Complications and posttreatment care following invasive laser skin resurfacing: A review

The application of a multi-component reaction peptide as a model regenerative active to enhance skin wound-healing postlaser procedure in a double-blinded placebo-controlled clinical trial

INTRODUCTION

Esthetic procedures are currently among the most effective options for consumers seeking to correct aging signs such as fine lines, wrinkles, and skin tone unevenness. Currently, there is a scientific need for an adjunct active to be paired with esthetic procedures to encourage wound recovery and address postprocedure pigmentation concerns.

OBJECTIVE

Toward that goal, this study assessed the efficacy of a peptide created from a multi-component reaction (multi-component peptide, MCP) as a model active for postprocedure care and evaluated its ability to promote skin healing in an ablative laser-induced wound model on the forearm.

METHODS

The mechanism of action of MCP was investigated using tubo assays, 2D melanocyte, and fibroblast cultures, reconstructed skin equivalents, and ex vivo skin explants. The MCP formula and the clinical benchmark formula of Aquaphor were assessed head-to-head by applying the products topically in an ablative laser-induced wound model (n = 20 subjects). The promotion of wound healing was evaluated by the investigator assessment of epithelial confluence, crusting or scabbing, general wound appearance, erythema, and edema.

RESULTS

MCP was determined to be beneficial to postprocedure skin recovery and healing by four main mechanisms of action: barrier repair as determined in an ex vivo tape-stripping model, reduction of inflammation and postinflammatory hyperpigmentation, reduction of elastase activity, and stimulation of fibroblast through the mTOR pathway. The formula containing 10% MCP enhanced the kinetics of epithelial confluence and improvement of the crusting or scabbing appearance of the laser-generated wounds in a laser-induced mini-zone wound healing study on the forearm.

CONCLUSION

This study demonstrates the use of MCP as a proof of concept regenerative active that when incorporated into an optimized postprocedure skincare formula can improve skin healing and enhance the appearance of skin after injury with relevance to ablative aesthetic procedures.

Carbon Dioxide Laser Rejuvenation of the Facial Skin

This article reviews the evaluation and techniques for facial skin rejuvenation using the fractionated carbon dioxide laser. It includes a detailed overview of laser skin rejuvenation and discusses the potential complications associated with this procedure. A review of clinical outcomes in the literature is also included.

Clinical Evaluation and Experience in Treatments Performed with Fractional CO2 Laser on Latin American Skin: An Observational Retrospective Study

Background: The carbon dioxide (CO₂) laser is an ablative system that evaporates, remodels, and coagulates tissues, becoming therefore a gold standard piece of equipment for the treatment of dermatological pathologies and esthetic imperfections. Objective: To evaluate the efficacy and safety of CO₂ laser treatments in different patients' skin pathologies. Methods: A total of 705 patients with an age range between 18 and 70 years, with phototypes on the Fitzpatrick scale III, IV, V, and VI, were enrolled from October 2021 to May 2022, and were treated using the CO₂ laser system. Results: Ninety-six patients were treated with fractional CO₂ laser, used for skin rejuvenation and stretch marks. One patient presented reactivation of herpes simplex, 10 postinflammatory hyperpigmentation that resolved after 3 months with depigmenting agents, 6 with persistent erythema. A total of 13 patients with rhinophyma were treated, and no complications were observed; a total of 64 patients with wrinkles were treated. They improved in 6 months. A total of 340 patients were treated for seborrheic keratosis, papulosa nigra dermatosis, fibropapillomas, sebaceous hyperplasias, verruca vulgaris, and condylomata acuminata. One patient presented with a complication hypopigmented macule. A total of 136 patients underwent treatment for laser ablation of intradermal nevi and verrucous epidermal nevi, without complications. A total of 56 patients were treated with keloids and hypertrophic scars. One patient presented with ulceration of a keloid that resolved with the application of clostridiopeptidase A and chloramphenicol after 2 weeks. Conclusions: The use of the CO₂ laser in any phototype and race, which are factors with a high incidence in Latin America, provides a safe and effective result for different dermatological pathologies.

Efficacy of a home-used high-intensity focused ultrasound device on wrinkle reduction

BACKGROUND

High-intensity focused ultrasound (HIFU) has been developed for the treatment of skin wrinkles on the face, neck, and body.

OBJECTIVES

This study aimed to evaluate the effects of a home-used HIFU device on wrinkles in mice based on the expression of fibrosis-related genes and proteins.

METHODS

The backs of 20-week-old mice were treated with a home-used HIFU using the following probes: 4 MHz, 1.5 mm focal depth. The treated mice were compared with young mice by histological examination, real-time polymerase chain reaction (PCR), and immunohistochemistry. Histological examination was performed by trichrome staining. Real-time PCR and immunohistochemistry were conducted to determine the expression of collagen types I and III, matrix metalloproteinase (MMP)-1, and tissue inhibitor of metalloproteinase (TIMP)-1.

RESULTS

Dermal thickness was increased after treatment with the home-used HIFU device at 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks on trichrome. Gene and protein expression of collagen types I and III and elastin were increased after treatment with HIFU at all options of 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks. Gene and protein expressions of MMP-1 and TIMP-1 were decreased after treatment with HIFU device at 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks.

CONCLUSION

The home-used HIFU device can be an effective therapeutic modality for skin tightening.

High energy, double pass helium plasma dermal resurfacing: A prospective, multicenter, single-arm clinical study

BACKGROUND

A previous multi-center clinical study of low energy (20% power), single-pass helium plasma dermal resurfacing (HPDR) showed positive results but did not fully reveal the true potential of this novel technology. A second multi-center clinical study, reported herein, was therefore undertaken to evaluate efficacy and safety of high energy (40%), double pass HPDR for treatment of facial rhytids (ClinicalTrials.gov Identifier: NCT04185909).

