Split-face comparison of radiofrequency versus long-pulse Nd-YAG treatment of facial laxity

Skin rejuvenating effect of a combined triple-wavelength (755 nm, 810 nm, and 1064 nm) laser: a preliminary study

With an increasing demand for noninvasive skin rejuvenation techniques, several light-based devices have been introduced. Due to its ability to deliver thermal energy from the superficial to deeper levels of the dermis, a combined triple-wavelength laser (755 nm, 810 nm, and 1064 nm) can be used for skin rejuvenation. The objective of this study was to assess the effectiveness and safety of a combined triple-wavelength laser for skin rejuvenation. A total of 28 female patients seeking skin rejuvenation treatment were included. All patients underwent five consecutive treatment sessions at a two-week interval. Clinical improvement of aging-related cutaneous change was noted by the treating dermatologists and patients. Biopsies were performed on the faces of consenting patients before and two weeks after the final treatment. Significant clinical improvements were observed by both patients and evaluating dermatologists. Based on the patient satisfaction questionnaire, 78% of patients reported a self-assessed improvement of more than 25%. Additionally, 86% of patients showed an improvement of more than 25% on objective assessment by dermatologists. Histopathological findings revealed increased collagen and elastic bundles throughout the dermis. Except for transient pain during treatment, no serious adverse effects were reported. The findings of this study suggest that the combined triple-wavelength laser may be an effective and safe nonablative option for skin rejuvenation.

Efficacy and safety of 1565-nm non-ablative fractional laser versus long-pulsed 1064-nm Nd:YAG laser in treating enlarged facial pores

Facial pores are visible openings of pilosebaceous follicles, and they are one of the major factors influencing facial skin appearance. This article aims to evaluate and compare the efficacy and safety of 1565-nm non-ablative fractional laser (NAFL) and long-pulsed 1064-nm Nd:YAG laser (LPNY) in treating enlarged facial pores. All subjects were treated with NAFL on their left faces and LPNY on their right. Five treatments were administered at 2-week intervals, with one follow-up session 2 months after the final treatment. Treatment efficacy was evaluated by subjective (pore improvement and subject satisfaction ratings) assessments and objective (pore number) assessments. At each appointment, any side effects or complications were recorded to evaluate the safety of the two lasers. A total of 18 individuals participated in this study. At the 2-month follow-up, NAFL and LPNY sides had significant reduction in pores (p < 0.0001 and p < 0.0001, respectively). However, there was no statistically significant difference in the mean number of pore reductions on either side (p > 0.05). There was no significant difference in pore improvement ratings and satisfaction ratings between the two sides (p > 0.05 and p > 0.05, respectively). Both lasers showed minimal side effects. Both lasers effectively treated enlarged facial pores and were well tolerated. The side effects of the 1064-nm LPNY were less severe than those of the 1565-nm NAFL. ClinicalTrial.gov Identifier: NCT05360043.

Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: A systematic review

BACKGROUND

Radiofrequency technology has emerged as a treatment for aesthetic rejuvenation.

OBJECTIVE

To examine radiofrequency for facial and neck rejuvenation, clinical studies were assessed on effectiveness and safety of radiofrequency for acne, acne scars, and facial aging by subjective and objective measures.

METHODS

A systematic literature review was performed. Eligibility criteria included articles in English, primary literature, clinical or ex vivo studies, use of radiofrequency, and face or neck treatment. Ablative techniques, home-use devices, combined modalities, and studies unrelated to rejuvenation were excluded. All studies were appraised for quality and biases.

RESULTS

We identified 121 articles. Radiofrequency effectively treated acne by reducing sebum levels and lesion count and improving acne scars. Radiofrequency demonstrated a volumetric reduction in facial fat, and improved skin laxity, elasticity, and global skin aesthetic. Patient satisfaction was higher for those desiring modest rejuvenation. There were histological changes consistent with repair response, neocollagenesis, and neoelastinogenesis. Radiofrequency was safe apart from one patient who developed a neck fistula.

CONCLUSION

Most studies demonstrated radiofrequency treatment of acne, scars, or facial rhytids had positive subjective improvement ratings. Objective studies demonstrated reduction of acne, decreased scarring, lifting effect, improvement in elasticity and collagen, volumetric fat changes, and wrinkle reduction.

