling materials, botulinum toxin injections or any dermabrasion procedures. All laser sessions were held every 15 days for a total of six sessions and all patients were photographed before treatment and then 2 months after the last treatment. Histological examinations were performed before laser treatment and 1 month after the final treatment. Results: Four of eight individuals showed clinical improvement. The histological proportion of collagen fibers was measured by using the Samba method. An increase in the mean optical densities (MOD) of collagen fibers compared with baselines was statistically significant in all patients (p<0.05). Conclusion: The 1064‐nm Q‐switched Nd:YAG lasers appear to be safe and efficient for non‐ablative remodeling of periorbital wrinkles.

Co 2 laser resurfacing for facial rhytides

Resurfacing of facial rhytides (periorbital crow-feet wrinkles) was performed in three cases by carbon dioxide laser (Sharplan® 1030 machine). Good to excellent results were observed. However, erythema and postinflammatory pigmentation were important side effects.

Salicyloyl‐phytosphingosine: a novel agent for the repair of photoaged skin

In recent years the importance of sphingolipids (cerebrosides, sphingomyelin, ceramides, sphingosine-1-phospate, etc.) in skin biology is receiving an increasing interest. Not only are ceramides essential for the barrier function of the skin, especially through their phytosphingosine, sphingosine and 6-hydroxysphingosine derivatives, they are now also known to be cell-signalling mediators which can improve epidermal differentiation. However, their effects on dermal anti-ageing markers and reduction of wrinkles have not been established. In this study, we were interested in the effects of a sphingolipid derivative, salicyloyl-phytosphingosine (SP), because of the known independent beneficial effects of salicylic acid and phytosphingosine on skin. Both of these agents are known to reduce the activities of the activator protein-1 transcription factor, in a manner similar to that observed with retinoic acid (RA) treatment. Through this mechanism, RA was shown to reduce the levels of matrix metalloproteases (MMPs) and the increase levels of extracellular matrix proteins. Therefore, we examined the effects of SP on procollagen-I synthesis in fibroblasts in vitro, its effects in vivo on the expression of dermal markers such as fibrillin-1, procollagen-I and MMP-1 immunochemically in biopsies taken from a short-term occluded patch test protocol and, its effects on periorbital wrinkle reduction over 4 weeks using Fast Optical In Vivo Topometry of Human Skin. In vitro we observed a significant increase in the production of procollagen-I by adult human fibroblasts (two fold increase, P < 0.01) which encouraged us to test the effects of SP in vivo. Initially, test products (SP at 0.05% and 0.2%, all-trans RA (0.025%) and vehicle were applied under occlusion for 8 days prior to biopsy and histological assessment in photoaged volunteers (n = 5). Increased deposition of fibrillin-1 and procollagen-I, together with reductions in the levels of MMP-1, were observed for the SP treatments (P < 0.05). Similar effects were observed for RA, except for the increases in procollagen-I. With these beneficial effects on the basement membrane and papillary dermal markers, we evaluated the effects of SP in an oil-in-water (O/W) cream for its effects in reducing the appearance of periorbital wrinkles in a 4-week, half-face clinical study compared to placebo cream (moderately photoaged female subjects aged 41-69 years; n = 30). Clear reductions in wrinkle depth and Rz (skin smoothness) together with Ra (skin roughness) parameters were observed (P < 0.05), indicating an anti-wrinkle benefit. In conclusion, this series of studies demonstrated for the first time that a ceramide derivative, such as that SP, was a novel agent for the repair of photoaged skin and highlight its effects at the cellular, tissue and organ levels.

Effect of a preparation containing a fucose‐rich polysaccharide on periorbital wrinkles of human voluntaries

