Objective Eyelid and periorbital rejuvenation is a common aesthetic concern. This study aimed to describe an original and detailed fractional CO₂ laser protocol and evaluate its efficacy and safety for skin tightening and wrinkle reduction in the upper and lower eyelids and periorbital region, with 12-month follow-up. Materials and Methods A single-arm, evaluator-blinded clinical trial was conducted in 27 patients presenting with eyelid and periorbital laxity and wrinkles. All patients underwent a single session of fractional CO₂ laser treatment. Clinical outcomes were assessed at 3, 6, and 12 months using two study-specific grading scales evaluated by two independent expert assessors, along with patient-reported outcomes. Results Significant reductions were observed in eyelid and periorbital laxity (p < 0.0001) and in fine lines and wrinkle depth (p < 0.0001). At 3 months, 74% of patients achieved good overall improvement (50–75% correction; p < 0.0001). Improvements were maintained over time with minor variations, including a peak effect at 6 months followed by a slight decline at 12 months. At 12 months, 70% of patients reported being satisfied or very satisfied. No unexpected adverse events or complications were observed. Conclusion The protocol described appears to be a safe and potentially effective approach for eyelid and periorbital rejuvenation, associated with improvements in skin tightening and wrinkle reduction, with high patient satisfaction and results generally maintained over at least a 12-month follow-up.

Thermal deposition of laser energy in the vaginal epithelium in genitourinary syndrome of menopause (GSM) results in clinical and biological effects, but many cellular and molecular changes indicating cell proliferation or senescence inhibition are unknown. The aim of this study is to evaluate the clinical efficacy of the fractional-pixel-CO2 laser in the possible improvement of GMS signs and symptoms that can be correlated with histological changes or with cellular or molecular indicators of restoration. A detailed prospective study was designed to assess 17 women diagnosed with GSM who were treated intravaginally with two laser sessions. Seven non-treated women diagnosed with GSM were used as controls. Three validated outcome questionnaires for assessment of quality of sexual life and urinary incontinence were performed. Vaginal biopsies were collected before the first laser treatment and 4 months following the second session. Histological status, elastin, collagen, and hyaluronic acid content of the biopsies were also evaluated. Cell proliferation was assessed by Ki67 staining. Telomere length (TL) was measured by qPCR. The results show an improvement of the clinical symptoms of GSM (p < 0.05), vaginal epithelium recovery and enhancement of collagen (p < 0.05), elastic fibers (p < 0.005), and hyaluronic acid (p < 0.0005) content in the lamina propria after fractional-pixel-CO2 laser treatment. The laser treatment induced a significant rise on the TL of vaginal epithelial cells (VECs), and a positive correlation was found between the improvements of the collagen and hyaluronic acid content and TL changes (r = 0.82, p < 0.05; r = 0.38, p < 0.05). The percentage of proliferative Ki67-positive VECs was increased in patients whose vaginal TL lengthened after laser treatment (p < 0.05). In conclusion, the results indicate that laser treatment may induce restoration of the vaginal epithelium which is associated to increased TL and proliferation in the VECs. Performing a TL assay could be a suitable tool to evaluate the efficacy of vaginal laser treatment.

Background and Objective Radiofrequency (RF) devices which are under ongoing technological development, are being increasingly used for minimally invasive rejuvenation procedures. The objective is to evaluate the efficacy and safety of a procedure that uses bipolar RF microneedles for rejuvenation of the lower face and neck. Study Design and Methods A prospective clinical and histological study, with a blind evaluation of the results by independent evaluators. Twenty-four women over 40 years of age were evaluated, who were treated with bipolar RF equipment (Profound (TM); Candela Medical) during a single session. Biopsy samples were taken from 12 patients. Microscopy images related to the immediate effects of RF and the changes observed 4 months after treatment were examined. The clinical results were established through questionnaires and by comparing before and after photographs. Mean (m), range (R), and percentage (%) values were calculated. Results Immediate lysis of adipocytes in submental fat was observed, as well as an increase in the density and compaction of elastin and collagen fibers 4 months later. The average percentage of reduction in fine lines, wrinkles, furrows, and folds was around 30%, while the average improvement of the neck silhouette was around 20%. Photographic signs of aging improved significantly, both in the face (p = 0.0007) and the neck (p = 0.002). Patient and therapist satisfaction with the results was 8.3/10 (R = 3-10) and 9.3/10 (R = 8-10), respectively. The adverse effects were mild and temporary and no complications were observed. Conclusion The procedure is safe, clinically effective, and satisfactory for patients.

