Resumen

Objectives: The primary objective of this study is to demonstrate the clinical efficacy, safety, and versatility of a novel "4-D" multi-layering treatment protocol. This approach integrates four distinct laser wavelengths—589nm, 755nm, 1064nm, and 1319nm—to address complex dermatological pathologies within a single session. The study focuses on achieving superior therapeutic outcomes for acne, acne scars, keloids, hypertrophic scars, peri-oral dermatitis, rosacea, melasma, stretch marks, and photo-damaged skin across all Fitzpatrick skin phototypes (I–VI), while minimizing downtime and adverse effects. Introduction: Traditional laser dermatology often targets single chromophores at fixed depths, limiting efficacy for multi-factorial conditions involving vascular congestion, dyschromia, and dermal degradation. The "4-D Approach" utilizes a multi-layering paradigm, applying 589nm, 755nm, 1064nm, and 1319nm wavelengths sequentially to optimize synergistic tissue responses. This strategy treats the entire architectural volume—resolving inflammation and pigmentation while triggering robust neocollagenesis for structural repair. Materials / method: A retrospective case series was conducted on patients presenting with various skin conditions, including inflammatory disorders, pigmentary dyschromia, and photoaging. Patients were treated with a sequential combination of 589nm, 755nm, 1064nm, and 1319nm wavelengths in a single session. Clinical outcomes were documented using standardized high-resolution photography and objective AI-camera skin scanning technology to visualize changes in pigmentation, vascularity, and texture. Results: Case series analysis showed significant improvement across all indications. AI-scanning confirmed reduced erythema in rosacea and peri-oral dermatitis, alongside decreased inflammatory acne. Patients with acne scars and stretch marks exhibited improved texture and depth reduction. For melasma and photo-damage, photography demonstrated clearer complexions and high satisfaction. The protocol proved exceptionally safe for dark skin phototypes; layering allowed lower individual fluences, preventing bulk heating and post-inflammatory hyperpigmentation (PIH). Conclusion: The combined 4-wavelength laser therapy (589nm, 755nm, 1064nm, and 1319nm) represents a paradigm shift in the management of complex skin pathologies. By adopting a multi-layering, multi-depth strategy, clinicians can provide a "total-skin" solution that is both highly effective and remarkably safe across diverse patient populations. This 4-D approach offers a comprehensive alternative to monotherapy, reducing the number of sessions required and expanding the therapeutic window for difficult-to-treat conditions like keloids and melasma.