Skin resurfacing procedures: new and emerging options

Evaluation of a Novel Ablative 1940 nm Pulsed Laser for Skin Rejuvenation

BACKGROUND

Skin rejuvenation is a widely sought-after goal, prompting advancements in laser technology for noninvasive and effective treatments. Ablative lasers, in particular, have evolved to address diverse skin concerns, with fractional ablative lasers offering better-tolerated outcomes. The introduction of a novel ablative Thulium pulsed laser, based on Thulium-doped Yttrium aluminum Perovskite (Tm:YAP) crystal, delivers precise and controlled skin rejuvenation by allowing customization of ablative microcolumns.

METHODS

A pilot in vivo study was conducted on the abdominal skin of a live female pig. Using the Laser Team Medical (LTM) prototype laser, treatments were administered with varying coagulation settings (minimal and maximum) and energies (32, 80, 120, and 160 mJ per microcolumn). Biopsies were harvested, fixed, and stained for subsequent analysis. The penetration depth and width of the microcolumns were evaluated.

RESULTS

Low coagulation settings produced ablative microcolumns with thermal affected zones of 160 µm width, while high coagulation settings resulted in wider zones of 400-530 µm. The ablation cavities' width was estimated to be less than 100 µm in both settings. The novel 1940 nm pulsed laser demonstrated superior microcolumn properties, offering potential advantages such as shorter downtime and increased efficacy compared to existing fractional ablative lasers.

CONCLUSION

This study presents encouraging preliminary results regarding the efficacy and safety of the first ablative 1940 nm pulsed laser. The results show ablative microcolumns thinner than the counterpart devices, showing the device safety and potential higher efficacy along with short downtime. The LTM novel ablative 1940 nm pulsed laser holds immense potential for enhancing skin rejuvenation treatments due to its superior microcolumns properties. The versatility of this laser can open new treatment procedures and may extend to different areas of dermatology.

Development and Validation of a Composite Skin Quality Scale

Background

The increasing demand for skin quality interventions in aesthetic medicine underscores the necessity for objective, evidence-based assessment tools that may be used to evaluate novel interventions or devices.

Objectives

To develop and validate a 5-point photonumeric rating scale for assessing overall skin quality, including radiance, color evenness, and smoothness.

Methods

The IBSA (Institut Biochimique SA) Composite Skin Quality Scale was developed and underwent live validation with 88 real-world patients, chosen to encompass a broad spectrum of skin qualities and Fitzpatrick skin types. Scale validation was performed by board-certified plastic surgeons and dermatologists over 2 rounds, 2 weeks apart. Reliability was assessed through intrarater and interrater agreements, utilizing weighted kappa statistics and intraclass correlation coefficient (ICC). The scale's ability to discern a clinically relevant 1-grade difference was evaluated with 72 photo pairs.

Results

Combined intrarater reliability results showed weighted kappa values of 0.812 (right side) and 0.815 (left side) and an ICC of 0.903 for both sides, indicating an almost perfect agreement. Interrater reliability ranged from substantial to almost perfect, with kappa coefficients between 0.654 and 0.853 and ICCs between 0.657 and 0.855 across all rater pairs in both rounds. The ability to detect a clinically relevant 1-point difference using the scale was established.

Conclusions

Integrating various key aspects of skin quality, the IBSA Composite Skin Quality Scale is a clinically relevant and highly reliable tool, suitable for skin assessment in clinical studies of new aesthetic technologies and products.

Level of Evidence 3

Comparative Efficacy of Chemical Peeling Agents in the Treatment of Melasma

BACKGROUND

Melasma is a complex skin disorder characterized by brown or dark patches, primarily affecting facial areas. Despite numerous treatment options, the effective management of melasma remains challenging. This study aims to fill a gap in the literature by rigorously comparing the effectiveness of three prevalent chemical peeling agents, 15% trichloroacetic acid (TCA), 15% phenol, and 2% glycolic acid, in treating melasma.

