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Efficacy evaluation of Endolift‐based Subcision on acne scar treatment

Wiley
Journal of Cosmetic Dermatology
Authors:

Abstract

Background People with acne scar suffer from destruction to the surface of the skin. Treating acne scars is a challenge that might need several methods. Aims Subsection is a method that has been informed to be a useful method in treating rolling acne scars. While Subcision is a valued procedure, its effect is mild to moderate due to its high reappearance rate, and patients' dissatisfaction with some of the side effects such as inflammation after procedure. Patients/Methods In this pilot study, 9 rolling acne scar patients underwent Subcision with the Endolift (200‐nm fiber) and followed up for 3 months. Outcomes were evaluated by 3 dermatologists (Blind). Also, the patients’ satisfaction was assessed to compare with dermatologist's opinions. Results Our results indicated that Subcision with the Endolift displayed good and very good improvement in about 90% of patient with a good and very good satisfaction in the patients. Photographic data evaluation indicated 100% improvement in scar depth, topography, and total acne scar appearance. The average numbers of lesions before the treatment were 25.5 ± 12.1, and after treatment, it was reduced to 11.4 ± 2.1 (P < .05). Conclusion Subcision with the Endolift seems to be a safe and effective method for acne scar treatment. It is done with a single perforation on each side (instead of several perforations), which reduces the pain and scar risk in the patients. Also, Endolift‐based Subcision needs fewer surgical sessions and less recovery time with less inflammation and erythema.
J Cosmet Dermatol. 2020;00:1–4. wileyonlinelibrary.com/journal/jocd
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  1© 2020 Wiley Periodicals LLC
1 | INTRODUCTION
Acne scarring, a common complication of acne, affects people both
emotionally and physically worldwide unrelatedly of age, sex, and or-
igin.1 While the best way to manage acne scars is to inhibit them by
appropriate acne control, many acne cases go untreated. As a result,
these patients in the future develop atrophic ulcers, which are de-
forming and so that it can cause emotional suffering.2 Treatment of
acne scars comprises multiple modalities such as surgical procedures
(punch excision, punch grafting, and Subcision), resurfacing meth-
ods (ablative laser treatment, dermabrasion, and chemical peels),
nonablative laser treatment, injection of autologous fat, or dermal
Received: 20 October 2020 
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  Revised: 18 Nove mber 202 0 
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  Accepted: 24 Nove mber 2020
DOI: 10.1111/jocd.13876
ORIGINAL CONTRIBUTION
Efficacy evaluation of Endolift-based Subcision on acne scar
treatment
Mohammad Ali Nilforoushzadeh MD1,2 | Tannaz Fakhim MD2|
Maryam Heidari-Kharaji PhD1| Amir Reza Hanifnia MD2| Somayeh Hejazi MD2|
Elham Torkamaniha MSc1,2
1Skin and Stem Cell Research Center, Tehran
University of Medical Sciences , Tehran, Iran
2Jordan Dermatology and Hair
Transplantation Center, Tehran, Iran
Correspondence
Tannaz Fakhim, Jordan Dermatology and
Hair Transplantation Center, Tehran, Iran.
Email: tannaz.fakhim60@gmail.com
Abstract
Background: People with acne scar suffer from destruction to the surface of the skin.
Treating acne scars is a challenge that might need several methods.
Aims: Subsection is a method that has been informed to be a useful method in treat-
ing rolling acne scars. While Subcision is a valued procedure, its effect is mild to
moderate due to its high reappearance rate, and patients' dissatisfaction with some
of the side effects such as inflammation after procedure.
Patients/Methods: In this pilot study, 9 rolling acne scar patients underwent
Subcision with the Endolift (200-nm fiber) and followed up for 3 months. Outcomes
were evaluated by 3 dermatologists (Blind). Also, the patients’ satisfaction was as-
sessed to compare with dermatologist's opinions.
Results: Our results indicated that Subcision with the Endolift displayed good and
very good improvement in about 90% of patient with a good and ver y good satisfac-
tion in the patients. Photographic data evaluation indicated 100% improvement in
scar depth, topography, and total acne scar appearance. The average numbers of
lesions before the treatment were 25.5 ± 12.1, and after treatment, it was reduced
to 11.4 ± 2.1 (P < .05).
