Treatment Of Facial Rhytides Research Articles

Fractional carbon dioxide laser versus combined fractional CO2 laser and platelet rich plasma in treatment of facial wrinkles: A comparative split face study.

Wrinkles are the most visible sign in skin aging and for which many people seek different aesthetic procedures. Treatment options varies from invasive to non-invasive procedures. Combining platelet rich plasma and fractional carbon dioxide laser (CO2 ) has been used frequently for showing promising results in treating photoaged skin generally and wrinkles specifically since the microscopic thermal zones created by the fractional laser facilitates the delivery of the plasma into the dermis which aids the process of collagen induction and skin rejuvenation. To compare and assess the clinical efficacy of fractional CO2 laser alone versus combined fractional CO2 laser and platelet rich plasma in treatment of facial rhytides (in terms of size, depth, and overall appearance). Twenty-six female patients were selected and each face was split into 2 halves a control side (Laser + saline) and an experimental side (Laser + platelet rich plasma). Treatment plan was 1 laser session per month for a total of 4 sessions. Clinical objective evaluation was done by the Antera camera in addition to assessment by two blinded dermatologists. The combined treatment was as effective in improving wrinkles as fractional CO2 laser alone. Antera camera scores showed statistical significance in overall wrinkles measurements on each side equally. Both treatment modalities gave optimum cosmetic results with no significant difference noticed when compared with each other, although overall satisfaction with wrinkles and skin were statistically greater than the initial satisfaction scores.

Clinical Evaluation of Fractional Radiofrequency for the Treatment and Reduction of Wrinkles: A Prospective Study.

Fractional radiofrequency (FRF) technology has been shown in clinical studies to improve skin laxity, and to treat various skin conditions related to aging and alternate collagen structures such as rhytids. The objective of this clinical study was to evaluate the safety and performance of FRF (up to 124 mJ per pin) for the treatment of facial rhytids, emphasizing the upper lip and perioral areas. Enrolled subjects received a series of 3 FRF treatments to the full face, 3 to 5 weeks apart. Immediately after treatment, the subjects were given a scale to assess pain and tolerability of the treatment. Subject satisfaction questionnaires were completed at follow-up visits at 6 and 12 weeks post final treatment. Before and after photographs were graded for change by three blinded evaluators using the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and the Global Aesthetic Improvement Scale (GAIS). Image sets of 10 enrolled subjects (average age 62.7 years) were assessed by blinded evaluators. The overall face FWES score improved from 5.97 (SE 0.20) at baseline to 5.78 (SE 0.22) at 12-week follow-up. The GAIS improved by 0.4 points and was significant compared to baseline (P = 0.0004). Subject satisfaction was high with subjects giving an average satisfaction score of 3.2 (“satisfied”) out of 4. Pain was rated “mild to moderate” with an average of 3.9 on a 11-point Wong Baker FACES Scale. Ninety percent (90%) of subjects reported either a mild, moderate, or significant improvement to their treatment area. Eighty percent (80%) of subjects reported that they would recommend the treatment to a friend. There were no reports of adverse events or unanticipated side effects during the duration of the study. A statistically significant reduction in rhytids of the upper lip and the perioral area, was found, as evaluated by independent blinded evaluators. There were no adverse events. Treatment pain was low and tolerable, and subjects had high levels of satisfaction with the results at last follow-up. J Drugs Dermatol. 2022;21(1):43-48. doi:10.36849/JDD.6492.

Effect of Radiofrequency Device for the Treatment of Facial Rhytides

Purpose: To evaluate the effect of radiofrequency device for treatment of facial rhytides. Methods: Twenty-three patients of more than 50 years of age with Glogau photoaging scale type Ⅲ, Ⅳ were included in this study. A Surgitron Dual Frequency device was used for facial rhytides, and a total of four treatment sessions spaced one week apart were performed. Clinical assessment was performed at one week, and at one, three, and six months after the last treatment session. The degree of objective & subjective improvement was determined using a five-step graded scale. Objective improvement was determined by two blinded assessors using before and after photographs. Subjective improvement was determined by questionnaire about rhytides improvement, patient satisfaction and prospect for another treatment session. Results: Significant improvement in facial rhitides was observed in the majority of patients until three months after treatment according to photography assessment. Self-estimation scores paralleled the photography scores and thus were also high until 3 months after treatment. Treatment of the periocular area was most effective. The procedure was associated with minimal downtime, and therewas no serious complication. Conclusions: treatment for facial rhitides using the Surgitron Dual Frequency device is effective in a relatively short time. This technology is a relatively easy treatment method because of the minimal downtime and minimal risk associated its use, making periodic repetition efficient for treating facial rhytides.