MATERIALS AND METHODS

A randomized controlled trial was conducted involving patients who were clinically diagnosed with melasma. Participants were divided into three groups, each receiving one of the chemical peeling treatments. The primary measure of efficacy was the Melasma Area and Severity Index (MASI) score, recorded before and after the treatment series. Side effects were also documented and analyzed.

RESULTS

Preliminary findings suggest a significant reduction in MASI scores in the group treated with 15% TCA peel. The average MASI score reduction was 8.5 points for the TCA group, 6.0 points for the phenol group, and 5.2 points for the glycolic acid group. Side effects such as redness and mild irritation were noted but were least prevalent in the TCA group.

CONCLUSION

Our study indicates that 15% TCA peel is not only effective but also comparatively safer in treating melasma. It shows a more rapid and significant improvement in reducing melasma symptoms than 15% phenol and 2% glycolic acid peels. However, further research is warranted to validate these findings over a larger population.

Wounding Therapies for Prevention of Photocarcinogenesis

The occurrence of non-melanoma skin cancer (NMSC) is closely linked with advanced age and ultraviolet-B (UVB) exposure. More specifically, the development of NMSC is linked to diminished insulin-like growth factor-1 (IGF-1) signaling from senescent dermal fibroblasts in geriatric skin. Consequently, keratinocyte IGF-1 receptor (IGF-1R) remains inactive, resulting in failure to induce appropriate protective responses including DNA repair and cell cycle checkpoint signaling. This allows UVB-induced DNA damage to proliferate unchecked, which increases the likelihood of malignant transformation. NMSC is estimated to occur in 3.3 million individuals annually. The rising incidence results in increased morbidity and significant healthcare costs, which necessitate identification of effective treatment modalities. In this review, we highlight the pathogenesis of NMSC and discuss the potential of novel preventative therapies. In particular, wounding therapies such as dermabrasion, microneedling, chemical peeling, and fractionated laser resurfacing have been shown to restore IGF-1/IGF-1R signaling in geriatric skin and suppress the propagation of UVB-damaged keratinocytes. This wounding response effectively rejuvenates geriatric skin and decreases the incidence of age-associated NMSC.

Combined with interventional therapy, immunotherapy can create a new outlook for tumor treatment

Recent progress in immunotherapy provides hope of a complete cure to cancer patients. However, recent studies have reported that only a limited number of cancer patients with a specific immune status, known as "cold tumor", can benefit from a single immune agent. Although the combination of immune agents with different mechanisms can partially increase the low response rate and improve efficacy, it can also result in more side effects. Therefore, discovering therapies that can improve tumors' response rate to immunotherapy without increasing toxicity for patients is urgently needed. Tumor interventional therapy is promising. It mainly includes transcatheter arterial chemoembolization, ablation, radioactive particle internal irradiation, and photodynamic interventional therapy based on a luminal stent. Interventional therapy can directly kill tumor cells by targeted drug delivery in situ, thus reducing drug dosage and systemic toxicity like cytokine release syndrome. More importantly, interventional therapy can regulate the immune system through numerous mechanisms, making it a suitable choice for immunotherapy to combine with. In this review, we provide a brief description of immunotherapies (and their side effects) on tumors of different immune types and preliminarily elaborate on interventional therapy mechanisms to improve immune efficacy. We also discuss the progress and challenges of the combination of interventional therapy and immunotherapy.

Dermatologic Device Clearance Within the Food and Drug Administration's 510(k) Pathway

BACKGROUND AND OBJECTIVES

Device innovation in dermatology is increasing. Medical devices identified as "substantially equivalent" to predicate ones by the United States Food and Drug Administration (FDA) may be exempt from premarket approval through the 510(k) pathway. The 510(k) pathway has been criticized for having less stringent clinical data requirements, and implications of dermatologic device clearance via this pathway are incompletely described. The objective of this study is to characterize dermatologic device clearance via the 510(k) pathway.

STUDY DESIGN/MATERIALS AND METHODS

We performed a retrospective review of the FDA's 510(k) database between January 1, 1996 and December 31, 2018. Dermatologic devices were included based on product code and classified by the application. Approval pathways and decision characteristics were compared among dermatologic device categories.