Conclusion: Subcision with the Endolift seems to be a safe and effective method
for acne scar treatment. It is done with a single perforation on each side (instead
of several perforations), which reduces the pain and scar risk in the patients. Also,
Endolift-based Subcision needs fewer surgical sessions and less recovery time with
less inflammation and erythema.
KEY WORDS
acne scars, efficacy, Endolift, subcision, treatment
2 
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   NILFOROUSHZA DEH Et AL.
fillers.3 Subcision is a method first presented in 1995 and used com-
monly to improve depressed scars. It purposes at freeing the fibrous
attachments under the scar to lift it up. Also, Subcision stimulates
the creation of connec tive tissue by normal physiological curing.4
Cannula or needle-based method can cause bruising, pain, and occa-
sionally hematoma. Additionally, the infection risk or long-term pain
is high. As an alternative to these methods, we evaluated the effect
of Subcision with Endolift. This tool is safer than other previous tools
with minimal side effects without hematoma and less recover y time
and less inflammation and erythema. The highest purpose of this
pilot study was to assess the efficiency of this method, side ef fect s,
treatment duration, and satisfaction of patient and physician after
applying this tool as a needle or cannula replacement. We are seek-
ing a tool by high performance and efficiency, minimal side effects,
and low recurrence rate that is available and appropriate for patient s
and doctors. In the current pilot study, we tried to evaluate the effi-
cacy of Endolift-based Subcision for treating atrophic acne. Endolift
is based on diode laser (1470-nm diode laser).
2 | MATERIALS AND METHODS
The study was done in the Jordan Dermatology and Hair
Transplantation Center, Tehran, Iran (2019). 9 patients, 4 males and
5 females, with rolling acne scars, were enrolled in the study. The
mean age of the participants was 30 years. An informed consent was
gained from patient s before starting the treatment. Patients with
history of diabetes, keloids, collagen disease, bleeding tendency, and
neuromuscular disease and pregnant women were not included. The
use of any treatment in the preceding 6 months was exclusion cri-
teria. The area to be subcised (about 10 mm wide) was sterilized,
outlined by a surgical marker, while the patients were sitting in a
fixed and comfortable position. For this study, we used EndoliftTM
(LASEMAR1500TM machine from Eufoton s.r.l.). The Endolift-based
Subcision (energy: 50-500 J, power: 2.5-3 watt, pulse: 25-50, fiber:
300 micron) was used for acne scar treatment without any incisions
or anesthetic. The 300 micron was easily inser ted under the skin
directly in the superficial dermis and passed via the subdermal plane
parallel to the skin surface. Rapid repetitive back and for th motion
of the fiber was done to scrape the underside of the dermis and
disconnect scar sub-surfaces such as the base, walls, borders, and
shoulders. After that, side-to-side fiber motion was also performed
to completely release fibrous tissues. After the final step, ice com-
pression was applied to the site of treatment for 20 minutes Patient
was instructed to apply antibiotic every 6 hours for 5 days after
treatment. This procedure was performed one time. Patients were
evaluated for results 1 month after the last procedure. Photographs
of patients were taken using Vision-face before the start of treat-
ment and after the final step of treatment. The results of Subcision
procedures were measured by 3 board-certified dermatologists
(blind). Patients’ satisfaction was assessed at the end of the process
of treatment. Patient graded their response to treatment as follows:
poor: 0, fine: 1-3, good: 4-6, and very good: 7-9.
2.1 | Statistical analysis
The data on target were analyzed using the SPSS 18 software.
3 | RESULTS
All patients were enrolled in the study and under went Subcision with
the Endolift. Af ter analyzing the results of photograph evaluation
(were taken before and after the treatment) by dermatologist, the
results showed good and very good improvement in about 90% of
patient. The patient satisfaction results showed good and very good
improvement in all of the involvements (100%). Photographic docu-
ments displayed a significant improvement in level of scar depth, to-
pography, and overall acne scar appearance in all 9 patients (Figure 1
and Figure 2). Patients with mild active acne experienced a decrease
in the development of scar after active phase of disease throughout
the treatment and follow-up inter val. The average numbers of le-
sions before the treatment were 25.5 ± 12.1, and after treatment, it
FIGURE 1 A 27-y-old female patient
before (A) and after (B) treatment
  
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NILFOROU SHZAD EH Et AL.
was decreased to 11.4 ± 2.1 (P < .05). Passing post–procedure mild
inflammations were identified among the patients that were cleared
wholly after 2 days of therapy. No sever swelling and bruising was
observed in the cases of underexamined patients. Also, the evidence
of skin infec tion was not reported. There was no evidence of hyper-
trophic scar or hyperpigmentation. The patients were followed up
for 3 months, and they were not revealed any side effect or recur-
rence throughout the course of the study.