Skin aging is accompanied by wrinkle formation. At some sites, as the periorbital skin, this is a relatively early phenomenon, variable from one woman to the other and even between the right and left eye. We tested the effect of a preparation with fucose-rich oligo- and polysaccharide (FROP-3) on periorbital wrinkles (crow's feet) on a team of voluntaries. The efficiency of a preparation containing as active principle a fucose-rich polysaccharide in a base-cream for the treatment of temporal periorbital wrinkles on 20 voluntary women was tested as follows: the women applied the cream twice a day for 4 weeks. Negative replicas were taken on the periorbital skin before and after 4 weeks of application of the cream. The results were evaluated by semi-automated morphometry on the plastic replicas and expressed as the 'wrinkle-factor' obtained by multiplying total wrinkle length in millimeters by the average wrinkle width. After 4 weeks of treatment, there was a significant improvement of the periorbital wrinkles for the majority of the voluntary team who tested the cream. On the 29 periocular wrinkles examined 65% showed an improvement at the end of the treatment. In two cases, the improvement was 100% on one eye (disappearance of the crow's feet) and of 75% and 79% on the other eye. On six eyes, there was no significant change after the end of the treatment, and on four eyes a worsening was observed. The age-dependent modifications showed that improvement was independent of age and was the result of individual skin reactions to the cream. The occurrence and the severity of crow's feet is highly individual, and differs from one side of the face to the other for the same person. These strong individual variations explain the highly variable results, not only from one woman to the other but also comparing one side of the face to the other for the same person. Under the effect of 4 weeks of treatment with the FROP-3-containing cream, most of the voluntaries had their periorbital wrinkles attenuated and some women showed a total regression of crow's feet on one of their eyes.

Treatment of periorbital wrinkles by repeated medium‐depth chemical peels in dark‐skinned individuals

The periorbital region serves as a barometer of chronological and environmental age and, as such, persons often seek its cosmetic rejuvenation. This study was conducted to determine the efficacy and safety of repeated, medium-depth chemical peels in the treatment of periorbital wrinkles in dark-skinned individuals. A total of 12 subjects (10 women and 2 men) with fine and/or medium-sized wrinkles were included in the study, the ages ranged from 30 to 55 years with a mean of 41.25. Focal, medium-depth peels of periorbital area including crow's foot wrinkles were performed using a combination of Jessner's solution followed by the application of 35% trichloroacetic acid (TCA). The study involved a four-session regimen. To be included in this study, the subject completed at least two peeling sessions, 1 month apart, and returned for follow-up according to the research schedule. Improvement occurred in 11 of 12 subjects. Marked improvement occurred in four subjects (33%), moderate improvement in three (25%), mild improvement in another three (25%), minimal improvement in one subject (8%), and no response in one subject (8%). There were seven patients with fine and five with medium periorbital wrinkles. For statistical analysis, the no and minimum response groups were categorized as nonresponders. The improvement that ranged between marked to mild occurred in 100% of subjects with fine wrinkles and 60% of subjects with medium wrinkles. Mild side effects appeared in four subjects (33%). It can be concluded that fine and/or medium periorbital wrinkling responds favorably to repeated, medium-depth chemical peels even in dark-skinned individuals with few mild side effects.

A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation

Background. The use of visible or near infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths and thus compounding their distinct stimulation of cellular components is proposed.Objective. To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin.Methods. Thirty‐one subjects with facial rhytids received nine light therapy treatments using the OmniluxTM LED system. The treatments combined wavelengths of 633 nm and 830 nm with fluences of 126 J/cm2 and 66 J/cm2 respectively. Improvements to the skin surface were evaluated at weeks 9 and 12 by profilometry performed on periorbital casts. Additional outcome measures included assessments of clinical photography and patient satisfaction scores.Results. Key profilometry results Sq, Sa, Sp and St showed significant differences at week 12 follow‐up; 52% of subjects showed a 25%–50% improvement in photoaging scores by week 12; 81% of subjects reported a significant improvement in periorbital wrinkles on completion of follow‐up.Conclusion. OmniluxTM combination red and near infrared LED therapy represents an effective and acceptable method of photo rejuvenation. Further study to optimize the parameters of treatment is required.