RESULTS

Of the 76,607 records screened, 4,637 met inclusion criteria. Laser/thermal devices comprised the largest category (64.2%), followed by wound (24.0%) and light-based devices (5.8%). The majority of 510(k) pathway submissions were traditional (89.2%) compared with alternative (10.8%) submission types (P = 0.003). Devices that were deemed substantially equivalent without limitations (98.5%) were the most common among all device categories. Rates of device clearance over the study period increased for all categories except laser/thermal devices.

CONCLUSIONS

Dermatologic devices are increasingly cleared via the FDA's 510(k) pathway through "substantial equivalence" with minimal requirements for premarket clinical data. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.

Plasma fibroblast skin tightening treatment resulting in bilateral chemical eye injury secondary to EMLA cream: a case report

Background

Plasma fibroblast skin tightening treatment is a relatively novel and growing minimally invasive aesthetic skin procedure. The treatment claims to rejuvenate skin by improving facial lines, wrinkles and skin pigmentation associated with photo-ageing. The skin is often anaesthetised prior to the procedure with topical creams such as EMLA (Eutectic mixture of local anaesthetics). We present the first case of bilateral chemical eye injury following plasma fibroblast skin tightening treatment secondary to EMLA cream. EMLA cream was inadvertently administered to both eyes in preparation for the treatment.

Case presentation

A patient was referred from the emergency department to a tertiary ophthalmology centre with bilateral exquisite eye pain, inability to open the eyes, photosensitivity and reduced vision. She underwent cosmetic plasma fibroblast skin tightening treatment at her local salon four hours earlier. She was found to have bilateral alkali chemical eye injuries with significant diffuse corneal epithelial loss. The injury was thought to be caused by inadvertent ocular exposure to EMLA cream, which was used in preparation for the plasma fibroblast skin tightening treatment. She was treated with topical antibiotics and achieved satisfactory recovery.

Conclusion

This case report highlights a possible complication following plasma fibroblast skin tightening treatment. We lay emphasis on the importance identifying chemical injury and recommend that medication attention should be sought if there is any concern.

Efficacy of a repair cream containing Rhealba oat plantlets extract l-ALA-l-GLU dipeptide, and hyaluronic acid in wound healing following dermatological acts: a meta-analysis of >2,000 patients in eight countries corroborated by a dermatopediatric clinical case

Background

The frequency of dermatological acts is increasing. These procedures often cause injuries and traumatic alterations in specific skin layers, slowing down wound healing.

Patients and methods

An open observational study lasting 1 month was conducted on 2,363 patients who had undergone various dermatological procedures. This study was conducted in eight European countries and an Asian country during which the tolerance and efficacy of a cosmetic cream based on Rhealba oat plantlets’ extract, l-ALA–l-GLU dipeptide, and hyaluronic acid were assessed on patients’ wounds.

Results

Efficacy was observed 5′ after the first application, which leads to an immediate relief, confirmed by the overall efficacy judged by the doctors as good or very good in 96.8% of the cases. In Germany, the efficacy of the same cream was assessed on children suffering from first- or second-degree burns. In this dermatopediatric case, the aim was to support the regeneration process and prevent scarring by using a topical cream rather than a silicon bandage or corticosteroids. A positive effect on skin regeneration and prevention of scaring could already be observed after 4 weeks of application without any undesired complication.

Conclusion

This clinical focus complements the previous meta-analysis by demonstrating that the tested cream containing Rhealba oat plantlets’ extracts, l-ALA–l-GLU dipeptide, and hyaluronic acid could also be used with a great efficacy in children after thermal burns to prevent scaring.

The healing effect of Pistacia lentiscus fruit oil on laser burn

CONTEXT

Since antiquity, Pistacia lentiscus L. (Anacardiaceae) fruit oil (PLFO) has been used as a remedy for primary health care such as burn treatment.

OBJECTIVE

This study assesses the healing effect of PLFO on CO₂ laser fractional burn in a rat model.