Split-face comparison of grid fractional radiofrequency vs 1064-nm Nd-YAG laser treatment of periorbital rhytides among Filipino patients

Despite multiple individual studies proving efficacy of grid fractional monopolar radiofrequency (Grid RF) and near-infrared irradiation 1064-nm long-pulsed neodymium:YAG laser (Laser Genesis), there is a lack of controlled comparative trials between these devices. This study aims to compare the efficacy and safety of Grid RF versus Laser Genesis in the treatment of periorbital rhytides. This is a randomized, single-blind, split-face, prospective study. Eight patients with moderate to severe periorbital rhytides were treated with either Grid RF or Laser Genesis on each side of the face. Photographic and live assessment with the Lemperle Wrinkle Assessment grading scale was compared after 2 months. Difference in scores between Grid RF vs Laser genesis groups after 2 months was not statistically significant (P = 0.244). Each group showed statistically significant improvement months post-procedure (P < .05). Immediate adverse effects and satisfaction scale were similar for both groups (P > .05). At 2 months follow-up, no adverse effects were seen. Grid monopolar radiofrequency (Grid RF) vs near-infrared radiation 1064 nm long-pulsed Nd-YAG laser (Laser Genesis) were equally efficacious, safe, and well-tolerated among patients in the treatment of periorbital wrinkles (P > .05).

Efficacy and safety of long pulse Nd:YAG laser versus fractional erbium:YAG laser in the treatment of facial skin wrinkles

Fractional lasers such erbium:YAG (Er:YAG) are among popular options for facial rejuvenation. Lasers with infrared wavelength ranges such as long pulse Nd:YAG have been used in nonablative rejuvenation of skin with variable outcomes. In this study, we plan to compare safety and efficacy of fractional Er:YAG and long pulse Nd:YAG for facial rejuvenation applying objective and subjective measurements. Twenty-five patients with Glogau photo aging scale of II to IV were recruited in this randomized face-split double-blind controlled trial. Individuals received three monthly treatments on two sides of the face; one side was treated by fractional Er:YAG laser and the other side by long pulse Nd:YAG laser. Outcomes were evaluated by two blinded dermatologists, patient satisfaction reports and objective measurements of cutaneous resonance running time (CRRT). Both modalities significantly improved periorbital wrinkling, nasolabial folds, dyschromia and skin laxity, and sagging of jowls (p value < 0.05), with no noticeable difference between two lasers. Mean CRRT values decreased significantly after treatment with both lasers. The downtime was significantly lower for the Nd:YAG-treated side. Fractional Er:YAG laser and long pulse Nd:YAG has comparable effects in facial rejuvenation but little to no downtime of the latter makes it popular for many patients. ClinicalTrials.gov Identifier: IRCT2015120320468N3.

Histological and molecular analysis of the long-pulse 1,064-nm Nd:YAG laser irradiation on the ultraviolet-damaged skin of hairless mice: In association with pulse duration change

BACKGROUND

Nonablative lasers have been widely used to improve photodamaged skin, although the mechanism underlying dermal collagen remodeling remains unclear.

OBJECTIVE

To investigate the effects and the molecular mechanisms of long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG) laser irradiation on dermal collagen remodeling in association with different pulse durations.

MATERIAL AND METHODS

Five hairless mice were pretreated with ultraviolet B irradiation for 8 weeks. The dorsal quadrant of each mouse was then irradiated twice at 1-week intervals at a pulse duration of 1 ms, 12 ms, or 50 ms, and a constant fluence of 20 J/cm(2). The levels of dermal collagen, mRNAs of procollagens, matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), and various growth factors were analyzed after 4 weeks.

RESULTS

Long-pulse Nd:YAG treatment increased the dermal collagen level. A substantial increase in the level of procollagens, MMPs, TIMPs, and various growth factors was also observed irrespective of pulse duration, with a trend toward maximal increase at a pulse duration of 12 ms.

CONCLUSION

Long-pulse 1,064-nm Nd:YAG laser irradiation promotes wound-healing process, which is characterized by the induction of growth factor expression and subsequent increase in MMPs and TIMPs, followed by matrix remodeling as confirmed by new procollagen production.

