Real-World Experience Using a Multi-Modality System using Intense Pulsed Light, Radiofrequency Microneedling, High-Intensity Focused Ultrasound, or Thermal Radiofrequency, 808, HIFU for Skin Rejuvenation Treatment.

BACKGROUND: Medical aesthetic procedures for facial rejuvenation with laser and energy-based devices (EBDs) are rapidly increasing. The following cases highlight real-life experience using a multi-modality system with various handpieces that combine intense pulsed light (IPL), laser hair removal (808 diode), high-intensity focused ultrasound (HIFU), radiofrequency microneedling (RFM), and thermal radiofrequency (RF) for antiaging and rejuvenation treatment. Laser and RFM treatments may improve skin conditions by inducing cutaneous changes that remodel the skin matrix. METHODS: Six physicians who treat patients for skin rejuvenation reported on clinical cases from their practice using a multi-modality system with various handpieces. RESULTS: During the meeting, the advisors discussed 15 cases and agreed to select seven patients with different ages and skin phototypes receiving various treatments for photodamage of the face, neck, and décolleté. The advisors discussed why they selected the case, previous treatment, type of treatment, results, and clinical pearls. CONCLUSION: Sharing best practices in medical aesthetics using combination treatments on a single multi-modality energy-based device such as laser and MRF for facial, neck, and chest skin may support healthcare providers treating patients for skin rejuvenation to improve clinical outcomes.

Investigating the efficacy of Endolift laser and Nanofat as a combination therapy for horizontal neck lines compared to Nanofat autologous alone.

BACKGROUND: The emergence of horizontal neck wrinkles is increasingly becoming a focal point for both cosmetic professionals and clients. Various treatment approaches must be considered to address this issue effectively, owing to its diverse underlying causes. The study explores the potential of utilizing the Endolift laser in conjunction with nanofat injection as a viable treatment option. METHODS: Twenty patients with horizontal neck wrinkles involved in the study. Ten patients underwent treatment with a combination of Endolift laser and nanofat injection and 10 patients treated with nanofat injection alone. The participants were monitored for 6 months post-treatment. Biometric measurements were utilized to assess outcomes, including changes in volume, depth, and area of the wrinkles, skin elasticity, as well as the diameter and density of the epidermis and dermis in the treated area. Skin improvement was evaluated by two independent dermatologists, who compared before and after photos in a blinded manner. Patient satisfaction levels were also documented. RESULTS: The Visioface analysis showed a notable decrease in neck wrinkle depth and area in both groups. However, the group receiving the combination treatment of Endolift laser and nanofat exhibited a significantly greater improvement compared to the group treated with nanofat alone. Skin ultrasonography results demonstrated an increase in thickness and density of the dermis and epidermis in both groups. Particularly, the group treated with Endolift laser-nanofat displayed significant enhancements in dermis and epidermis density and thickness when contrasted with the nanofat-only group. Analysis with Cutometer revealed a marked enhancement in skin elasticity in the Endolift-nanofat treated group in comparison to the nanofat-only treated group. Furthermore, in the Endolift-nanofat treated group, a substantial majority (90%) of patients exhibited improvement. Patient evaluations highlighted significant distinctions between the two groups, with 95% of patients in the Endolift-nanofat treated group demonstrating enhancement. CONCLUSION: Both methods notably enhance horizontal neck wrinkles; nevertheless, the combination of endolift laser and nanofat seems to be more efficient for treating horizontal neck wrinkles.

Advancements in laser technologies for skin rejuvenation: A comprehensive review of efficacy and safety.