METHODS

Fifty-five eligible subjects seeking improvement in facial rhytids were enrolled for study at one of four investigational sites. All subjects underwent full-face HPDR treatment. The forehead, nose, cheeks, and peri-oral treatment zones were treated at 40% power with two passes whereas the peri-orbital and jawline/mandibular zones were treated at 20% power (up to 40% for jawline/mandibular zone) and one or two passes. Photographic images of the face were captured using the VISIA-CR system. Three-month posttreatment Fitzpatrick Wrinkle and Elastosis Scale (FWS) scores were compared to baseline scores as determined by blinded independent photographic reviewers (IPRs) and study investigators.

RESULTS

Blinded IPRs and study investigators observed a ≥1-point FWS improvement in 100% of subjects with mean change in IPR FWS from baseline to the 90-day visit of -3.6 (±1.2). 96.4% of subjects indicated "improvement" in appearance at the 90-day visit utilizing the modified Global Aesthetic Improvement Scale. Evaluation of VISIA-CR data revealed statistically significant improvements in wrinkles, brown spots, and pore counts. Overall, 269 Adverse Events in 55 subjects were reported; most were mild-moderate in severity (99.3%), anticipated (86.2%), and of relatively short duration with most having resolved within 30 days (60.6%) of treatment.

CONCLUSION

Treatment of facial rhytids with high energy, double pass HPDR as detailed herein enables a marked improvement in FWS that parallels or surpasses competing technologies. VISIA-CR analysis demonstrates additional improvements in skin quality with statistically significant quantitative improvements in brown spots and enlarged pores as well as wrinkles. Effective rhytid effacement combines with high subject satisfaction and few unanticipated adverse events for a reasonable benefit-risk ratio.

Practical Considerations in Adopting New Technology for Facial Cosmetic Procedures

The field of facial plastic and reconstructive surgery encompasses both surgical and nonsurgical facets, creating a supplemental level of care and an additional layer of complexity. Determining the "best course of care" can be very difficult in experienced situations, but even more so when considering adopting an emerging technology. A basic and practical method of analyzing a new technology requires investigating the risk-to-benefit assessment, the utility and clinical outcomes compared with other treatment options, and an introspective ethical appraisal of whether the technology is foremost for patient care purposes. Even after employing a new technology, constant monitoring and reevaluation of the results is necessary to determine if it should be continued or altered.

Full-face skin resurfacing using a combination of fractional and full spot ablative 2940 nm erbium laser

BACKGROUND

Full-field deep ablative laser resurfacing is a popular method for skin rejuvenation due to maximum improvement in a single treatment. However, it is associated with disadvantages such as pain, prolonged erythema, swelling, crusting, infections, pigmentary changes, and scarring. Patients are increasingly seeking less invasive options with comparable effect.

AIMS

The aim of this retrospective study was to evaluate the safety and efficacy of full-face resurfacing using a combination of full spot and fractional erbium (Er:YAG) laser resurfacing.

PATIENTS/METHODS

About 109 patients, mostly females over 50 years old, were treated with a two-phase protocol: full spot ablation (5 J/cm² , three passes) and fractional ablation (132 J/cm² , 5% coverage, three passes). We recorded time to re-epithelization and duration of post-treatment erythema. Any side effects observed at follow-up or reported by the patient were recorded. Patient satisfaction questionnaire and blinded evaluation of pre- and post-treatment photographs were used to assess efficacy.

RESULTS

A single session was performed in 96% of cases. Postoperative re-epithelization lasted on average 6.4 ± 2.9 days. Post-treatment erythema lasted on average 13.8 ± 15.2 days. One patient had hyperpigmentation, one infection, one hypo-pigmentation, and one ulcer. All side effects resolved without complications. According to the blinded assessment of photographs, 78% of patients showed improvement. About 97% of patients were satisfied with the results of the treatment.

CONCLUSIONS

A combination of fractional and full spot ablative Er:YAG laser is a safe and effective option for full-face resurfacing.

The Effects of a Standardized Extract of Centella asiatica on Postlaser Resurfacing Wound Healing on the Face: A Split-Face, Double-Blind, Randomized, Placebo-Controlled Trial

Background: Centella asiatica, a medicinal plant, has been used traditionally to promote wound healing. Its efficacy on promoting postlaser resurfacing wound healing is lacking. Methods: Thirty individuals with facial acne scars underwent a treatment with 2940 nm Er:YAG laser. Half side of the face was randomized to receive 0.05% w/w ECa 233 gel, a standardized extract of C. asiatica, and the other half a placebo gel. The gels were applied four times daily for 7 days then twice daily for 3 months. Erythema, melanin, and texture index (TI) from Antera3D,^® and skin biophysics were obtained at baseline, days 2, 4, and 7, then every 2 weeks for the first month, and every month for 3 months. Three blinded dermatologists assessed the photographs and provided a grading scale of wound appearances. Results: The ECa 233 treated side exhibited significantly less erythema index over total follow-up by 0.03 U (coefficient = -0.03 [95% CI -0.06 to -0.0006]; p = 0.046). In keeping with the physicians' assessment that showed significantly higher improvements in skin erythema at days 2, 4, and 7 (p = 0.009, 0.0061, 0.012), crusting at days 2 (p = 0.02), and general wound appearance at days 2, 4, and 7 (p = 0.008, 0.001, 0.044), TI showed a trend toward better outcome in the ECa 233 group. Skin biophysics did not differ between the two groups. Conclusion: ECa 233 might be an option for postlaser treatment to improve wound appearance.