Single-Center, Prospective, Randomized, Phase 4 Clinical Trial to Determine the Effects of Single-Pass 560-nm Filter Intense Pulsed Light with or without an Additional Pass with a 755-nm Filter for the Reduction of Facial Rhytides

Objective: To investigate the clinical efficacy of the addition of a triple pulsed, 755-nm filtered flashlamp intense pulsed light to a single-pass 560-nm filter for the treatment of facial rhytids and other aspects of photodamage. Design: A single-center, prospective, randomized, phase 4 split-face clinical trial. Methods: Twenty female volunteers with Fitzpatrick skin type I–IV with a Rao-Goldman wrinkle score of 2 or higher received 2 split-face treatments 4 weeks apart, in which half of the face was treated with 1 pass of a double-pulsed 560-nm filter and the other half was treated with a double-pulsed 560-nm filter followed by a triple-pulsed 755-nm filtered nonablative intense pulsed light. Fluence varied from 15–19 J/cm2. Efficacy was evaluated by patient self-assessments and by blinded clinical and photographic evaluations 1 month after the final treatment. Adverse effects were assessed clinically. Results: All patients noted improvement in pigmentation on both sides of the face, and 60% of patients noted an improvement in skin texture on the side that received the 755-nm filter; however, there was no discernable difference in rhytid reduction between the 560 + 755 filtered side compared with the 560 filtered side alone. Discussion: Two split-face intense pulsed light treatments delivered 4 weeks apart with half of the face receiving double-pulsed 560 filter treatment and the other half receiving a double-pulsed 560 filter + triple-pulsed 755 filter treatment showed no improvement in rhytid reduction. There was a subjective improvement in texture and pore size noted by patients on the side treated with the 560 + 755-nm filtered intense pulsed light treatment.

Remodelage et photoréjuvénation

Resurfacing by CO 2 or Er:YAG laser techniques in the treatment of facial rhytids has traditionally involved ablative methods with, however, associated complications and limitations due to the epidermis “sacrifice”. Recently, rhytid improvement and dermal remodelling have been observed, with the utilization of non-ablative approaches. The underlying principle of non-ablative laser remodelling is to induce a controlled injury to the collagen in the dermis, while completely sparing the epidermis from damage. As dermal collagen heals and remodels under an undamaged outer layer, the skin tightens and smoothes, thus improving it’s appearance. Two classes of lasers are used for non-ablative laser remodelling : i) visible light lasers, including green and yellow light lasers adapted or modified from their original use as treatments for vascular lesions. 532nm (green) and 585nm (yellow) light are strongly absorbed by oxyhemoglobin and melanin in the epidermis and upper dermis. The heating effect in these skin layers triggers the release of various growth factors that stimulate collagen remodelling and tightening. ii) infrared lasers, emitting at 980nm, 1320nm, 1450nm and 1540nm produce invisible light that is absorbed by primarily by water, which heats the superficial layers of the skin. These lasers use contact or non-contact skin cooling to limit the heating effect to the dermis, creating a controlled injury to the dermal collagen, with subsequent remodelling and tightening. More recently, non-ablative photorejuvenation with intense pulsed light (IPL) has been introduced. Several clinical studies on non-ablative lasers, using objective evaluations (silicone imprints, cutometer, ultrasound imaging) have clearly demonstrated a progressive improvement over months. Histological examinations of the treated areas have clearly showed a superficial dermal band of well organized elastin and collagen fibres replacing pre-treatment elastic tissue. This improvement of the skin was not associated with any adverse effects. Concerning intense pulsed light, only a few clinical studies have reported varied clinical results with non-ablative photorejuvenation.

