Stimulation of collagen and elastin production in-vivo using 1,540 nm Er:Glass laser: assessment of safety and efficacy

Keloid and Hypertrophic Scars Treatment

BACKGROUND

Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen.

OBJECTIVE

To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device.

METHODS

Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3-1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded.

RESULTS

A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics.

CONCLUSIONS

The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars.

LEVEL OF EVIDENCE II

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.

Hybrid fractional laser facial resurfacing: A comparison between a single treatment at high settings versus multiple treatments at low to moderate settings

OBJECTIVES

Fractional laser treatments for facial skin rejuvenation is an evolving field with the increase of innovative technologies. Typically, better results are achieved by using more aggressive approaches although this is accompanied by an increased risk. The demand for a modality that combines efficacy with minimal downtime and risk of adverse events led to the development of a hybrid laser, which delivers a fractional treatment of ablative CO2 and nonablative 1570 nm lasers, simultaneously. This study compares the clinical results, side effects, and downtime profile of the hybrid laser in multiple low-to-moderate-setting treatments versus a single high-setting treatment in the facial area.

MATERIALS AND METHODS

This retrospective single-center study included 44 patients who underwent 1-3 treatments with the hybrid laser for facial rejuvenation between the years 2020-2022. The patients were divided into two groups based on the number of treatments they had received (Group A; single high-setting treatment, Group B; 2-3 low-to-moderate setting treatments). Three independent nontreating physicians evaluated the objective improvement by assessing the patients' standardized clinical photographs before and after the treatments, using three different scales. Treatment data, adverse events, and patients' satisfaction in each group were also reviewed.

RESULTS

A superiority to 2-3 low-to-moderate setting treatments (Group B) was found in most of the evaluated scales. Patients' satisfaction was significantly higher in Group B, and the average downtime was significantly lower: 4.3 ± 1.6 days versus 7.3 ± 2.3 days in Group A. The expected treatment effects were significantly milder in severity in Group B as graded by the patients, and no adverse events were reported in this group. An average overall improvement of 51%-75% according to Global Esthetic Improvement Scale (GAIS) was found in both groups.

CONCLUSIONS

The new hybrid laser generates remarkable clinical outcomes in facial rejuvenation. Performing several treatments at mild to moderate settings can lead to a safer and more favorable procedure while maintaining high efficacy and achieving higher patients' satisfaction.

Hyaluronic Acid Dissolving Microneedles and Nonablative Fractional Laser for Infraorbital Wrinkles: A Prospective, Randomized, Split-Face Study

Background. Recently, hyaluronic acid dissolving microneedles (HA-DMNs) have been widely used in antiwrinkle research studies. However, the comparison of HA-DMNs with nonablative fractional laser (NAFL), which is regarded as the gold standard in the treatment of facial wrinkles, is still lacking. Objective. The purpose was to compare the therapeutic effects and adverse effects of HA-DMNs and NAFL on infraorbital wrinkles. Methods. A prospective, randomized, split-face trial was performed with HA-DMNs on one side and NAFL on the other. The wrinkle numbers, photo-numeric scores, and VISIA assessment scores were compared at baseline and 2, 4, 8, and 12 weeks post-treatment. Reflectance confocal microscopy (RCM) was used to monitor collagen fibers. Adverse effects and subjects’ satisfaction scores were evaluated using scales. Results. The final analysis included 28 patients. The wrinkle numbers and photo-numeric scores decreased on both the HA-DMNs side and the NAFL side in week-2, 4, 8, and 12. The VISIA scores decreased on the HA-DMNs side in week-8 and on the NAFL side in week-2. There were no significant differences in these indexes between the two sides. The RCM images demonstrated a similar increase in collagen density on the two sides. Burning, erythema, edema, and crust scores were higher on the NAFL side than on the HA-DMNs side. There was no significant difference in the subjects’ satisfaction scores of the two sides. Conclusion. HA-DMNs are effective treatment options for infraorbital rejuvenation. From the change of wrinkle numbers and scores, HA-DMNs provided comparable efficacy as NAFL in an observation period of 12 weeks. Meanwhile, HA-DMNs offered a more favorable adverse effect profile than NAFL therapy. Mild but persistent pain, erythema, and edema during the HA-DMNs therapy are noteworthy and require improvement.

Stem cell-derived exosomes in the treatment of melasma and its percutaneous penetration

BACKGROUND AND OBJECTIVES

Melasma is a refractory skin disease due to its complex pathogenesis and difficult treatment. Studies have found that human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-Exos) could serve as a novel cell-free therapeutic strategy in regenerative and esthetic medicine. It could potentially treat melasma, but the skin barrier is a challenge. In this study, we aim to explore the safety and efficacy of hUCMSC-Exos in the treatment of melasma and the means to promote its percutaneous penetration.

MATERIALS AND METHODS

In the animal study about the effect of penetration, percutaneous penetration of PKH67-labeled hUCMSC-Exos was studied under microneedles, 1565 nm nonablative fractional laser (NAFL), and a plasma named Peninsula Blue Aurora Shumin Master (PBASM) treatments, observed by confocal laser scanning microscopy. In the clinical application study, 60 patients with melasma treated in our department were divided into four groups. NAFL combined with normal saline treatment was used for Group A. Microneedles, NAFL, and PBASM combined with hUCMSC-Exos treatments were used for Groups B, C, and D, respectively. Each patient received four treatments at 1-month intervals. Assessments were done using the degree of pain posttreatment, melasma area and severity score, improvement rate, physician global assessment score, satisfaction, and complications.

RESULTS

In the animal study about the effect of penetration, hUCMSC-Exos can penetrate the deep dermis under microneedles, NAFL, and PBASM treatments. In the clinical application study, compared with Group A, Groups B, C, and D showed significantly improved therapeutic effect and patient satisfaction (p < 0.05), and there was no significant difference among Groups B, C, and D.(p > 0.05). Patients in Group B reported higher pain levels than those in the other three groups (p < 0.05); the treatment experience of patients in Group D was better.

CONCLUSION

hUCMSC-Exos can improve the symptoms of melasma safely and effectively. Compared with microneedles, NAFL and PBASM can also achieve a good effect toward promoting penetration. These findings are worthy of exploration and clinical application.