INTRODUCTION: Laser technology has fundamentally transformed the landscape of dermatology, offering nuanced solutions for skin rejuvenation and resurfacing. This paper aims to explore the spectrum of laser technologies, from ablative to non-ablative and fractional lasers, their mechanisms, benefits, and tailored applications for diverse skin conditions. As we delve into the intricacies of each technology, we also consider the scientific advancements that have made these treatments safer and more effective, promising a new horizon in skin rejuvenation. OBJECTIVE: This comprehensive analysis seeks to evaluate recent advancements in laser technology for skin rejuvenation, focusing on efficacy, safety, and patient satisfaction. METHODS: The selection criteria for studies in this publication focused on recent, peer-reviewed articles from the last 20 years, emphasizing advancements in laser technologies for skin rejuvenation. Our comprehensive review involved searches in PubMed, Cochrane, Scopus and Google Scholar using keywords like "skin rejuvenation," "laser technology," "efficacy," "safety," and "dermatology." This approach focused on inclusion of recent research and perspectives on the efficacy and safety of laser treatments in the field of dermatology. RESULTS: Our literature review reveals advancements in laser skin resurfacing technologies, notably fractional lasers for minimal downtime rejuvenation, ablative lasers for precise tissue vaporization, and non-ablative lasers for coagulation effect promoting collagen with reduced recovery. Hybrid and picosecond lasers are highlighted for their versatility and effectiveness in addressing a wide array of skin concerns. The findings also emphasize the development of safer treatment protocols for ethnic skin, significantly reducing risks like hyperpigmentation and scarring, thus broadening the scope of effective dermatological solutions. CONCLUSION: This extensive review of advancements in laser technologies for skin rejuvenation underscores a remarkable evolution in dermatological treatments, offering an expansive overview of the efficacy, safety, and patient satisfaction associated with these interventions. Furthermore, the exploration of combination treatments and laser-assisted drug delivery represents a frontier in dermatological practice, offering synergistic effects that could amplify the therapeutic benefits of laser treatments.

Outstanding user reported satisfaction for light emitting diodes under-eye rejuvenation.

The under-eye region is an area of significant cosmetic concern. Photobiomodulation (PBM) has emerged as an effective, safe, inexpensive, and convenient treatment for skin rejuvenation. Herein, we aim to evaluate the safety and efficacy of a LED under-eye device for under-eye rejuvenation, as measured by objective and patient reported outcomes. Eleven participants self-administered treatment using a commercially available LED device emitting red (633 nm) and near infrared (830 nm) light for six weeks. Standardized photographs and questionnaires were administered at baseline and six weeks. Photographic digital analysis indicated an improvement in under-eye wrinkles at six weeks compared to baseline, with a reduction in wrinkle score from 20.05 to 19.72. However, this finding was not statistically significant. Participants self-reported consistent improvements in under-eye wrinkles, texture, dark circles, bags, pigmentation, and erythema. All participants reported a high degree of comfortability, ease of use, and satisfaction with the eye device. The participants noted no moderate or severe adverse events and few reports of transient expected outcomes such as mild erythema. The participants' self-reported improvements and high user satisfaction, and the device's favorable safety profile, highlights the benefits of at-home LED devices for under-eye rejuvenation. Future randomized controlled trials with larger sample sizes could further establish the safety and efficacy of at-home LED under-eye treatments.

A faster CO2 fractional scanner system mode for skin rejuvenation. A clinical study.

BACKGROUND: The market requires ever-faster techniques, in particular for pre-rejuvenation condition. AIM: The purpose of this study was to assess if a fractional CO2 scanner modality (called moveo) results in a faster full-face rejuvenation treatment in comparison to the standard mode, currently existing in the scanner system. MATERIALS AND METHODS: A total of 12 female patients affected by fine lines participated in a split-face clinical investigation and underwent to two sessions with a fractional CO2 laser system equipped with an existing and a faster dedicated scanner units. Pain was assessed using VAS. Three-dimensional clinical photographs were captured before, immediately after, 3 days, 14 days after the first treatment and immediately after the second treatment and 1 months after the last one. The uniformity and aesthetic coverage of treatments were assessed using dermatoscopy. Global aesthetic improvement scale (GAIS) was used. The time taken to treat the two sides of the face and all possible side effects were monitored. RESULTS: Following only two treatment session with both scanner modes, the patient's skin texture improved significantly, with fine lines reduction. There is no statistically significant difference in perceived pain between patients. The GAIS score showed satisfactory results following both modalities. The time parameters indicated that with the faster scanner mode the full-face treatment time was reduced by 30% compared to the standard one. No adverse effects were observed. CONCLUSIONS: The moveo modality provide faster treatment and a better final dermal aesthetic outcome than the standard procedure while maintaining the same safety profile.

A retrospective study of non-insulated microneedle radiofrequency on wrinkles of facial photoaging subjects.

Non-insulated microneedle radiofrequency (NIMNRF) is a method of promoting dermal collagen shrinking and remodeling with minor injury reducing wrinkles. We conducted a 3-years retrospective observation on wrinkles of facial photoaging subjects treated with NIMNRF in Chinese subjects to demonstrate the efficacy and side effects. Chinese subjects clinically diagnosed as facial photoaging treated with MNRF in the Laser Center of The First Hospital of China Medical University and Guangzhou Mylike Medical Cosmetic Hospital from Jan 1, 2018 to Dec 31, 2021 were enrolled in this study. Inclusion criteria included. Each subject was treated with NIMNRF for 1-3 sessions, with a 3-month interval. At baseline and 3 months after each treatment, a Wrinkle Assessment Scale (WAS) was used to score the wrinkles in 10 areas. The total WAS score and WAS improvement rate was assessed at each time point. A total of 96 subjects, aged 25-65 years old, received at least one session of NIMNRF were enrolled. 63, 24, 9 of them received 1, 2 or 3 sessions, respectively. The total WAS score decreased from 14.65 ± 9.20 to 11.51 ± 8.70 after Session 1, from 15.92 ± 9.48 to 12.17 ± 8.83 after Session 2 and from 17.56 ± 6.99 to 11.11 ± 7.13 after Session 3 (P < 0.01). The WAS improvement rate was 25.61%, 30.69% and 39.82% after 1, 2, 3 sessions, respectively. As for subjects in different age groups, the improvement rate decreased with age, from 39.13% in 25-30 years old group to 16.39% in over 60 years old group after Session 1 (P < 0.05). Better efficacy and less sessions of treatments were conducted in younger subjects. NIMNRF can be used in the treatment of facial wrinkles in photoaging subjects, especially in youngster as better efficacy.

Neuromuscular electrical stimulation for facial wrinkles and sagging: The 8-week prospective, split-face, controlled trial in Asians.

OBJECTIVE: This study aims to fill the knowledge gap regarding the effects of high frequency facial neuromuscular electrical stimulation (fNMES) on facial aging, using a device equipped with CERTEC (Cell Energy Regeneration Technology) operating between 40 and 190 kHz. METHODS: This prospective split-face study was conducted at Tokyo University Hospital between March and May 2023 with 24 healthy adult women aged 30-59. The intervention group used the fNMES device along with basic skin care on one side of the face, and basic skin care alone on the other side for 8 weeks. Evaluations included changes in skin wrinkles, sagging, and blood flow. RESULTS: This study found significant improvements in skin elasticity and degree of wrinkles in the areas intervened with fNMES (p < 0.05, respectively). In addition, the intervention resulted in significant improvements in jawline angle (p < 0.01), submental volume (p < 0.05), cheek volume (p < 0.05), maximum nasolabial fold depth (p = 0.03), and total volume of the nasolabial folds (p = 0.03). The fNMES intervention also showed improvement in blood flow (p < 0.05). These improvements were also subjectively assessed by the participants in subject questionnaires at 8 weeks after the intervention (p < 0.05). CONCLUSION: This study suggests that high frequency fNMES effectively improves facial skin elasticity, reduces wrinkles and sagging, promotes blood flow, and contributes to overall facial appearance rejuvenation. Although further studies are needed, high frequency fNMES appeared promising as a noninvasive anti-aging therapy.

Complications of Chemical Peels, Lasers, and Energy-Based Device Procedures Performed by Core Cosmetic Physicians: A Retrospective Analysis.

BACKGROUND: There has been a proliferation of physicians of different levels of experience and training offering nonsurgical cosmetic procedures. Rising demand, compounded by increasing utilization of new and existing technologies by numerous physician specialties, compels discussion of adequate standardized training and patient safety. METHODS: A retrospective chart review of patients who presented to our single site dermatology clinic for managment of complications following chemical peel, laser or energy-based device treatments performed by core cosmetic physicians between the years of 2013 and 2024 was conducted. Core cosmetic physicians included plastic surgery, facial surgery/otolaryngology, oculoplastic surgery, and dermatology. Charts were reviewed for documentation of the type of complication, procedure causing the complication, and physician credentials, and referral source. RESULTS: Twenty-five patients were identified as having complications from chemical peeling, laser treatment or energy-based devices. Devices implicated included CO2 laser (fractional or fully ablative), chemical peels, 1064 nm long-pulsed Nd:YAG laser, 1320 nm Nd:YAG laser, intense pulsed light, 595 nm pulsed dye laser, Q-switched Nd:YAG laser, radiofrequency with and without microneedling, and 1550 nm erbium-doped fiber laser. Complications included hypertrophic scarring, atrophic scarring, post-inflammatory erythema, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation. CONCLUSIONS: Even in experienced hands, complications can arise. It is imperative that all physicians offering cosmetic treatments are equipped to recognize clinical endpoints, identify and manage complications, or make a timely referral to decrease the risk of a permanent and potentially devastating esthetic outcome for patients.

Rotational radiofrequency-based technology leads to adipose tissue reduction and contouring effect in the thighs, abdomen, and flanks.

BACKGROUND: Excess body adiposity and skin irregularities represent a major problem in today's society. Currently, radiofrequency-based devices constitute an increasingly popular medical-aesthetic application and a powerful non-invasive method to combat this problem. OBJECTIVE: This study aims to determine the efficacy and safety of the high-frequency device Zionic™ (Termosalud, Inc., Gijón, Spain) in reducing body contouring and improving skin appearance in the abdomen/flanks or thighs. MATERIALS AND METHODS: Thirty nine individuals were treated with the Zionic™ device in the abdomen/flanks or thighs. A total of 8 sessions of 40-50 min each, 72/96 h apart were performed. At baseline, body measurements were taken including photographs, body contours, and ultrasound scans to assess dermal thickness, dermal echogenicity, and subcutaneous fat thickness. The measurements were repeated after the eight sessions for comparison and analysis. Quantitative data was complemented with a customized survey to evaluate participants satisfaction level. RESULTS: At the follow-up visit, a significant average reduction of 3% in abdomen/flanks circumferences and 2% in thighs contours was noticed. Abdomen/flanks and thighs subcutaneous fat layer thickness was significantly reduced by 8% and 6%, respectively. Dermal echogenicity changes, related to skin collagen content and organization, showed non-significant increasing tendencies of 7% for abdomen/flanks and 8% for thighs. Thighs dermal thickness was significantly increased by 6%. Results were associated to a high satisfaction level (80%) and no severe adverse events. CONCLUSION: Zionic™ treatment is a safe, effective, and well-tolerated noninvasive procedure for body contouring and improvement of skin properties in abdomen, flanks, and thighs.

Nasal filling guided by high frequency ultrasound: Reducing risks.

BACKGROUND: Given the significant increase in the quantity of cosmetic procedures utilizing hyaluronic acid fillers, including in the nasal region, the initial evaluation of patients using high frequency ultrasound becomes a crucial instrument in evaluating and handling nonsurgical rhinoplasty. AIMS: The aim of this article is to introduce an assessment methodology for nasal filling guided by high frequency ultrasound. PATIENTS/METHODS: A prospective and single-center study was conducted with 12 Latin American patients. The patients underwent nasal filling with hyaluronic acid following high power ultrasound mapping. RESULTS AND CONCLUSIONS: In the evaluation of the GAIS scale, all patients reported improvement with the treatment. No infections, nodules, ischemia, or other relevant adverse effects were noted. Real-time ultrasound-guided filler techniques have been developed to reduce the risk of vascular compromise, confirming the distribution pattern of blood vessels. It's also crucial to visualize the cannula at the same moment as the vessels, even if the previous vascular mapping was performed. Therefore, the utilization of high frequency ultrasound can act as a pivotal tool in augmenting procedure safety.

Energy-based devices and hyaluronic acid filler, polymer filler, and threads: Cadaveric study.

INTRODUCTION: The objective of this experiment was to investigate the thermal effects on hyaluronic acid fillers, PCL fillers, and PDO threads when exposed to controlled heat. This study aims to provide insights into how these materials respond to thermal energy, which is crucial for safe and effective cosmetic procedures involving combined modalities. MATERIALS AND METHODS: Cadaveric tissue was utilized to simulate clinical conditions. Hyaluronic acid fillers were injected at approximately 1 mm and 5 mm thicknesses, with variations in G' value (high and low). PCL fillers were similarly injected in 1 mm and 5 mm thicknesses. PDO threads were also inserted. All materials were injected at a depth of 2 cm. A thermometer was used to measure heat penetration, and a multi-wavelength laser was applied to the tissue. The temperature was maintained at 60°C for 5 min to assess whether heat penetrated more than 3 cm in thickness. Observations were made regarding the heat distribution and any physical changes in the fillers and threads. RESULTS: In thick layers, heat accumulated above the PCL filler without penetrating deeper layers. In thin layers, heat penetration was observed. For the HA fillers, heat energy was not blocked, regardless of the G' value or thickness. For the threads, no significant heat blockage effect was observed. For all materials, no visual changes were detected in any of the materials due to temperature exposure. DISCUSSION: The findings suggest that the thickness and composition of fillers significantly influence heat penetration. Thick PCL fillers act as a thermal barrier, whereas thin PCL fillers allow deeper heat penetration. Hyaluronic acid fillers do not impede heat transfer, regardless of their physical properties. PDO threads do not exhibit any notable thermal resistance. These insights are essential for optimizing the safety and efficacy of combined filler and energy-based device treatments in esthetic medicine.

Efficacy and safety of a novel monopolar radiofrequency device with a continuous water-cooling system in patients with age-related facial volume loss.

BACKGROUND: Esthetic radiofrequency (RF) technology has much attracted public attention with the increasing demand for skin rejuvenation. A continuous water cooling-based monopolar RF (MRF) device was designed for the first time to protect the epidermis and maximize clinical outcomes. OBJECTIVE: Assess the efficacy and safety of the proposed MRF device in patients with mild-to-moderate sunken cheeks and jawline laxity. METHODS: Twenty-one patients underwent a single session of MRF treatment. Quantitative analysis was performed using a 3D imaging technique. Postprocedural clinical improvements were assessed with the Merz Scale. Regarding safety, adverse events (AEs), thermal sensation (TS) and pain intensity were explored. Patient satisfaction was surveyed with the Self-Assessment Questionnaire (SAQ). RESULTS: The follow-up investigation demonstrated that facial volume increased across the cheek and jawline, with lifting effects throughout the treatment area. The Merz Scale assessment revealed that sunken cheeks, sagging jawlines and wrinkles were markedly improved. In addition, there were transient AEs, mild TS and moderate pain. In SAQ, 81% patients were satisfied with the procedure. CONCLUSIONS: This study provided quantitative evidence for postprocedural volumetric increases along with enhanced lifting effects, strongly implying that the proposed MRF device can be an attractive option for improving facial skin volume loss and laxity.

The investigation and comparison of the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated infraorbital dark circles and wrinkles: A controlled blinded randomized clinical trial.

BACKGROUND: To evaluate the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated dark circles and wrinkles under the eyes. METHOD: This study was a single-blinded randomized clinical trial conducted on patients with suborbital darkening under the eyes that randomly divided into control and case groups. In the control group, 15 patients were treated with one session of nanofat injection only, and five patients of each intervention groups received one session of nanofat+SVF injection, nanofat+PRP injection, and nanofat injection+Nd:YAG laser, respectively. Assessments methods were (1) evaluation of the degree of darkness and repair under the eyes by a blinded dermatologist based on clinical photographs, (2) investigating patient satisfaction, (3) using biometric variables for color, thickness, and density of the skin (only 3 months after the treatment), and (4) recording the possible adverse effects. CONCLUSION: In terms of the extent of reduction in the intensity of darkness under the eyes, the combined treatment of nanofat injection together with SVF, PRP, and Nd:YAG laser had a much greater therapeutic effect than nanofat injection alone. In all three groups of combined treatments, patients were 100% satisfied. In terms of biometric variables, amount of changes in colorimeter, complete and dermal thickness, complete and dermal density, between the different groups was statistically significant. The use of combined treatments including nanofat with SVF injection, PRP, and 1064 Q-switched Nd:YAG laser may be more effective than nanofat alone, in reducing infraorbital dark circles and wrinkles.

Herpes simplex virus reactivation after nonablative fractional laser to treat facial photoaging.

Contemporary approaches for facial rejuvenation encompass the utilization of both ablative and nonablative laser techniques. Extensive research has elucidated the adverse consequences associated with ablative laser treatment, such as the emergence of infectious, follicular, scarring, and pigmentary alterations. Nonablative fractional lasers exhibit commendable cosmetic outcomes, characterized by a diminished incidence of complications owing to their photomechanical mechanisms, in contrast to ablative laser modalities. Nonetheless, it is imperative to acknowledge that untoward effects may still manifest. In this report, we present two cases of herpes simplex virus (HSV) reactivation subsequent to nonablative fractional resurfacing. Timely identification and the appropriate administration of antiviral agents are important, which serve as imperative measures to mitigate the long-term consequences that may arise in the event of complications.

Microneedle fractional radiofrequency associated with drug delivery for facial atrophic acne scars and skin rejuvenation.

Microneedle fractional radiofrequency (MFRF) has been used to improve photoaging and scars. This study aimed to evaluate the efficacy and safety of MFRF with basic fibroblast growth factor (bFGF) for facial atrophic acne scars and skin rejuvenation by blinded visual evaluation, self-report, and reflective confocal microscopy (RCM). Fifteen subjects were randomized to the MFRF with bFGF group and fifteen to the MFRF group. All subjects underwent three-session therapy and a follow-up period. Significant group differences were in ECCA, global improvement score, satisfaction, and downtime before and after treatment. Combination therapy could be more effective than monotherapy for acne scars and facial rejuvenation. In addition, RCM can be used to observe the changes in skin collagen before and after treatment in evaluating cosmetic efficacy.

Facial tightening using a novel vacuum-assisted microneedle fractional radiofrequency system: A prospective, randomized, split-face study.

BACKGROUND: The microneedle fractional radiofrequency system (MFRS) is able to rejuvenate facial appearance by heating and coagulating certain depth of skin tissue. OBJECTIVE: To evaluate the safety and efficacy of a novel vacuum-assisted MFRS for facial contour tightening. METHODS: This prospective, randomized, split-face study included 21 patients who underwent three treatments with a vacuum-assisted MFRS at 1-month intervals. Half of the face was treated with the MFRS; the other half was untreated (control). Facial volume changes and wrinkles were objectively measured using a three-dimensional imaging system and VISIA-CR. RESULTS: Volume changes of the treated midface were -0.24 ± 0.75, -0.59 ± 0.92, and -0.55 ± 0.65 mL at 1, 3, 6 months follow-up; however, measurements of the control side were 0.08 ± 0.70, -0.08 ± 0.53, and - 0.10 ± 0.86 mL, indicating significant reductions (p < 0.05). The number of facial wrinkles on the treated side was significantly reduced to 12.44 ± 4.85 at 3 months and sustained at 6 months (11.11 ± 4.100) compared to the control side (14.89 ± 5.26 and 13.22 ± 4.44, respectively; p < 0.05). No long-term side effects occurred. CONCLUSION: The vacuum-assisted MFRS is safe and effective and is recommended for improving facial tightening and reducing wrinkles. This technology is sufficient to ensure the insertion depth, thus helping to improve the treatment accuracy and safety. The MFRS provides sustained effects for at least 6 months.