Comparative evaluation of wrinkle treatments

BACKGROUND

Skin wrinkles are one of the most cosmetically concerning signs of aging for women, and improvements in the visual effect of wrinkles become a matter of concern that has an impact on the quality of life. Although various wrinkle treatments are being tried in the area of aesthetics and noninvasive cosmetic surgery, no guideline on how to treat wrinkles exists to date. This study evaluated the clinical effects of four wrinkle treatment methods [fractional erbium yttrium-aluminum-garnet (YAG) laser treatment, intense pulsed light (IPL) therapy, CD-atRA external application, and nutritional therapy with intake of amino acid supplements]. These four methods were selected as promising candidates in a pilot case study to improve wrinkles by following the consensus guideline (Task Force Committee for Evaluation of Anti-Aging Function, J Jpn Cosmet Sci Soc 31:411-431, 2007) for the evaluation of anti-wrinkle effects issued by the Japan Cosmetic Industry Association.

METHODS

The wrinkle area fraction and skin viscoelasticity were measured by objective evaluation. Furthermore, a satisfaction survey of the subjects was conducted on the basis of subjective evaluations using the visual analog scale (VAS) method and in accordance with the guideline for the evaluation of antiwrinkle effects.

RESULTS

Fractional erbium YAG laser treatment showed statistically significant improvement in both of the objective evaluations (wrinkle area and skin elasticity). The IPL method showed statistically significant improvement in both of the objective evaluations (wrinkle area and skin elasticity), and it especially demonstrated a more significant difference in skin elasticity. The CD-tretinoin external application method showed statistically significant improvement in both of the objective evaluations (wrinkle area and skin elasticity), and it especially demonstrated a more significant difference in wrinkle area. Nutritional therapy showed statistically significant improvement in wrinkle area, whereas IPL, CD-tretinoin external application, and nutritional therapy demonstrated statistically significant improvement in the degree of wrinkle. As for the subjective assessment of VAS, all four treatments demonstrated equivalent satisfaction.

CONCLUSION

All four minimally invasive procedures (fractional erbium YAG treatment, IPL therapy, CD-atRA external application, and intake of amino acid supplements) showed significant improvement of wrinkles. Comparative evaluation of wrinkles using the same criteria is important. The findings clearly showed that an evidence-based approach to wrinkle treatments supported by validation of their effectiveness is required.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of long-pulsed 1,064-nm neodymium-doped yttrium aluminum garnet laser on dermal collagen remodeling in hairless mice

BACKGROUND

Nonablative lasers are used for dermal collagen remodeling. Although clinical improvements have been reported using various laser devices, the mechanism of dermal collagen remodeling remains unknown.

OBJECTIVE

To investigate the effects of energy fluences of the long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) nonablative laser on dermal collagen remodeling and evaluate the dermal collagen remodeling mechanism.

MATERIALS AND METHODS

Hairless mice were pretreated with ultraviolet B irradiation to produce photo-damage. The laser treatment used a long-pulse 1,064-nm Nd:YAG laser at energy fluences of 20, 40, and 60 J/cm(2) . The amount of dermal collagen and expressions of transforming growth factor beta (TGF-β), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) of laser treated skin were compared with those of nontreated control skin.

RESULTS

The long-pulse Nd:YAG laser treatment increased dermal collagen and significantly increased TGF-β expression. The expression of MMP-1 decreased with low energy fluence. The expression of TIMP-1 was not significantly different.

CONCLUSION

Long-pulsed 1,064-nm Nd:YAG laser increases the dermal collagen in association with the increased expression of TGF-β.

Radiofrequency facial rejuvenation: evidence-based effect

BACKGROUND

Multiple therapies involving ablative and nonablative techniques have been developed for rejuvenation of photodamaged skin. Monopolar radiofrequency (RF) is emerging as a gentler, nonablative skin-tightening device that delivers uniform heat to the dermis at a controlled depth.

OBJECTIVE

We evaluated the clinical effects and objectively quantified the histologic changes of the nonablative RF device in the treatment of photoaging.

METHODS

Six individuals of Fitzpatrick skin type III to IV and Glogau class I to II wrinkles were subjected to 3 months of treatment (6 sessions at 2-week intervals). Standard photographs and skin biopsy specimens were obtained at baseline, and at 3 and 6 months after the start of treatment. We performed quantitative evaluation of total elastin, collagen types I and III, and newly synthesized collagen using computerized histometric and immunohistochemical techniques. Blinded photographs were independently scored for wrinkle improvement.