A 35-month profilometric and clinical evaluation of non-ablative remodeling using a 1540-nm Er:glass laser

BACKGROUND/OBJECTIVE: As remodeling is getting more popular with patients, long-term studies are becoming necessary. The aim of this 35-month clinical study was to evaluate the long-term benefits obtained using a 1540-nm Er:glass laser for non-ablative remodeling of perioral and periorbital rhytids. The role of maintenance treatments was also investigated. STUDY DESIGN/METHODS: Eleven women with periorbital and perioral rhytids underwent a series of five treatments at 6-week intervals with an Er:glass laser. Five patients subsequently received two maintenance retreatments and six did not. The maintenance treatments were performed at 14 and 20 months. Silicone imprints were performed to measure anisotropy before treatment, at 6 months, at 14 months and at 35 months. Patient self-evaluation/questionnaire was also done to assess adverse effects and subjective clinical improvement. RESULTS: For all 11 patients, the percentage of anisotropy reduction was 41.21% at 6 months, 51.76% at 14 months and 29.87% at 35 months. No adverse effects were noted. Patient satisfaction was high at the end of the evaluation. Retreated patients were more satisfied than non-retreated ones. However, there was no difference in the anisotropy factor between the two groups. CONCLUSION: Treatment of facial rhytids with a non-ablative 1540-nm Er:glass laser system can produce benefits that persist over 2 years after the last treatment.

New collagen formation after dermal remodeling with an intense pulsed light source.

Laser resurfacing in the treatment of facial rhytides has traditionally involved ablative methods with their associated complications and limitations. More recently, rhytid improvement and dermal remodeling has been seen with non-ablative approaches. Such laser-induced remodeling may be associated with evidence of new dermal collagen formation. The aim of this study was to evaluate the histologic changes seen after dermal remodeling with a non-laser intense pulsed light source. Five patients underwent four sessions of dermal remodeling with an intense pulsed light source. All patients received a pretreatment biopsy and a second biopsy 6 months after the final treatment. Biopsies were evaluated for histologic evidence of new collagen formation 6 months after the final treatment. All patients showed histologic evidence of new upper papillary dermal collagen formation. Dermal remodeling with an intense pulsed light source can lead to histologic evidence of new collagen formation with associated clinical improvement.

Comparison of Erbium:YAG and Carbon Dioxide Laser for the Treatment of Facial Rhytides.

Comparison of Erbium:YAG and Carbon Dioxide Laser for the Treatment of Facial Rhytides.

Treatment of Facial Rhytids with a Nonablative Laser: A Clinical and Histologic Study

Current facial resurfacing modalities (laser, chemical peels, and dermabrasion) remove the epidermis and thus cause open wounds which carry significant risks and extended recovery periods. The nonablative laser is a novel Nd:YAG system designed to alleviate facial rhytids without injuring the epidermis. This new modality may offer patients rhytid removal without the risk seen in currently used resurfacing techniques. To describe a novel nonablative laser system and assess its safety profile and efficacy. Ten patients received laser treatments of their periocular rhytids and postauricular skin. Clinical variables (rhytid severity, hyperpigmentation, hypopigmentation, scarring, and level of discomfort) were assessed at 1 and 3 months posttreatment. Postauricular skin biopsies were taken both pre- and posttreatment for histologic analysis. Patient discomfort was minimal. Three months posttreatment, 4 of 10 patients showed a one-point improvement in periocular rhytid severity when judged on a six-point scale. The results were not statistically significant. Biopsy analysis showed a small posttreatment increase in the amount of dermal collagen in three patients. A small decrease in collagen was noted in one patient. Three patients also showed a small posttreatment increase in the degree homogenization of dermal collagen. No change from baseline was noted in other assessed histologic parameters. Complications observed included hyperpigmentation in three patients and pitted scarring in three patients. The nonablative laser gave clinically subtle and statistically insignificant improvement in rhytid severity. Unfortunately its use was associated with complications that included hyperpigmentation and scarring. This technology may eventually offer patients a new resurfacing option, but its efficacy and complication rate must be improved first.

Laser resurfacing of the neck: a review of 48 cases.

With the advent of the new sophisticated carbondioxide (CO2) laser, effective treatment of facial rhytides and pigmented lesions of the photodamaged skin has been gaining popularity. Partial and full facial skin resurfacings have been reported. However, resurfacing of the neck has been ignored or discouraged. The objective of this study is to assess the feasibility, benefits, and risks of laser resurfacing of the neck, combined with the additional resurfacing of the whole face. A total of 48 patients underwent the procedure with a high-power and short-exposure time CO2 laser (ultrapulse). Patients were evaluated and classified preoperatively. The great majority of patients had local anesthesia (topical and infiltrative) with minimal sedation. A computer pattern generator was used in all cases but one. In this paper, preoperative preparation, postoperative care, laser resurfacing techniques, and depth guidelines are discussed. Incorporating the neck with the facial resurfacing has given very satisfactory results, with minimal drawbacks.

Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers.

Scars have a significant effect on a person's physical and social being. Many treatment modalities for scar improvement such as surgical scar revision, electrosurgical planing, chemical peeling, filler substance implantation, and dermabrasion have been developed. Recently, the resurfacing carbon dioxide (CO2) laser systems have proven to be a useful and safe treatment in the treatment of facial rhytides and acne scarring. The purpose of this study was to evaluate the resurfacing CO2 lasers in the treatment of various surgical, traumatic, acne, and varicella scars. Thirty subjects, aging between 14 and 84 years, with surgical, traumatic, acne, or varicella scars were evaluated. Two types of resurfacing laser systems were utilized in this study, a high-energy, short-pulsed CO2 laser and a continuous wave CO2 laser with an optico-mechanical computer flash-scanner. Post-surgical scars were treated with laser resurfacing between 4 and 6 weeks after scar formation. Traumatic, acne, and varicella scars were treated after scar maturation (range, 1-10 years). Scar improvement was evaluated by photographic analysis of before and after images by four independent health care workers using a quartile scale of improvement (< 25%, 25-49%, 50-74%, > 75%) as well as optical profilometry using silicone surface impressions in 12 scars. Twenty of 24 surgical scars had greater than 75% improvement, and 24 of 24 had greater than 50% improvement by photographic analysis. All six traumatic, acne and varicella scars had greater than 50% improvement. Optical profilometry and surface topography maps reveal a significant flattening of related and depressed scars. The high-energy, short-pulsed CO2 laser and the continuous wave CO2 laser with flash-scanning attachment are safe and effective as a treatment modality for scar revision. In general, elevated scars improve more dramatically than depressed scars.

A quantitative method for the assessment of facial rejuvenation: a prospective study investigating the carbon dioxide laser

Laser resurfacing has been reported to have a useful role in the treatment of facial rhytides, however the results of published series have relied on subjective methods of assessment. The aim of this investigation was to develop an accurate method of measuring wrinkle depth and secondly to use this to assess the efficacy of laser rejuvenation. Wrinkle depth was measured in 30 patients with perioral rhytides using a silicone mask to provide a negative replica. Depth was measured using simple light microscopy and the accuracy of this was confirmed with the electron microscope. A highly significant correlation was found between these two methods of measurement (R2 = 0.97, P < 0.0001) with an accuracy of 0.03 mm. Using this method laser rejuvenation was evaluated in a prospective series of 30 patients with perioral rhytides (median follow-up 11.5 months, range 5-20 months). Resurfacing was found to achieve a significant reduction in mean wrinkle depth of 91% (paired t-test, P < 0.00001). The only complication reported was erythema which was always transient. The use of light microscopy on silicone moulds therefore provides a simple and accurate method for assessing the outcome of facial rejuvenation. Using this technique, the carbon dioxide laser was objectively found to provide a safe and effective treatment for facial rhytides.

Treatment of facial rhytides with a high-energy pulsed carbon dioxide laser.

Facial rhytides are a common problem that often presents for treatment. Because of the tendency for rhytides to involve delicate tissue areas, traditional treatment modalities have been limited by complications of scarring or pigmentary alterations. With the advent of the new-generation high-energy pulsed carbon dioxide lasers, skin requiring resurfacing can now be treated successfully with minimal risk and side effects. This study included 259 patients with facial rhytides (104 perioral, 83 periorbital, 53 glabellar, and 17 forehead). Each patient received treatment with a high-energy pulsed CO2 laser system, and individual responses were evaluated independently by two blinded assessors at 1, 4, 8, 12, and 24 weeks postoperatively. While clinical response rates were uniformly excellent, they varied in different locations. On average, there was a 90 percent improvement in all areas under study. The periorbital regions responded best, an average 93 percent improvement being seen. The facial rhytides with the lowest response rates (86.8 percent) were those which were most severe and those caused by excessive muscle movement (i.e., frown lines at the glabella). No incidences of scarring were noted, but erythema persisting 1 to 3 months (mean 2.2 months) following laser irradiation was typical. Transient postinflammatory hyperpigmentation of 3 months' average duration was seen in 30 percent of patients and was not limited to those individuals with darker skin tones. The high-energy pulsed carbon dioxide laser is a safe and effective treatment for facial rhytides. Treatment can be delivered in an outpatient setting without the need for general anesthesia, and preliminary evidence suggests long-lasting results.