Objectives: 1. Understand changes occurring in the aging skin
2. Formulate a comprehensive treatment to address the different elements of the aging skin using laser and light
2. Learn a combination treatment approach of laser and light in treatment and understand its efficacy and safety

Introduction: The aging process involves laxity, hyperpigmentation, and telangiectasias. It is important to target those elements of aging to be successful at achieving rejuvenation. Our goal is to determine the efficacy, safety, and patient satisfaction of a combination IPL and 1440nm diode laser versus either treatment alone.

Materials / method: 40 subjects were enrolled in this randomized split-face trial. 20 were randomized to group A (received IPL on one side of the face and IPL followed by the 1440nm diode laser on the other side), and 20 were randomized to group B (received 1440nm diode laser on one side of the face and IPL followed by the 1440nm diode laser on the other side).

Results: Investigators reported a percent improvement of 40%-50% in all three groups at day 120; blinded investigator Global Aesthetic Improvement Scores were better in the combination group- 90% compared to 84% and 83% in the IPL and 1440nm diode laser groups, respectively. Wrinkling scores was significantly improved in the 1440nm diode and combination groups. Hyperpigmentation and telangiectasias were significantly improved in all three groups. Adverse events were self-limited.

Conclusion: Combination treatment with IPL and 1440nm diode laser was found to be safe and effective and resulted in higher subject satisfaction.

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Objectives: 1. Know principles of laser-assisted hyaluronic acid delivery.
2. Comprehend morphologic and metabolic changes with laser-assisted HA delivery.
3. Understand benefits and limits of multiphoton tomography for LADD monitoring.

Introduction: Laser-assisted drug delivery (LADD) is a treatment method to enhance the penetration of pharmaceuticals to and through the skin. In recent years, laser-assisted delivery of cross-linked HA gels has gained enormously in popularity, but our current understanding is mostly limited to clinical assessments. The aim of the present study is to track and monitor hyaluronic acid (HA) and analyze its effect on human skin in vivo after ablative fractional laser (AFL) treatment.

Materials / method: Healthy male and female subjects were recruited. Four areas were marked on their forearms and each area was assigned to either (i) AFL + HA, (ii) AFL monotherapy, (iii) topical HA monotherapy, or (iv) untreated control. A carbon dioxide laser was used for the AFL treatment. Follow-up measurements were scheduled 30 minutes and 30 days after treatment using multiphoton tomography equipped with fluorescence lifetime imaging (MPT-FLIM).

Results: 11 subjects were recruited. By detecting fluorescence lifetimes, HA gel and the anesthetic ointment could be distinguished from the surrounding tissue. Following AFL treatment, HA gel was detectable throughout all epidermal and upper dermal layers. In contrast, in intact skin, HA gel was only found in the superficial layers, and the levels were noticeably lower. The cellular mean fluorescence lifetime calculations suggested that the HA gel used had advantageous attributes for supporting the wound healing process following laser treatment.

Conclusion: LADD has demonstrated its effectiveness in enhancing HA uptake into the skin, allowing for improved hydration and skin rejuvenation over time. Additionally, LADD may be a beneficial treatment option in laser resurfacing treatments. MPT-FLIM has shown to be an appropriate diagnostic tool for monitoring drug delivery and assessing treatment responses, enabling personalized therapy adjustment.

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Objectives: To assess the safety and efficacy of using a combination of calcium hydroxylapatite biostimulation and fractionated microneedle radiofrequency for treating stretch marks.

Introduction: Stretch marks, a common cutaneous scarring, can cause psychological distress. Skin stretching and a decrease in collagen and elastin could be the reasons. While topical therapy is ineffective, physical methods are being investigated. There is evidence that fractionated microneedle radiofrequency (RF) reduces skin laxity. Calcium hydroxylapatite (CaHA) also volumizes and biostimulates. Even when diluted, CaHA stimulates collagen synthesis and skin tightening.

Materials / method: Each patient's management plan included four sessions, separated by one month. In the first session, CaHA was diluted 1:4. The linear threading technique was used to inject 3 mL of hyperdiluted filler subdermally with a 25-gauge cannula. During the course of three consecutive sessions, RF microneedling was conducted. Cartridges with 40 micro-needles were used. Two passes were made per session. Two dermatologists who were unaware of the type of treatment assessed photographs of pre- and post-treatment using the Manchester Scar Scale (MSS).

Results: Eight female patients with stretch marks on the abdomen encircling the umbilicus participated in the study. The average age of the participants was 36.6 ± 7.3. Three patients exhibited striae rubra, whereas five patients presented with striae alba. There was a substantial decrease in their MSS from an initial value of 14 ± 0.93 to a final value of 6.88 ± 1.64 (P value<0.0001, paired t-test). The average level of satisfaction reported by patients regarding the ultimate outcomes was 8.12 ± 1.72. Only two individuals reported persistent erythema after the therapy regimen.

Conclusion: To the best of our knowledge, this study is the first to reveal the safety and efficacy of hyperdiluted CaHA and microneedling radiofrequency for the aesthetic enhancement of stretch marks. The suggested combination is a promising treatment for a common disfiguring disease with few treatment options. Future research should investigate how fractionated microneedling radiofrequency and hyperdiluted CaHA work best for treating stretch marks.

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Objectives: The aim of this study is to propose a combination approach of various old treatments used to treat infraorbital dark circles and skin laxity to achieve considerable improvement without any significant side effects and improved patient satisfaction.

Introduction: Infraorbital area is a minefield of complex anatomy and pathophysiology. Dark circles, although not a medical term, refers to the darkening of the infraorbital area contributing to constant aged and tired appearance in an individual. Although, dark circles have variable number of causes which includes thin undereye skin, hyperpigmentation secondary to genetic and dermatological causes such as atopic dermatitis, infraorbital fat herniation, tear trough deformity and increased skin laxity in this area, making it one of the most challenging areas to treat for a physician. Infraorbital skin laxity

Materials / method: We treated 15 Asian - Pakistani patients, Fitz Patrick skin type IV and V aged between 25 and 55 years. We first used a Q-switched 1064nm Nd-Yag laser with low fluence ranging between 1.0J to 1.5J for the infraorbital area. We then combined patient’s PRF with intradermal long chain polynucleotide in a 10cc syringe with 32-gauge needle. The cocktail was injected intradermally with a serial puncture technique in 15 points with 0.05cc infiltration on each point.

Results: All the subjects experienced post procedure mild swelling which resolved spontaneously over next 48 hours. All subjects noticed considerable improvement starting after one week post procedure lasting up to 3 months

Conclusion: Low fluence Q-switched 1064 Nd-Yag laser is a safe and effective way to reduce pigmentation. Polynucleotides on the other hand helps to restore normal physiology of the skin by regeneration of autologous components like glycosaminoglycans. PN has shown to increase skin elasticity by increasing fibroblast activity which is synergistic with effects exerted by PRF. It also contains significantly higher levels of growth factors which are known to improve pigmentation and skin laxity in individuals.A combination treatment shows significantly favorable and long term sustainable natural outcomes.

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