RESULTS

RF produced noticeable clinical results, with high satisfaction and corresponding facial skin improvement. Compared with the baseline, there was a statistically significant increase in the mean of collagen types I and III, and newly synthesized collagen, while the mean of total elastin was significantly decreased, at the end of treatment and 3 months posttreatment.

LIMITATIONS

A limitation of this study is the small number of patients, yet the results show a significant improvement.

CONCLUSIONS

Although the results may not be as impressive as those obtained by ablative treatments, RF is a promising treatment option for photoaging with fewer side effects and downtime.

Effectiveness of non-ablative three dimensional (3D) skin rejuvenation: a retrospective study involving 46 patients

BACKGROUND

Three dimensional (3D) skin rejuvenation is proposed to be effective for all skin layers. The aim of this concept is to treat sun spots with broad-band pulse light; large pores, fine lines and vascular lesions with a long-pulsed 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser system and skin ptosis and laxity with a 1100-1800 nm infrared light source.

OBJECTIVE

In this study, 46 patients treated with the 3D skin rejuvenation procedure were retrospectively evaluated to assess the effectiveness of the 3D procedure according to both patient and doctor satisfaction.

METHODS

The 3D procedure was carried out over the course of five sessions with 15 day intervals between sessions. Results were judged by an experienced laser dermatologist both by direct patient examination and by comparison of "before" and "after" photographs. Results were ranked into five categories ranging from 0 to 4. At the final control, the patients were also asked to rate their satisfaction with the procedure in five categories, ranging from 0 to 4.

RESULTS

All of our patients showed improvement, with an overall patient satisfaction score of 2.65. Female patients were more satisfied than male patients. Patient and doctor satisfaction scores were generally correlated.

CONCLUSIONS

Our clinical results indicate that the 3D procedure is an effective nonsurgical skin rejuvenation method.

High-frequency ultrasound evaluation of cellulite treated with the 1064 nm Nd:YAG laser

OBJECTIVES

To investigate non-invasive laser treatment for cellulite using the 1064 nm Nd:YAG laser and to correlate clinical results with high-frequency skin ultrasound images.

METHODS

Twelve individuals of normal weight were treated on either the left or right posterior side of the thigh with the following parameters: fluence 30 J/cm, 18 mm spot size and dynamic cooling device pulse duration of 30 ms. Three treatments were performed at intervals of 3-4 weeks, and followed-up 1 and 3 months after the last session. Photographs and ultrasound imaging were assessed before each session.

RESULTS

The 1064 nm Nd:YAG laser resulted in a tightening of the skin and an improvement in cellulite. No side effects were reported. High-resolution ultrasound imaging showed a significant improvement in dermis density and a reduction of dermis thickness. The method is described in detail in Appendix 1.

CONCLUSION

Infra-red lasers may constitute a safe and effective treatment for cellulite and high-frequency ultrasound imaging provides a quantitative and objective measurement of the treatment efficacy.

Single-treatment skin tightening by radiofrequency and long-pulsed, 1064-nm Nd: YAg laser compared

BACKGROUND AND OBJECTIVE

To compare single-treatment facial skin tightening achieved with the current radiofrequency (RF) protocol with single-treatment tightening achieved with the long-pulsed, 1064-nm Nd:YAG laser.

STUDY DESIGN/MATERIALS AND METHODS

A total of 12 patients were treated with RF energy on one side of the face and laser energy on the other. Results were evaluated on a numerical scale (0-12 with 12 = greatest enhancement) from pre- and posttreatment photographs by a blinded panel.

RESULTS

Upper face improvement (posttreatment score minus pretreatment score) was essentially the same on both sides (30.2 and 31.3% improvement for laser and RF, respectively, P=0.89). Lower face improvement was greater in the laser-treated side (35.7 and 23.8% improvement for laser and RF, respectively), but the difference was not significant (P=0.074). Overall face improvement was significantly greater on the laser-treated side (47.5 and 29.8% improvement for laser and RF, respectively, P=0.028).

CONCLUSION

A single high-fluence treatment with the long-pulse 1064-nm Nd:YAG laser may improve skin laxity more than a single treatment with the RF device. Further controlled split-face or very large non-self controlled studies are needed to conclusively determine the relative efficacies of the two technologies.