MATERIALS AND METHODS

The study was carried out on 18 adult male Wistar rats. A second-degree laser burn (wound area = 2.2 cm²) was inflicted in the dorsal region by the application of CO₂ fractional laser within the following parameters; Energy level: 25 MJ and Depth level: 4. After applying laser, the rats were divided into three groups: the first was treated with saline solution, the second with a reference cream 'CYTOL BASIC^®' (0.13 μg/mm²) and the third with PLFO (0.52 μL/mm²). All treatments were topically administered for eight days. The healing effect was assessed using macroscopic, histological and biochemical parameters.

RESULTS

After eight days, the higher percentage of wound healing contraction was observed among the PLFO-treated group (100%) followed by the 'CYTOL BASIC^®' treated group (61.36%) and untreated group (32.27%). During the treatment, the PLFO-treated group showed less erythema, less crusting/scabbing, higher general wound appearance scores and a high content of collagen (220.67 ± 7.48 mg/g of tissue) than the other groups.

DISCUSSION AND CONCLUSION

The current study has shown, for the first time, the healing effect of PLFO on CO₂ laser fractional burn. Their wound healing effect could be attributed to their antimicrobial, anti-inflammatory and antioxidant effects.

Impact of Age and Insulin-Like Growth Factor-1 on DNA Damage Responses in UV-Irradiated Human Skin

The growing incidence of non-melanoma skin cancer (NMSC) necessitates a thorough understanding of its primary risk factors, which include exposure to ultraviolet (UV) wavelengths of sunlight and age. Whereas UV radiation (UVR) has long been known to generate photoproducts in genomic DNA that promote genetic mutations that drive skin carcinogenesis, the mechanism by which age contributes to disease pathogenesis is less understood and has not been sufficiently studied. In this review, we highlight studies that have considered age as a variable in examining DNA damage responses in UV-irradiated skin and then discuss emerging evidence that the reduced production of insulin-like growth factor-1 (IGF-1) by senescent fibroblasts in the dermis of geriatric skin creates an environment that negatively impacts how epidermal keratinocytes respond to UVR-induced DNA damage. In particular, recent data suggest that two principle components of the cellular response to DNA damage, including nucleotide excision repair and DNA damage checkpoint signaling, are both partially defective in keratinocytes with inactive IGF-1 receptors. Overcoming these tumor-promoting conditions in aged skin may therefore provide a way to lower aging-associated skin cancer risk, and thus we will consider how dermal wounding and related clinical interventions may work to rejuvenate the skin, re-activate IGF-1 signaling, and prevent the initiation of NMSC.

Fractional CO2 Laser vs Fractional CO2 with Topical Platelet-rich Plasma in the Treatment of Acne Scars: A Split-face Comparison Trial

Background:

It is a challenge to treat acne scars and a multimodal combination approach is necessary. While fractional CO₂ lasers (FCLs) are an established treatment option, the role of platelet-rich plasma (PRP) in the treatment of acne scars is not established though it is being used extensively in other fields of medicine owing to its healing properties. We combined the two methods to assess the proposed synergistic action on acne scars.

Aims and Objectives:

To evaluate the effect of FCL alone vs FCL combined with PRP on the quality of acne scars.

Materials and Methods:

This is a left–right split-face comparison study with 30 patients with moderate-to-severe acne scars. The patients underwent three sessions of FCL and FCL + topical PRP on right and left sides of the face, respectively, at monthly intervals.

Results:

There was significant improvement on both sides of the face (right side, P = 0.001; left side, P = 0.0001), but the difference between the right and the left sides of the face was not statistically significant (P = 0.2891). The symptoms of redness, edema, and pain on the treated areas with laser were significantly lesser on the FCL + PRP (left) side as compared to the FCL-only (right) side.

Conclusion:

Both methods were effective in management of acne scars. Addition of PRP does not improve the scar quality; however, the downtime and inflammation associated with laser treatment gets significantly reduced on the PRP-treated side.

Overview of Facial Plastic Surgery and Current Developments

Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques.