Fractional carbon dioxide laser for facial rejuvenation: A prospective study to evaluate the efficacy and the safety

Laser-Assisted Hyaluronic Acid Delivery by Fractional Carbon Dioxide Laser in Facial Skin Remodeling: A Prospective Randomized Split-Face Study in France

BACKGROUND AND OBJECTIVES

Combining the efficacy of ablative fractional carbon dioxide lasers (AFXL) to laser-assisted hyaluronic acid delivery (LAHAD) has not yet been studied. The objective of our study was to evaluate the safety and the efficacy of laser-assisted hyaluronic acid (HA) delivery with AFXL in facial skin remodeling.

STUDY DESIGN/MATERIALS AND METHODS

We conducted a prospective, double-blinded, randomized split-face study on 20 patients from 30 to 70 years old, with a skin phototype from I to IV. Each patient received full-face treatment with AFXL, immediately followed by the application in droplets into the fractional ablative tunnels of 1 ml of HA gel on one hemiface and 1 ml of physiological saline on the other hemiface. To evaluate postlaser aftermath, the intensity of erythema, edema, and crusts was graded. To assess facial skin remodeling, we scored the improvement of skin texture, firmness, fine lines, and skin radiance from baseline. Patients were evaluated on the 3rd and 7th day, 1st and 3rd month using clinical evaluations, photographs, and patient questionnaires.

RESULTS

We showed equivalence in postlaser aftermath between HA-treated and nontreated hemiface. Trend data analyses at the 3rd month suggested that immediate application of HA after AFXL resulted in a greater improvement in facial skin remodeling, especially for skin texture (mean score of 2.60 vs. 2.45) and skin firmness (mean score of 2.55 vs. 2.40). Skin radiance showed the best improvement, reaching almost a score of 5/10.

CONCLUSIONS

LAHAD with AFXL is a safe treatment showing promising results in facial skin remodeling. These findings need to be confirmed by a larger study to evaluate the value of LAHAD in daily clinical practice. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Early and maintained application of the secretion of Cryptomphalus aspersa (SCA) 40% improves cutaneous healing after ablative fractional laser in skin aging

BACKGROUND

Ablative fractional laser generates a regulated skin damage, which secondarily improves skin aging.

AIMS

The main objective of the present study was to figure out if the adverse effects induced by laser and the skin recovery could improve with the application of a cosmetic product based on the secretion of Cryptomphalus aspersa (SCA).

PATIENTS/METHODS

A prospective double-blind controlled study with vehicle in 10 patients with skin aging. The patients received one session of fractional ablative CO₂  laser, and the formulation with SCA 40% was applied immediately and maintained throughout the 21-day duration of the study. The active treatment (SCA) was applied to one hemifacial area and vehicle to the other, and the patient acting was her own control. Clinical evaluations, dermoscopy, photography, and other parameters like cutaneous hydration, elasticity, and wrinkles were evaluated. In addition, the severity of the adverse effects was evaluated.

RESULTS

Significant greater decrease in the density of microcolumns produced by laser was detected on the active-treated side, indicating greater and faster postprocedure recovery compared to the vehicle-treated side. In addition, side effects were reduced and some antiaging effects were more apparent on the side treated with SCA 40%.

CONCLUSION

SCA 40% applied immediately after ablative laser, and during the next days, it can accelerate laser-induced damage regeneration. In addition, SCA improves the cosmetic outcome after laser application.

Searching predictive factors of efficacy and safety in a fractional CO2 laser

A few studies discussed short outcomes in fractional CO₂ laser. This study aimed to seek factors of medium-term efficacy and safety in patients treated for facial rejuvenation or acne scars. This single-center, prospective, single-arm, evaluator-blinded cohort study included patients of 18 years and older undergoing a fractional CO₂ laser for facial skin rejuvenation or atrophic acne scars. One session of ultrapulsed fractional 10 600 nm CO₂ laser was performed with the Deep FX TM mode in acne scars and the Active FX TM mode in facial rejuvenation and acne scars. Follow-up was carried out for 6 months. In the end, a patient self-satisfaction assessment was obtained. A blinded physician graded improvement based on pretreatment and 6-month photography. The study included 75 patients, of whom 88% were women. Forty-five had facial rejuvenation, and 30 had atrophic acne scars treatment. Half of the patients were satisfied. The physician-blinded evaluation indicated "good to very good" improvement in 46.7% of facial rejuvenation patients, and 30% of acne scars patients. Hyperpigmentation and folliculitis were recorded in 15 and 3 patients, respectively. This study did not find statistically significant factors to predict outcomes in a fractional CO₂ laser. We could however note better results in acne scar patients of thicker skin, and facial rejuvenation patients of younger age and thinner skin. We counted more hyperpigmentation events in phototypes III and IV, and it was reversible in all cases.

CO2 lattice laser reverses skin aging caused by UVB

The carbon dioxide (CO₂) lattice laser has been successfully used to treat facial skin photoaging induced by UV light. In this study, we analyzed the effect of CO₂ lattice laser irradiation on skin photoaging, and investigated the underlying mechanisms. Our results demonstrate that the laser promoted collagen synthesis and proliferation of primary human skin fibroblasts, inhibited cell senescence, and induced expression of superoxide dismutase (SOD) and the signaling protein SMAD3. In addition, this laser reversed cell cycle arrest and fibroblast apoptosis induced by UVB irradiation, and restored fibroblast proliferation inhibited by SMAD3 silencing. Using a rat model of photoaging, our results show that the laser increased collagen expression and dermal thickness, demonstrating that the CO₂ lattice laser has a profound therapeutic effect on photoaged skin. Together, our in vitro and in vivo data show that the CO₂ lattice laser can reverse the skin aging caused by UVB, and indicate that this effect is mediated through SMAD3.

Percutaneous Lower Blepharoplasty: A Novel Technique in Lower Eyelid Aesthetics

BACKGROUND

More preservative approaches are being adopted in periorbital surgery each day. To avoid the possible complications of transcutaneous and transconjunctival blepharoplasty, the author has developed the safe and simple "Percutaneous Lower Blepharoplasty" technique, which he has been performing since 2008. The technique consists of the removal and transfer of lower orbital fat pads through 4-mm skin incisions with minimal dissection.

PATIENTS AND METHODS

The study is designed as a retrospective analysis of the operations done by the author from 2008 to 2018. The author performed 297 percutaneous lower blepharoplasty operations alone or in combination with tear-trough deformity correction, pinch skin excision, and/or carbon dioxide laser application. The video of the technique is demonstrated in the supplemental digital content.

RESULTS

The patients were followed for an average of 58.8 months. All the patients were satisfied with the result. There were no retractions or scleral show seen. The only complication was chemosis in 1 patient that subsided with steroid ointment.

CONCLUSION

Percutaneous lower blepharoplasty is a novel technique that has the following advantages: Simple and fast, low complication rates, good cosmetic outcomes, tear trough deformity correction, better estimation of fat amount to be removed, and minimal dissection and avoidance of violation of lamellar structures. It can be performed safely alone or in combination with pinch excision and/or fractional laser resurfacing.