Single-Pass Carbon Dioxide Laser Skin Resurfacing Combined With Cold-Air Cooling

Ablative skin resurfacing with carbon dioxide (CO(2)) and erbium:YAG lasers is still considered the gold standard for treating rhytides, photodamage, and acne scars. However, the prolonged downtime and undesired concomitant effects that are involved have sent dermatologists looking for less invasive nonablative laser techniques to rejuvenate skin. To combine cold-air cooling with single-pass CO(2) laser skin resurfacing to generate as much benefit as possible while minimizing the spectrum of adverse effects. The efficacy of single-pass CO(2) laser skin resurfacing on perioral and periorbital wrinkles was examined prospectively during a 6-month follow-up period. In a side-by-side comparison, the influence of simultaneous cold-air cooling on concomitant effects, pain tolerance, therapeutic success, and patient satisfaction was also studied. Eight patients with perioral and/or periorbital wrinkles underwent the procedure. During laser treatment, only the right half of each face was cooled using a cold-air system. Six months after treatment, a mild improvement of the wrinkles was observed in all cases. The use of cold-air cooling did not have any impact on the long-term results, although in a direct comparison between sides, it was observed that cooling reduced the recovery period from 3.9 +/- 1.5 (mean +/- SD) days to 3.5 +/- 1.4 days (P = .09) and helped postoperative erythema fade more quickly, from an average of 21.3 +/- 17.9 days to 11.7 +/- 3.9 days (P = .17). The reduction of pain was significant, which led to a much higher level of patient acceptance: on a numerical analog scale of 1 to 10, the rate decreased from an average of 6.8 +/- 1.8 (mean +/- SD) to 3.6 +/- 1.7 (P = .006). Given the clear decline in demand for invasive laser technologies, single-pass CO(2) laser skin resurfacing in conjunction with cold-air cooling is a worthwhile alternative both to conventional resurfacing and to conventional subsurfacing. The use of cold-air cooling not only minimizes intraoperative and postoperative adverse effects, it also contributes strongly to patient satisfaction.

Periorbital treatment, 2 major contributions: Botulinum toxin and volumetric fillers

Botulinum toxin, by creating a „biological section“, produces a very efficient, safe and durable treatment of the dynamic periorbital wrinkles. Indeed, those lines are usually treated with much more risks and less durability by procedures as face lifts and other surface medical treatments. In other hands, in this peiorbital area: If a loose of volume is existing, volumetric fillers, as fat grafting and other effective exogenous products, are the best approach.

Advanced Thermage Procedure Techniques

Introductory Sentence: The ThermaCool TC System is FDA cleared for the treatment of periorbital wrinkles and rhytids. Currently several off label uses are under investigation for the treatment of other areas of the face and neck. Since the first introduction of the system many changes in the technology and the techniques have taken place.

Non‐ablative skin remodeling: an 8‐month clinical and 3D in vivo profilometric study with an 810 nm diode laser

BACKGROUND: Non‐ablative remodeling has recently been proposed as a new anti‐aging treatment with no downtime.OBJECTIVE: This study aimed to evaluate objectively, with a three‐dimensional (3D) in vivo profilometric study, the efficacy and safety of non‐ablative skin remodeling with an 810 nm diode laser on periorbital wrinkles with an 8‐month follow‐up.METHODS: Ten female patients (mean age: 55 years) were treated three times at 1‐month intervals and then evaluated 5 months after the last treatment. Patients were evaluated using clinical data, standardized photographs and 3D in vivo profilometry in order to quantify the degree of improvement. This objective method evaluates the general degree of roughness (anisotropy) and the depth of the wrinkles.RESULTS: An observer independent from the study showed slight improvement in the quality of the skin and visual aspect of the wrinkles at 3 months. Eight months later this was confirmed to a lesser degree by clinical and 3D profilometry. No immediate or late adverse effects were noted at any stage of the procedure.CONCLUSION: This study demonstrated that irradiation with a 810 nm laser emitting in a pulsed mode and connected to a cooling system reduced anisotropy of the skin and improved the clinical aspects of the wrinkles. Results appear quickly at 3 months and are stable at 8 months.

Nonablative laser treatment of wrinkles: meeting the objective? Assessment by 25 dermatologists

Established skin resurfacing methods causing superficial wounds and extended recovery times have become less popular since the introduction of nonablative lasers. To evaluate the clinical efficacy of a nonablative 1450-nm diode laser system. Nine patients (Fitzpatrick skin type II-IV) with periorbital wrinkling class I-II were treated three times at 3-weekly intervals with a 1450-nm diode laser. Clinical outcome was determined by 25 independent dermatologists evaluating standardized photographs taken before treatment and 1 month after treatment. The patients were satisfied with the procedure, and reported a mild to moderate improvement in all cases. Among 25 dermatologists, only two provided ratings which were significantly in favour of a positive treatment effect. Nonablative laser treatment subjectively satisfies patients but does not convince objective judgement.

A pilot study on the treatment of facial rhytids using nonablative 585-nm pulsed dye and 532-nm Nd:YAG lasers.

There have been reports of successfully using the pulsed dye laser and long-pulse Nd:YAG laser to improve skin wrinkles. To evaluate the efficacy of these lasers in the treatment of moderate to severe wrinkles. Seven subjects had one side of their periorbital wrinkles treated with pulsed dye laser (585 nm, 0.45 ms, 2.5 J/cm2, single-pass 10% overlap, three treatments at 6 weeks apart). The second part of the study involved using the long-pulse Nd:YAG laser (532 nm, 2 ms, 7.0 J/cm2 with cooling, three laser passes, three treatments at 6 weeks apart) to treat the contralateral wrinkles in five subjects. Pretreatment and posttreatment photographs were taken, and blinded assessors were asked to choose the better of the two unlabeled photographs. Assessors found that two of the seven subjects had a better posttreatment photograph in the pulsed dye laser-treated group. Three of five subjects had a better posttreatment photograph in the long-pulse Nd:YAG laser-treated group. None of the subjects reported any subjective improvements. Neither the pulsed dye laser nor the long-pulse Nd:YAG laser at the previously mentioned parameters produced any improvement in moderate to severe facial wrinkles.

Multicenter study of noninvasive radiofrequency for periorbital tissue tightening.

This 6-month study evaluated the efficacy and safety of treatment with a nonablative radiofrequency (RF) device. Eighty-six subjects received a single treatment with the ThermaCool TC System (Thermage, Inc., Hayward, CA) and were evaluated for 6 months after treatment. Independent scoring of blinded photographs resulted in Fitzpatrick wrinkle score improvements of at least 1 point in 83.2% (99/119) of treated periorbital areas. Treating physicians, without reference to pre-treatment photographs, noted improvements in 28.9% (48/166) of treatment areas. Fifty percent (41/82) of subjects reported being satisfied or very satisfied with periorbital wrinkle reductions. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of edema/erythema were very low (e.g., vs. ablative procedures). Overall 2nd-degree burn incidence was 0.36% (21 per 5,858 RF applications). Three patients had small areas of residual scarring at 6 months. A single treatment with this RF tissue tightening (RFTT) device produces objective and subjective reductions in periorbital wrinkles, measurable changes in brow position, and acceptable epidermal safety. These changes were indicative of a thermally induced early tissue-tightening effect followed by additional tightening over a time course consistent with a thermal wound healing response.

Laser blepharoplasty in Asians.

Traditional blepharoplasty removes periorbital wrinkles by cutting and stretching the skin. However, this method has a substantial risk of producing ectropion or scleral show. In addition, fine periocular wrinkles may persist because this method does not change skin texture. The pulsed CO2 laser has recently become a primary surgical tool in treating aging eyelids. Periorbital wrinkles vary in depth not only from person to person, but also among different races. Compared with whites, most Asians have a thicker dermis, so more laser passes and a higher power may be required to remove periorbital wrinkles, but concerns about hyperpigmentation and prolonged erythema have limited its use on Asian skin. In this study, 346 patients underwent laser blepharoplasty at the Korea University Medical Center and at Dr Choi's Aesthetic Clinic. They were followed for 12 months on average from September 1995 to September 1999. The CO2 laser was used in resurfacing periorbital wrinkles, transcutaneous skin excision, and transconjunctival blepharoplasty, including fat removal. The authors assessed the benefit of using the UltraPulse CO2 laser in Asian blepharoplasty. They found that 291 patients (84%) had good to excellent results. The incidence of side effects was very low. Prolonged erythema occurred in 19 patients (5%) and hyperpigmentation occurred in 35 patients (10%), but the erythema disappeared spontaneously within 2 months and the hyperpigmentation could be managed readily by the topical use of retinoids and hydroquinone cream. Therefore, the authors conclude that postoperative hyperpigmentation is no longer a problem limiting laser resurfacing in Asian blepharoplasty. The UltraPulse CO2 laser is a safe and effective rejuvenation method for treating aging eyelids in Asians.

New treatment possibilities for skin changes with the CO2 laser in head and neck surgery

Laser treatment of various skin changes has become common clinical practice in recent years. Due to its physical properties, the CO2 laser is particularly well suited for cutting and ablating tissue. The high absorption of its wavelength in water (lambda = 10600 nm) is responsible for its low penetration depth in biological tissue. Shortening the exposure time minimizes thermal side effects, such as carbonization and coagulation. This effect can be lessened with the Silk Touch scanner, since the focussed laser beam is moved over a defined area by rapidly rotating mirrors. This enables a controlled and reliable removal of various dermal lesions. Particularly well-suited for treatment hypertrophic scars, post-acne scarring, perioral and periorbital wrinkles, rhinophymas and benign neoplasms including verruca vulgaris. Cosmetically favorable reepithelialization of the treated skin surfaces occurs within a very short time after treatment. Periorbital resurfacing and correction of a rhinophyma are used as examples of dermal treatment with the CO2 laser and the Silk Touch scanner.

Treatment of Periorbital Wrinkles

Chemical peels are an effective treatment for wrinkles, but their use is limited because of the associated risk of scarring, hypopigmentation, and the inability to accurately control the depth of tissue injury. High energy, pulsed, or computer scanned continuous wave carbon dioxide (CO2) lasers cause minimal thermal injury, decrease the risk of scarring, and allow for precise control of tissue vaporization to predictable depths.To compare the effectiveness and side effect profile of a medium-depth chemical peel to that of the SilkTouch CO2 laser in the treatment of periorbital wrinkles.Twenty-four subjects (nine male, 15 female) with moderate to severe periorbital wrinkles were assigned a wrinkle score (1 = mild through 5 = severe) before treatment and 6 months after treatment. Each subject was treated with Jessner's solution and 35% trichloroacetic acid on one side and the SilkTouch CO2 laser on the other side.The average periorbital wrinkle score decreased from 4.00 +/- 0.78 before laser treatment to 1.75 +/- 0.68 6 months after treatment. The chemical peel wrinkle score decreased from 4.13 +/- 0.85 to 3.29 +/- 0.99. The degree in which the wrinkle score improved after laser treatment compared with after chemical peel treatment was statistically significant. Posttreatment erythema lasted an average of 4.5 months for the laser-treated areas and 2.5 months for the chemical peel-treated areas.Treatment of periorbital wrinkles with the SilkTouch CO2 laser resulted in a greater degree of improvement than treatment with a medium-depth chemical peel but had longer lasting posttreatment erythema.

Treatment of periorbital wrinkles. A comparison of the SilkTouch carbon dioxide laser with a medium-depth chemical peel.

Chemical peels are an effective treatment for wrinkles, but their use is limited because of the associated risk of scarring, hypopigmentation, and the inability to accurately control the depth of tissue injury. High energy, pulsed, or computer scanned continuous wave carbon dioxide (CO2) lasers cause minimal thermal injury, decrease the risk of scarring, and allow for precise control of tissue vaporization to predictable depths. To compare the effectiveness and side effect profile of a medium-depth chemical peel to that of the SilkTouch CO2 laser in the treatment of periorbital wrinkles. Twenty-four subjects (nine male, 15 female) with moderate to severe periorbital wrinkles were assigned a wrinkle score (1 = mild through 5 = severe) before treatment and 6 months after treatment. Each subject was treated with Jessner's solution and 35% trichloroacetic acid on one side and the SilkTouch CO2 laser on the other side. The average periorbital wrinkle score decreased from 4.00 +/- 0.78 before laser treatment to 1.75 +/- 0.68 6 months after treatment. The chemical peel wrinkle score decreased from 4.13 +/- 0.85 to 3.29 +/- 0.99. The degree in which the wrinkle score improved after laser treatment compared with after chemical peel treatment was statistically significant. Posttreatment erythema lasted an average of 4.5 months for the laser-treated areas and 2.5 months for the chemical peel-treated areas. Treatment of periorbital wrinkles with the SilkTouch CO2 laser resulted in a greater degree of improvement than treatment with a medium-depth chemical peel but had longer lasting posttreatment erythema.

Pulsed Carbon Dioxide Laser Resurfacing of Photoaged Facial Skin

public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microsecond-domain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1- millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four ¿blinded¿ reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythemia and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heat-induced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.