La crisis del coronavirus que sufrimos globalmente pronto debiera acabar En el momento de escribir estetexto (17/4/2020), en el mundo se contabilizan mas de 150 000 muertos por esta causa, y casi un millon decasos confirmados Por la carencia de tests diagnosticos y por la politica sanitaria de efectuar analisis, principalmente a los queingresan con respiratorios en los hospitales, se desconoce la cifra real de afectados, que debe ser muchomayor a los casos contabilizados Nosotros, autores de esta carta al editor tenemos familiares afectados,incluso en Unidades de Cuidados Intensivos (UCI) Las autoridades sanitarias y politicas no paran de decirque lo peor esta por llegar, y ciertamente, ciertamente, algo importante, que todos nos quedemos encasa Una vez decretado por los Gobiernos el estado de alarma nacional, el cumplimiento del aislamientodebemos tomarlo como una obligacion para todos The coronavirus crisis we are suffering globally should soon be over As of this writing (4/17/2020), there have been 150,000 deaths accounted for due to this cause and almost one million confirmed cases worldwide Due to the lack of diagnostic testing and health politics to carry out analysis, mainly to those who are admitted to hospitals with symptoms, we still do not know the actual number of affected individuals, but it must be much higher than reported cases The authors themselves have affected family members, even in Intensive Care Units (ICU) The healthcare and political authorities continue to say that the worst is yet to come And certainly, very important, that we all stay at home Once the national state of emergency is declared by governments, physical distancing compliance should be taken as an obligation for all

Resumen Introducción y objetivo Los ultrasonidos focalizados de alta intensidad (HIFU) producen lisis del adipocito por calor con la finalidad no invasiva de remodelar la grasa corporal localizada. Observamos de forma prospectiva los efectos de un sistema que emite ultrasonidos de baja frecuencia, intensidad media y múltiple focalización, y sus posibilidades de disminución y remodelación de los acúmulos de grasa subcutánea del abdomen. Material y método Presentamos el primer análisis técnico específico de un sistema de emisión diferente a los clásicos HIFU, y los resultados en 10 pacientes entre 24 y 56 años e IMC<28, que recibieron 3 sesiones de tratamiento en abdomen con idéntico protocolo y separadas por 3 semanas. Evaluamos resultados finales a los 3 meses de la tercera sesión, comparando con el estado al inicio del tratamiento. Medimos con plicometría el contorno abdominal y el grosor del pliegue graso. Comparamos fotografías estandarizadas y obtuvimos muestras para microscopía en 3 tiempos de control del estudio empleando tinciones de hematoxilina, tricrómico de Masson e inmunohistoquímica. Implementamos cuestionarios para que pacientes, terapeuta y 2 médicos ajenos al estudio evaluaran resultados. Resultados El control específico de las características técnicas del sistema empleado indicó que, a diferencia de los HIFU, la emisión es de ultrasonidos de baja frecuencia, intensidad media y múltiple focalización. En las fotografías, plicometría y circunferencia abdominal encontramos reducción significativa del volumen abdominal. Las respuestas a las preguntas de los cuestionarios fueron positivas en cuanto a resultados, tanto por las pacientes como por los médicos evaluadores y la terapeuta que realizó los tratamientos. En las histologías observamos cambio de la forma típica del adipocito y lisis de su membrana tras la primera sesión de tratamiento. Identificamos desarrollo de nuevo colágeno y mejoría de la elastosis, significativas de mejoría de la tensión en las áreas tratadas. De las 10 pacientes, 9 confirmaron estar muy satisfechas y 1 satisfecha con la reducción del contorno y volumen del abdomen que se mantuvo 3 meses después del último tratamiento. No observamos efectos adversos importantes salvo ligero eritema y edema tras las sesiones, que desapareció a las 24 horas. Conclusiones El sistema empleado, con su particular modo de emisión y actuación sobre el tejido subcutáneo, resultó eficaz en la remodelación de la grasa localizada. Consideramos que además puede emplearse como tratamiento no invasivo para complementar las liposucciones quirúrgicas.

