Periorbital Ablative and Nonablative Resurfacing

Treatment of periorbital wrinkles using thermo-mechanical fractional injury therapy versus fractional non-ablative 1565 nm laser: A comparative prospective, randomized, double-arm, controlled study

BACKGROUND

Non-ablative fractional laser is an effective modality for the treatment of periorbital wrinkling, one of the earliest signs of skin aging. Thermo-mechanical fractional injury (TMFI) therapy (Tixel®, Novoxel®, Israel) is an innovative technology that is now being used for facial skin rejuvenation. Our study compares the clinical results, side effects, and downtime profile between TMFI treatment and non-ablative fractional 1565 nm laser (ResurFX®, Luminis, Israel).

METHODS

This was a prospective study of 68 patients (64 women, 4 men) with skin types I-VI in two medical centers (34 from Israel, 34 from the USA) that were randomized to receive either TMFI or NAFL treatment for periorbital wrinkling. Patients received 3-5 treatments, 3-5 weeks apart. Six months after the last treatment, the change in Fitzpatrick Wrinkling Classification System (FWCS) was calculated by three non-involved physicians and compared to pretreatment results. Side effects and downtime profiles were assessed in each group (including VAS pain assessment, time required to refrain from work and social activity, and time required for the resolution of redness, edema, and crusts.) RESULTS: A moderate improvement in periorbital wrinkling was demonstrated in both groups, with an average improvement of 1.6 ± 0.6 in FWCS in the TMFI group and an average improvement of 1.7 ± 0.8 in the NAFL group (p < 0.001). Postprocedural VAS score was 5.86 ± 2.3 in the NAFL group and 4.01 ± 2.6 in the Tixel® group. Approximately 80% of subjects returned to both work and social activities two days postprocedure. Crusts were reported by 52% of patients in the TMFI group, compared to 16% of patients in the NAFL group more than 48 hours postprocedure (p < 0.05). There were no statistically significant differences in the other parameters between the two groups.

CONCLUSION

TMFI is an effective and safe modality for the treatment of periorbital wrinkling, with comparable results to the 1565 nm NAFL.

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

BACKGROUND

Many modalities have been described for the treatment of periorbital wrinkling.

AIMS

The purpose of this study is to quantify the improvement of periorbital wrinkling achieved by current nonablative modalities, using a fractional 1565 nm Er:glass fiber laser.

METHODS

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.

RESULTS

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 8 weeks. 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.

CONCLUSION

Our study suggests that current nonablative laser skin resurfacing technology offers a mild-moderate improvement in periorbital wrinkling.

Update in minimally invasive periorbital rejuvenation with a focus on platelet-rich plasma: A narrative review

BACKGROUND

The periorbital region is among the first areas to be affected by the process of aging, which is influenced by genetic and constitutional factors. As the region plays an important role in overall facial appearance, rejuvenation of the area has immense cosmetic benefit and various treatment modalities have been used to achieve the same.

AIMS

This article reviews commonly used non-surgical and minimally invasive modalities for periorbital rejuvenation.

METHODS

The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review.

RESULTS

Autologous platelet rich plasma (PRP) is increasingly used in dermatology for skin and hair conditions. The use of PRP is rapidly growing in popularity as a modality to achieve skin rejuvenation. The mechanism by which PRP leads to skin rejuvenation is by increasing the dermal fibroblast proliferation, expression of matrix metalloproteinase and collagen synthesis.

CONCLUSION

The evidence discussed in this article indicates the increasing importance of minimally invasive modalities in periorbital rejuvenation and a promising role for PRP as solo therapy or in multimodality regimens.

Split-face comparison of the erbium micropeel with intense pulsed light

BACKGROUND

A variety of photorejuvenative techniques have been utilized to reverse the signs of cutaneous photoaging, including ablative and nonablative laser resurfacing as well as light-based devices.

OBJECTIVE

The purpose of this split-face randomized prospective open-label trial was to determine the effectiveness of sequential erbium:yttrium-aluminum-garnet (Er:YAG) laser versus intense pulsed light (IPL) for the treatment of mild to moderate facial photodamage.

MATERIALS AND METHODS

Ten subjects (ages 35-63) with facial dyschromia and rhytides were enrolled. Study patients were randomized to the two treatment arms, Er:YAG (3.8 J/cm(2), 30% pattern overlap, 0% interpulse overlap, 15 microm per pass with no coagulation) and IPL (560-nm filter, 30 J/cm(2), 2.4/4.0-ms pulse with 10-ms delay), each receiving three sequential treatments spaced 1 month apart. Subjective and blinded physician evaluations were performed at baseline and 4, 8, and 20 weeks posttreatment using a nominal scale from 1 to 4. Erythema and adverse events were assessed 1 week following each treatment.

RESULTS

Ten female subjects with mild to moderate facial photodamage were treated with one pass of either IPL or Er:YAG in a split-face fashion. Patients received three treatments each spaced 1 month apart. Nine of 10 patients completed the trial; 1 withdrew due to pain during the second Er:YAG treatment. Baseline subjective and blinded physician dyschromia and rhytid scores revealed no significant difference between the IPL and Er:YAG randomly assigned sides. Up to three IPL or Er:YAG treatments did not result in a significant improvement in rhytid scores. Subjective and blinded physician dyschromia scores improved 26 and 38%, respectively, 3 months after the final IPL treatment, but only by 7 and 29%, respectively, with Er:YAG. Subjective global facial appearance scores worsened by 5% while blinded physician scores improved by 16% 3 months after 3 Er:YAG treatments, but by 28 and 20% for IPL, respectively. The overall incidence of adverse events and subsequent downtime was increased for Er:YAG (1/10 patients experienced hyperpigmentation, 3/10 exfoliation, 1/10 blistering, and 5/10 discomfort) compared to IPL (1/10 exfoliation and 1/10 discomfort), although no permanent side effects were observed with either treatment arm.

CONCLUSIONS

While low-fluence erbium resurfacing has a modest effect on facial photodamage, patients preferred IPL because it resulted in less downtime. The authors have indicated no significant interest with commercial supporters.

Fractional Photothermolysis: A Novel Aesthetic Laser Surgery Modality

The ubiquity of increased sun exposure, oral contraceptives, and phototoxic drugs has led to an increased prevalence of conditions such as dyschromia, melasma, rhytides, and other signs of photoaging over the past few decades. Through the application of selective photothermolysis, laser surgery has attempted to create therapeutic options for these medically recalcitrant conditions. To date, however, this technology has been met with limited success, due to a high incidence of posttreatment side effects, inability to treat off the face, and a safety profile tailored to Fitzpatrick skin types I to III. More recently, a novel approach coined "fractional photothermolysis" was developed in an attempt to overcome these limitations. This new laser treatment modality has allowed for effective treatment of a diverse array of dermatologic conditions on and off the face with a wider therapeutic index and improved safety profile independent of Fitzpatrick skin type. This review sheds light on the technical aspects, biologic mechanisms, and clinical effects of fractional photothermolysis that help set it apart from previous modes of laser surgery.