Objectives: The aim of the study is to evaluate the efficacy of combination treatments such as fractional CO2 laser and PRP (Platelet Rich Plasma) along with botulinum toxin in lateral periorbital static wrinkles in 89 patients. Static expression wrinkles is a challenging problem to solve as patients satisfaction rates are relatively low when a monotherapy is applied.
Introduction: Fractional CO2 laser, through the induction of thermal damage, leads to collagen production and skin rejuvenation. Autologous mesotherapy PRP (Platelet Rich Plasma), promotes the activation of stem cells, targeting cell rejuvenation and tissue healing. In the present study, we examine the effectiveness of combined fractional CO2 and PRP performed in the same session plus botulinum toxin A as a way to correct stubborn static periorbital lines.
Materials / method: The protocol consisted of 3 sessions of fractional laser & PRP every 4 weeks on the crow’s feet in 89 patients (68 women, 21men, mean age: 48 y). All patients had undergone Botulinum toxin A as a monotherapy in the past. Neurotoxin was performed 15 days before the first combined session at an average dose of 15 units on orbicularis oculi (Onabotulinum toxin Α). Photographs were taken before, 15 days and 2 months after the last session. Fractional laser settings were: Energy 15-20 mJ, Power 8-10 W, density 89-100 dots/cm2. PRP was administered injectably after centrifugation and activation.
Results: A significant reduction of static wrinkles was noticed 15 days after the last treatment, with a patient satisfaction rate of up to 80% on month 4, compared with 60% when botulinum toxin was used as monotherapy. The patients reported better results in the depth of wrinkles and the duration of the result. Nearly all patients mentioned a better appearance regarding the skin quality and elasticity, whilst none of them complained about any severe side effects, except for a mild feeling of flushing and a slight roughness of the skin in the following 2 days.
Conclusion: The combination of Fractional laser CO2 plus PRP with botulinum toxin A is a safe, minimally invasive therapeutic approach with great results in the treatment of static wrinkles in periorbital area. PRP reduces the symptoms of skin injury caused by the application of Fractional co2 laser alone, promoting a faster healing and collagen production of the skin. In addition botulinum toxin seems to have better performance and longer duration when applied as part of fractional CO2 skin rejuvenation protocol.
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