Objective: To evaluate the safety and efficacy of a specific treatment protocol using a new and improved non-ablative fractional high-power 1064-nm Q-switched Nd:YAG laser for face and neck rejuvenation. Methods: Sixteen women, aged 30 to 60 years old, were selected to undergo three consecutive treatment sessions with this new laser at maximum energy (2,400 mJ/pulse, Clear Lift laser (R)-Harmony XL-Pro, Alma Lasers Ltd.). Face and neck were treated in eight patients, respectively. Each treatment used the same protocol. The efficacy was evaluated by the therapist (TS), the patient (PS), and two separate independent experts who were blind to the study (E1 and E2). Results: According to E1 and E2, the mean reduction in signs of skin aging on a Global Esthetic Improvement Scale was 30-40%. Using a 0-10 points scale, TS and PS mean (range) satisfaction rates were 9.0 (8-10); 9.2 (6-10) for the face and 8.7 (8-10); 8.0 (3-10), for the neck, respectively. The procedure was practically painless, no significant adverse effects were observed, and the patients returned to their daily and work activities without downtime. Conclusion: This laser was safe and effective for face and neck minimally invasive rejuvenation, with excellent results using our usual routine use conditions.

Background It is shown that despite exponential increase in the number of clinically exciting results in low level light therapy (LLLT), scientific progress in the field is retarded by a wrong fundamental model employed to explain the photon-cell interaction as well as by an inadequate terminology. This is reflected by a methodological stagnation in LLLT, persisting since 1985. The choice of the topics is, by necessity, somewhat arbitrary. Obviously, we are writing more about the fields we know more about. In some cases, there are obvious objective reasons for the choice. Progress in LLLT is currently realized by a trial and error process, as opposed to a systematic approach based on a valid photon-cell interaction model. Methods The strategy to overcome the current problem consists in a comprehensive analysis of the theoretical foundation of LLLT, and if necessary, by introducing new interaction models and checking their validity on the basis of the two pillars of scientific advance (I) agreement with experiment and (II) predictive capability. The list of references used in this work, does contain a representative part of what has been done in the photon-cell interaction theory in recent years, considered as ascertained by the scientific community. Results Despite the immense literature on the involvement of cytochrome c oxidase (COX) in LLLT, the assumption that COX is the main mitochondrial photoacceptor for R-NIR photons no longer can be counted as part of the theoretical framework proper, at least not after we have addressed the misleading points in the literature. Here, we report the discovery of a coupled system in mitochondria whose working principle corresponds to that of field-effect transistor (FET). The functional interplay of cytochrome c (emitter) and COX (drain) with a nanoscopic interfacial water layer (gate) between the two enzymes forms a biological FET in which the gate is controlled by R-NIR photons. By reducing the viscosity of the nanoscopic interfacial water layers within and around the mitochondrial rotary motor in oxidatively stressed cells R-NIR light promotes the synthesis of extra adenosine triphosphate (ATP). Conclusions Based on the results of our own work and a review of the published literature, we present the effect of R-NIR photons on nanoscopic interfacial water layers in mitochondria and cells as a novel understanding of the biomedical effects R-NIR light. The novel paradigm is in radical contrast to the theory that COX is the main absorber for R-NIR photons and responsible for the increase in ATP synthesis, a dogma propagated for more than 20 years.

Los láseres o diodos emisores de luz de baja densidad de potencia (LLLT) junto a tratamientos de la denominada medicina natural pueden proporcionar resultados satisfactorios a muchos pacientes, sin efectos adversos asociados.

Sclerotherapy continues to be the treatment of choice for varicose veins in the legs. However, isolated treatment using microfoam or lasers requires a high number of sessions to eliminate them. In 2013, we published results about the efficacy and safety 3 years after the combined treatment with microfoam injections and subsequent application of Nd:YAG laser. The aim of this paper is to clinically evaluate the treatment of varices in a control visit after 5 years, when polidocanol microfoam is used and is immediately irradiated in the tissue with 1064-nm Nd:YAG laser beam. The outcome persistence after 5 years was studied in the legs that had received combined treatment and had been studied 3 years after treatment. Patients were contacted by phone, interviewed, and examined with echo-Doppler. Out of the 259 patients who were contacted, 221 agreed to make the appointment, although in the end, only 202 came, which meant analysing 404 legs. At 5 years, the clearance rates were very high: patients were included in class CEAP C1 showing vessels of from 0.5 to 3 mm diameter. The patients showed a high level of satisfaction. Regarding adverse effects, only 4 cases of hypopigmentation described in the previous publication persisted. Although the action mechanisms between the microfoam and the Nd:YAG laser must still be elucidated, it is notable that combining microfoam with laser exposure obtained a complete, effective treatment of legs in only 2 sessions, with high clearance rates and high level of satisfaction among patients.

BACKGROUND: Several studies confirm microscopic changes in the cutaneous architecture following various rejuvenation techniques using non-ablative lasers.OBJECTIVE: To investigate the histological changes that occur after the application of an improved high-power 1064-nm fractional Q-switched Nd: YAG laser, using different focusing tips.MATERIAL AND METHODS: Experimental skin resurfacing of the retroauricular area in 15 female volunteers, in three treatment sessions of one pass each, using the Clear Lift® laser (Alma Lasers, Israel) and five different focusing tips. Biopsies were taken before and immediately after the first treatment session, one month after the first session, and one month after the third session. A total of 60 microscopic images were evaluated at a micrometric scale.RESULTS: The five tips used caused characteristic and similar histological changes in both the dermis and the epidermis. The signs of thermal damage and the formation of new collagen were observed at different depths, in accordance with the focal length of each tip. Neo-formation of collagen with the increase, reorganization and compaction of fibers began one month after the first treatment session, and was blindly confirmed, with all the tips used, one month after the third treatment session.CONCLUSION: The skin takes on a new conformation, with histological signs of skin rejuvenation, concordant with previous clinical observations.J Drugs Dermatol. 2019;18(12):1261-1266.

Photobiomodulation, Photomedicine, and Laser SurgeryVol. 37, No. 9 Guest EditorialReflections on the Er:YAG Laser Used in “Nonthermal Mode” to Rejuvenate SkinMario A. Trelles and Vladimir KhomchenkoMario A. TrellesAddress correspondence to: Mario A. Trelles, MD, PhD, Vilafortuny, Villa #728b, Al Wasl Road, Jumeirah 3, Dubai, UAE E-mail Address: mario.trelles@vftdubai.comE-mail Address: imv@laser-spain.comVilafortuny Medical Institute, Tarragona, Cambrils.Search for more papers by this author and Vladimir KhomchenkoMinsk, Belarus.Search for more papers by this authorPublished Online:5 Sep 2019https://doi.org/10.1089/photob.2019.4646AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Reflections on the Er:YAG Laser Used in “Nonthermal Mode” to Rejuvenate Skin." Photobiomodulation, Photomedicine, and Laser Surgery, 37(9), pp. 515–516FiguresReferencesRelatedDetailsCited byEarly laser treatment of local complications after surgical blepharoplasty2 February 2023 | Issues of Reconstructive and Plastic Surgery, Vol. 25, No. 4Erbium Laser for Skin Surgery: A Single-Center Twenty-Five Years’ Experience24 November 2021 | Medicines, Vol. 8, No. 12Laser treatment of acne conglobatа with concomitant oral isotretinoin use25 November 2020 | Dermatologic Therapy, Vol. 34, No. 1Combined approach to the correction of age-related facial changes: laser technologies, botulinum toxin and hyaluronic acid fillersKlinicheskaya dermatologiya i venerologiya, Vol. 20, No. 2Laser treatment of post‐facelift flap necrosis: A clinical case4 June 2020 | Dermatologic Therapy, Vol. 33, No. 4Treatment of psoriatic skin lesions with a new Er:Yag laser technology: A case series studyDermatologic Therapy, Vol. 33, No. 2Reasonable choice of a complex program for correction of age-related facial changes using injection and laser technologiesKlinicheskaya dermatologiya i venerologiya, Vol. 19, No. 6 Volume 37Issue 9Sep 2019 InformationCopyright 2019, Mary Ann Liebert, Inc., publishersTo cite this article:Mario A. Trelles and Vladimir Khomchenko.Reflections on the Er:YAG Laser Used in “Nonthermal Mode” to Rejuvenate Skin.Photobiomodulation, Photomedicine, and Laser Surgery.Sep 2019.515-516.http://doi.org/10.1089/photob.2019.4646Published in Volume: 37 Issue 9: September 5, 2019PDF download

Resumen Introducción y Objetivo En los últimos años existe un creciente interés en el empleo de tecnología láser parcialmente ablativa en el rejuvenecimiento facial. Entre los láseres desarrollados con esta finalidad, el de Erbio:YAG acoplado a un sistema de ablación espacial modulada (RecoSMA®, Linline, Minsk, Bielorrusia) merece atención porque cambia el tradicional depósito térmico del láser por un fenómeno de empuje mecánico. Nuestro objetivo fue determinar la eficacia y seguridad de un nuevo método de rejuvenecimiento facial que emplea un láser de Erbio:YAG acoplado al sistema RecoSMA®. Material y Método Estudiamos 26 mujeres, con fototipos II a V y signos de envejecimiento facial entre moderados y severos en relación con su edad cronológica. Todas se sometieron a 2 sesiones de tratamiento separadas por 3 semanas. En cada sesión tratamos la totalidad de la cara. Tomamos fotografías y biopsias antes del primer tratamiento y 3 y 6 meses después del segundo. Evaluamos la eficacia clínica, tolerancia, efectos adversos, complicaciones y cambios clínicos e histológicos. Resultados Las líneas finas, arrugas y las características del envejecimiento facial global mejoraron de forma significativa (p< 0.0001). La media de mejoría de líneas finas y arugas en ambos grupos fue de 66,4 ± 9,4 (r= 45-85). La media de mejoría del envejecimiento global en ambos grupos (A+B) fue de 76.2% ± 6.2 (r = 60 - 85%) a los 3 meses, y de 59.4% ± 9.6 (r= 40 -75%) a los 6 meses. Mostramos a todas las pacientes fotografías comparativas de antes y después del tratamiento, y el 85% manifestaron estar satisfechas o muy satisfechas con los resultados. Vimos también que los resultados obtenidos a los 3 meses disminuían en la evaluación a los 6 meses, con un 62% de pacientes satisfechos. Conclusiones El perfil eficacia-seguridad fue muy satisfactorio con ventajas adicionales respecto a otros láseres empleados para el rejuvenecimiento facial. Hay que tener en cuenta la disminución de resultados a los 6 meses para indicar sesiones adicionales, aunque debe advertirse previamente a los pacientes.

Endogenously produced reactive oxygen species (ROS) are essential to life, being involved in many different biological functions. However, when overproduced, or when the levels of antioxidants become severely depleted, these reactive species become highly harmful, causing oxidative stress through the oxidation of biomolecules (1). Oxidative stress is implicated in the etiology of several diseases and in aging. In their paper entitled Genesis on diamonds II: contact with diamond enhances human sperm performance by 300% (2).

Endogenously produced reactive oxygen species (ROS) are essential to life, being involved in many different biological functions. However, when overproduced, or when the levels of antioxidants become severely depleted, these reactive species become highly harmful, causing oxidative stress through the oxidation of biomolecules (1). Oxidative stress is implicated in the etiology of several diseases and in aging. In their paper entitled Genesis on diamonds II: contact with diamond enhances human sperm performance by 300% (2).

BACKGROUND:Photothermolysis of unwanted hair depends on the presence of melanin in the hair follicle as the chromophore, but is not effective in patients with non-pigmented, melanin-sparse hair shafts and follicles. This split-scalp, double-blind study was to monitor the efficacy of melanin bound in nanosomes to inject exogenous melanin into the hair follicles thus potentiating successful photothermolysis.MATERIAL AND METHODS:Twelve patients, phototypes II-III, with white or very fair hair, were treated with a compound containing melanin encapsulated in nanosomes (Melaser®) together with a fluorescent marker. Two equal 6 cm² areas were marked on each side of the occiput of the subjects. The compound was applied to a randomly selected experimental side on each patient (area A), and a saline solution applied in the same manner to the contralateral control side (area B). Penetration of the melanin into the hair follicle was assessed using optical and fluorescence microscopy. Also, condition of hair structure was checked in vivo after standard laser settings used for epilation.RESULTS:A slight transient erythema was observed in those areas where the compound was applied with some perifollicular edema. No such effects were noticed in those areas where saline solution was applied. No persistent complications such as scarring, hypo- or hyperpigmentation were observed in any of the experimental or control areas. Under fluorescence microscopy, the hair structures in the areas to which the compound had been applied showed a clear melanin deposit confirmed by the immunofluorescence intensity, which was highest at 2 hours after application. By optical microscopy, external melanin was deposited in hair follicles. Tests with standard settings for epilation were efficacious in damaging melanin-marked white hair.CONCLUSION:This study strongly suggests the safety and efficacy of the application of nanosomes encapsulating melanin for the introduction of melanin into hair follicles. Changes noticed in the hair structure compromising its viability indicated potential application of this external melanin marker for white hair photoepilation.J Drugs Dermatol. 2016;15(5):615-625.

Scars are problematic for thousands of patients. Scarring is a natural part of the healing process after an injury. However, the appearance of a scar and its treatment depend on multiple factors and on the experience of the therapist and the options available. Despite a plethora of rapidly evolving treatment options and technical advances, the management of atrophic and hypertrophic scars remains difficult. Innovative technologies provide an attractive alternative to conventional methods in the treatment of scars. The purpose of this trial was to determine the clinical and histological results of a method of treatment that combines radiofrequency, ultrasound, and transepidermal drug delivery. This was a prospective study conducted on 14 patients with scars of different sizes, types, and characteristics. All patients underwent six treatment sessions with the Legato device. Atrophic scars were treated with retinoic acid and hypertrophic scars with triamcinolone. Photographs and biopsies were taken before treatment and at 6 months after the last treatment session. The scars improved significantly (P < 0.0001). The mean attenuation in the severity of scars was 67% (range: 50-75%), where 100% indicates complete disappearance of the scar. Clinical and histological images of scar tissue in six patients in whom attenuation in the range of 55-75% was achieved are shown. Biopsies show regenerative changes in the scar tissue, in both the epidermis and dermis. The method makes it possible to treat extensive, heterogeneous scars on different sites with good results that are similar and predictable.

Abstract Objective: A clinical observation of a professional tattooing procedure and the skin damage caused by the tattooing technique and the healing process of the lesions. Materials and methods: Three tattoos were performed using black, red and white ink, together with a fourth “tattoo” with the same characteristics and an identical procedure, but using no ink. The evolution of the lesions was observed over a period of 6 months using photographs and biopsies. Results: The tattoos evolved with no complications. At 72 h, full destruction of the epidermis and de-structuring of the papillary dermis were confirmed. At 3 months, an almost ad integrum restoration of the skin structure was observed with a settling of the inks on the reticular dermis. With regard to the inkless tattoo, a wound with self-limiting capillary bleeding was observed which gradually healed, leaving only a sclerotic and hyperpigmented residual lesion by month 6. Conclusion: An awareness of the tattooing procedure would lead to a better understanding of potential complications, which might arise. This study contains the description and evolution of the lesions and provides the first images of skin damage caused by contemporary professional tattooing techniques, without the masking factor of the ink.