4 | DISCUSSION
Treatment of acne scar with a new base device is challenging. All
surgical methods are continuously modified with the aim of reaching
the best results through easier, convenient, and prac tical techniques
to achieve the best final outcome with fast recovery and minimal
complications. With a wide range of treatments, prominent skin scar
depression can be significantly improved. To achieve the desired re-
sults, treatment design should be scheduled giving to the patient's
conditions such as age, sensitivity, aesthetic needs, and predicted
downtime.5 Subsection is an appreciated surgical procedure that
can be used to reduce depressed scars, cellulite, wrinkles, striae, and
boxer.5 This method is generally used to control depressed scars.
As explained by S. Orentreich and N. Orentreich in 1995, the pur-
pose of Subcision is to remove the fibrous components under the
scar, in the subcutaneous stage. This helps to lift up scarring and
connective tissue formation through normal physiological healing.4
It was performed by utilizing a Nokor or hypodermic needle (gauge
of needle depends on the scar size). Recently, several adjustments
to this surgical procedure have been prepared via many surgeons to
make it more ef fective and easier. One of the modifications made by
Al-Ghamdi was the use of a needle holder for the Nokor needle to
preser ve its horizontal direction without the need to remove from
the entr y point to visualize the orientation and change the direction
of the needle.6 Another modification performed by N. Khunger and
M. Khunger was the bending of the needle with a 90-degree angle
arter y forceps to avoid skin penetration or damage to the dermis.7
Also, Nilforoushzadeh et al reported that Subcision with the Cannula
is an acceptable alternative method for acne scar treatment.8 In an-
other study by Nilforoushzadeh et al, the effect of cannula Subcision
was compared to common needle method.9 In the present study,
we evaluated all sides of the use of another special device (Endolift
technique using a 1470-nm diode laser) for acne scar Subcision. We
concentrated on the acne scar treatment through Subcision proce-
dure with the Endolif t to break up fibrous bands that cause rolling
scars. Endolif t is based on the diode laser and can remove the f ibrous
components under the scar, induce the creation of connective tis-
sue, remodel the derma, and activate the collagen production. In our
knowledge, this is the first time that Endolift was used for Subcision
of the acne scars.10 -14 We detected an effective cure rate data (more
than 50% af ter 2 weeks). Hyperpigmentation, hypertrophic scar,
swelling, inflammation, ecchymosis, and redness are common side
effects among Subcision with common needle that are informed in
50% of patients (even up to 70%-80% of patients), but Subcision
with the Endolift seems to be a safe technique with high efficacy for
acne scar treatment and high patient's satisfaction. Another advan-
tage of our new designed technique is that Subcision with Endolift
has been done through single perforation in each side in place of
multiple perforations that can decrease the patients’ pain and risk of
scars throughout and after the process. Additionally, Endolift-based
Subcision compared with other Subcision techniques requires sig-
nificant fewer sessions of surgery and also it needs less recover y
time. Generally, all these useful tips increase patient satisfaction.
However, more controlled trials should be performed to evaluate
the efficacy and side effects of Endolift compared with needles and
other techniques.
5 | CONCLUSION
Acne scars can be a significant cosmetic concern, and many indi-
viduals seek treatment for this common condition, but there is
FIGURE 2 A 29-y-old male patient
before (A) and after (B) treatment
4 
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   NILFOROUSHZA DEH Et AL.
limited research on their therapy. We showed that Subcision with
the Endolift seems to be a safe technique with high efficacy for acne
scar treatment and high patient's satisfaction.
5.1 | Study limitation
Even this study was performed for free, but the cost of this therapy
is high, and it can be a problem for the patients.
ACKNOWLEDGEMENTS
We appreciatively acknowledge the colleagues and st affs in Skin and
Stem Cell Research Center, Tehran University of Medical Sciences,
Tehran, Iran.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
AUTHOR CONTRIBUTIONS
N.MA , F. T, H. AR, and H. S. performed the research. N. MA and T.H
designed the research study. H-K.M analyzed the data. T.E collected
the data. H-K. M wrote the paper.
ETHICAL STATEMENT
The authors state that the patients have given their informed con-
sent for the photographs and details.
DATA AVAIL ABI LIT Y S TATEM ENT
The data that support the findings of this study are available on re-
quest from the corresponding author.
ORCID
Mohammad Ali Nilforoushzadeh https://orcid.
org/0000-0001-6143-8039
Tannaz Fakhim https://orcid.org/0000-0003-2206-6177
Maryam Heidari-Kharaji https://orcid.
org/0000-0001-6954-7942
Elham Torkamaniha https://orcid.org/0000-0003-3116-3163
REFERENCES
1. Fried RG, Wechsler A. Psychological problems in the acne patient.
Dermatologic Ther. 2006;19(4):237-240.
2. Goulden V, Stables G, Cunliffe W. Prevalence of facial acne in
adults. J Am Acad D ermatol. 1999;41(4):577-580.
3. Hay RA, et al. Inter ventions for acne scars. Cochrane D atabase Syst
Rev. 2016;4:CD011946.
4. Orentreich DS, Orentreich N. Subcutaneous incisionless (subci-
sion) surgery for the correc tion of depressed scars and wrinkles.
Dermatol Surg. 1995;21(6):54 3-549.
5. Jordan R , Cummins C, Burls A. Laser resurfacing of the skin for the
improvement of facial acne scarring: a systematic review of the ev-
idence. Br J Dermatol. 2000;142(3):413- 423.
6. Al Ghamdi KM. A better way to hold a Nokor needle during subci-
sion. Dermatol Surg. 2008;3 4(3):378-379.
7. Khunger N, Khunger M. Subcision for depressed facial sc ars made
easy usin g a simple modif ication. Dermatol Surg. 2011;3 7(4):514 -517.
8. Nilforoushzadeh M, Elahe L, Elmira N, Bahareh S, Marjan S. Can
subcision with the c annula b e an accept able alternative method in
treatment of acne sc ars? Med Arch. 2015;69(6):384.
9. Nilforoushzadeh MA, Lotfi E, Heidari-Kharaji M, Nickhah N, Alavi
S, Mahmoudbeyk M. Comparing cannula-based subcision with
the common needle method: A clinical trial. Skin Res Technol.
2020;26(1):39-44.
10. Lehman JW III, G erstein H. An evaluation of a new mechanized
endodontic device: the Endolift. Oral Surg Oral Med Oral Pathol.
1982;53(4):417-424.
11. Crassas Y. Full face Endolift: 10 years evolution. J Cosme t Laser Ther.
2003;5(3–4):223-225.
12. Tazbir M. Endolifting 4d.
13. Shilov B , Eaves FF, Bostwick J, Nahai F, Bried JT. Endoscopically-
assisted face and neck lift : anatomical considerations. Eur J Plast
Surg. 1997;20(1):1-3.
14. Scrimali L, Lomeo G . Endolaser soft lift: from theory to practice.
Union of Aes thetic Medicine–UIME. 2015;27.
How to cite this article: Nilforoushzadeh MA , Fakhim T,
Heidari-Kharaji M, Hanifnia AR, Hejazi S, Torkamaniha E.
Efficacy evaluation of Endolift-based Subcision on acne scar
treatment. J Cosmet Dermatol. 2020;00:1–4. ht t p s: // do i .
org /10.1111/j ocd.13 876
... This method stimulates collagen production, increases dermal thickness, and tightens the underlying skin without causing skin wounds [9]. Regarding the mentioned properties, the endo-lift method is currently an effective treatment modality for anti-aging and skin diseases due to its rapid recovery time and the absence of wounds, scarring, pain, and severe side effects [10]. ...
... The most prevalent indication was face rejuvenation, which was performed in 55.3% of the participants (n = 433) [8,9,12,23,24]. Other indications comprise treatment application (21.6%, n = 169) [10,15,17,[25][26][27][28], fat reduction (14.8%, n = 116) [29][30][31][32], periorbital area (7.3%, n = 57) [11,[33][34][35], and nose remodeling (1%, n = 8) [14]. The number of treatment sessions for the endo-lift laser procedure was reported to be once in most cases, except for nose remodeling with two sessions, arm and under abdomen fat reduction, as well as the treatment of hypertrophic scars, keloid, and acne vulgaris which required one to three sessions. ...
... The efficacy of subcision with the endo-lift laser in acne scars has been evaluated in a pilot trial by Nilforoushzadeh and colleagues [10]. The findings of the photographic documents demonstrated remarkable improvement in scar depth, topography, and appearance of acne scars in all subjects. ...
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Background: The prominence of minimally invasive aesthetic approaches has become increasingly pivotal. The endo-lift laser method is an intralesional 1470 nm diode laser connected to a fiber that serves both therapeutic and aesthetic properties. We sought to evaluate the efficacy and safety of the endo-lift laser method for dermatological aesthetic applications. Methods: PubMed, Ovid-Embase, and Web of Science were systematically searched up to November 5th, 2023. A citation search was also performed. The National Institute of Health (NIH) Quality Assessment Tool was used to evaluate the quality of the studies. Results: Out of 339 articles, twenty-three relevant studies were included in the current review. Applying the endo-lift laser method for rejuvenation, including face and neck lifting, enhancing skin laxity, and disappearing wrinkles, folds, and lines, demonstrated favorable efficacy and safety profile. Moreover, most studies have shown that the endo-lift laser method is promising in eliminating the adipose tissue in the jowl, abdomen, thighs, and arms. The endo-lift laser technique was also efficacious in nose remodeling and blepharoplastic procedures, including treating eyelid and eyebrow ptosis, eye bag, eyebrow position, and eyelid laxity. Patients who suffer from several diseases, such as hidradenitis suppurativa, progressive lipodystrophy, acne vulgaris, scars, and keloids, benefit from procedural treatment with the endo-lift laser technique. Across all studies, the adverse events were mild and self-limiting. Investigating the endo-lift laser method in all aesthetic and therapeutic indications resulted in high patient satisfaction rates. Conclusion: The endo-lift laser technique has therapeutic effects and is recommended for various dermatological aesthetic indications. Further clinical studies with control groups and larger sample sizes are needed to acquire more reliable evidence.
... It is considered a non-invasive [9][10][11][12] or minimally invasive [13][14][15] technique, and might be used to improve texture and tone skin, leaving it firmer. In addition, minimizing sagging and facial wrinkles mainly those glabellar and nasolabial expression lines, unsightly appearances of the mandibular border and "marionette lines" [5,9,10,16], periorbicular changes of the eyes [17] etc. ...
... In addition, minimizing sagging and facial wrinkles mainly those glabellar and nasolabial expression lines, unsightly appearances of the mandibular border and "marionette lines" [5,9,10,16], periorbicular changes of the eyes [17] etc. It is also treats acne vulgaris and acne scars [11,14], as well as rosacea [4], and finally various lipodystrophies such as localized adiposities and cellulite [13,18,19] as well as "double chin" [16]. ...
... Antibiotic therapy has been reported [8,11,40,61] as part of post-endolift procedures in order to minimize the risks of infection after the procedure. ...
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Introduction: The endolift technique has become known for using a laser beam with a 1470 nm wavelength emitted through an optical fiber inserted into the subdermal tissue with the aim of reducing subcutaneous fat and/or toning the skin through neocollagenesis. In Brazil it became popular and commonly called endolaser or endolift laser, as in addition to 1470 nm it also uses a length of 980 nm with the same therapeutic goals. Few complications have been previously reported, most of which include mild and transient erythema, edema, ecchymosis, and nerve palsy. However, the incidence of most serious cases has increased in Brazilian territory. Objective: This study aimed to describe the authors' experience through several cases of complications resulting from endolift or endolaser technique application in Br0061’zil, and which brought to light to some important complications after the procedure. Also, it brings a brief review of the world literature on the subject. Materials and methods: It was carried out exploratory research presented in a narrative review, to highlight the action of the endolift (1470 nm) or endolaser (980 nm) technique used in the treatment of aesthetic dysfunctions. The review explored scientific articles published and available in the following databases: MEDLINE (Online Medical Literature Analysis and Recovery System), PubMed (National Library of Medicine), SCIELO (Scientific Electronic Library Online), LILACS (Latin American Literature and of the Caribbean in Health Sciences), and Google Schoolar. Furthermore, it was were added to this study a series of complications cases from the using endolift/endolaser technique which happened in Brazil in a multicentric manner and developed with the use of various commercially available devices. Results: It was found that the endolift laser technique has the potential to cause important injuries during and after its use when used without suitable criteria for antisepsis, dosimetry and skin temperature controlling. The most common complications described in this study are peripheral neuropathies, burns, local infection and steatonecrosis, the latter considered the main one. However, it was also identified general complications such as hematoma, edema, hyperchromia and optic fiber breaks. Conclusion: Despite the few reports in the world literature, serious secondary complications to the use of subdermal laser using fiber optics (1470 nm and/or 980 nm) are totally possible of happening and have become common in Brazil. Therefore, deserving full attention to the adoption of appropriate application techniques to minimize such complications, among them: greater dosimetric control, adoption of appropriate instruments to better control skin temperature, and greater rigor regarding biosafety measures (mainly antisepsis) when handling the required instrument to perform the technique.
... 5 gained popularity in recent years and is increasingly available in various locations offering cosmetic procedures. [15][16][17][18][19][20][21][22][23] Given all of that, this study aimed to examine how combination therapy with nanofat and endolift laser impacts enhancing skin quality, in reducing neck wrinkles. Additionally, it aimed to discuss the safety, biometric assessment findings, and post-treatment patient satisfaction. ...
... Endolift is a noninvasive method without any side effects. The effect of Endolift laser on wrinkles and acne scar treatment was evaluated in several studies.17,21,24 In this research study, we observed positive outcomes when treating horizontal neck wrinkles using a combination of Endolift laser and nanofat injection. ...
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Background The emergence of horizontal neck wrinkles is increasingly becoming a focal point for both cosmetic professionals and clients. Various treatment approaches must be considered to address this issue effectively, owing to its diverse underlying causes. The study explores the potential of utilizing the Endolift laser in conjunction with nanofat injection as a viable treatment option. Methods Twenty patients with horizontal neck wrinkles involved in the study. Ten patients underwent treatment with a combination of Endolift laser and nanofat injection and 10 patients treated with nanofat injection alone. The participants were monitored for 6 months post‐treatment. Biometric measurements were utilized to assess outcomes, including changes in volume, depth, and area of the wrinkles, skin elasticity, as well as the diameter and density of the epidermis and dermis in the treated area. Skin improvement was evaluated by two independent dermatologists, who compared before and after photos in a blinded manner. Patient satisfaction levels were also documented. Results The Visioface analysis showed a notable decrease in neck wrinkle depth and area in both groups. However, the group receiving the combination treatment of Endolift laser and nanofat exhibited a significantly greater improvement compared to the group treated with nanofat alone. Skin ultrasonography results demonstrated an increase in thickness and density of the dermis and epidermis in both groups. Particularly, the group treated with Endolift laser‐nanofat displayed significant enhancements in dermis and epidermis density and thickness when contrasted with the nanofat‐only group. Analysis with Cutometer revealed a marked enhancement in skin elasticity in the Endolift‐nanofat treated group in comparison to the nanofat‐only treated group. Furthermore, in the Endolift‐nanofat treated group, a substantial majority (90%) of patients exhibited improvement. Patient evaluations highlighted significant distinctions between the two groups, with 95% of patients in the Endolift‐nanofat treated group demonstrating enhancement. Conclusion Both methods notably enhance horizontal neck wrinkles; nevertheless, the combination of endolift laser and nanofat seems to be more efficient for treating horizontal neck wrinkles.
... Furthermore, skin aging is also associated to the increased Lívia Assis livinha_fisio@yahoo.com.br 1 Programa de Pós-graduação em Engenharia Biomédica, Universidade Brasil Itaquera, São Paulo, SP 08230-030, Brazil provide selective photothermolysis of the subdermal layer of the skin, stimulating collagen production in the treated region. Many studies have showed that subdermal highpower laser is able of induce positive effects on the treatment of skin disorders such as hypertrophic scars and acne [12][13][14][15], submental adiposity, arm and abdomen [16], lower eye bag [17], upper eyelid lifting and eyebrow ptosis [18], nose reshaping [19] and sagging skin [11]. Moreover, it has also been showed that subdermal high-power laser is capable of promoting a natural regenerative process, attenuating the signs of aging [20][21][22]. ...
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The aim of the present study was to evaluate the photothermal effects of a subdermal high-power diode laser at a wavelength (λ) of 1470 nm in the skin of rats. Twenty male Wistar rats were used, divided into 2 groups: placebo laser (PL) and active laser (AL). A high-power diode laser equipment was applied to 5 subdermal vectors on the animal’s back region. The results demonstrated that active laser animals showed a better arrangement of collagen fiber bands, an increase in the thickness of the dermis and the number of vessels. Furthermore, animals treated with active laser showed an increased immunoexpression of TGF-β and VEGF compared to the placebo. The present work demonstrated that the subdermal high-power diode laser increases the vascularization and the expression of factors that enhance skin regeneration and may be promising resource in the esthetic and dermatology clinical treatment of skin rejuvenation.
... lower eyebag, skin laxity, jowl fat, nasolabial folds, and marionette lines was evaluated previously.18,19,[32][33][34][35][36][37][38][39] Our results were similar to these studies' results. ...
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Background The nasolabial folds are the most marked sign of aging. Endolift laser was used for the treatment of nasolabial folds and marionette lines (one of the facial danger zones). Methods Ten female subjects were engaged in this study. Patients underwent Endolift laser for nasolabial folds and marionette lines treatment. The efficacy of the Endolift technique on the nasolabial folds and marionette lines was evaluated by biometric assessment with Cutometer, Visioface, and the Skin Ultrasound Imaging system. Also, patient's satisfaction and blinded dermatologists’ assessment were assessed. Results The Visoface results displayed that the Endolift laser treatment significantly declined the depth and area of the nasolabial wrinkles. The skin ultrasonography results reported that the epidermis and dermis density and thickness were significantly increased. Also, the cutometer outcomes showed that the Endolift laser treatment can increase skin elasticity. The results showed that a large number of patients were very satisfied with the technique. Conclusion In conclusion, Endolift laser has an effective technique for decreasing the nasolabial folds, marionette lines, and improve the appearance of the face without any sever side effect. This technique does not need general anesthesia and recovery time.
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Background Periorbital hyperpigmentation (POH) is a common cosmetic concern. Numerous techniques of treatment have been assessed with variable results. Aim The purpose of this research is to assess the efficacy of non‐ablative radiofrequency, Sublative fractional Radiofrequency (SFR) on POH treatment. Methods In this research study, nine patients with POH and the age range of 25−57 years, were enrolled. The patients were treated by non‐ablative radiofrequency SRF. The outcomes were assessed by biometric assessment. The skin lightness and melanin content of the periorbital skin were assessed by colorimeter and Mexameter. Skin elasticity was assessed by Cutometer. The skin ultrasound imaging system was used to evaluate the diameter and density of the epidermis and dermis. Visioface was used to evaluate the skin color and wrinkles. Also, patient's satisfaction and physician's assessment were assessed. Results The results showed that the lightness and elasticity of the periorbital skin were significantly increased after treatment. Also, the melanin content of the skin was decreased. The denser skin layers were seen in both dermis and epidermis. The Visioface results displayed the reduction in the percent change of the skin color and wrinkle (p < 0.05). Similarly, the physician and patients’ assessment confirmed the outcomes. No serious adverse effect was reported. Conclusion In conclusion, the SFR technique is an effective and satisfactory therapeutic choice for treatment of POH.
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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of interventions for treating facial acne scars.
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Four methods of canal preparation are tested: hand instrumentation with preflaring and step back, Giromatic, Union Broach Endo Angle, and the Kerr Endolift. The preparations are analyzed with plastic blocks and extracted human teeth. Hand instrumentation with preflaring and step-back is superior to and safer than the mechanized endodontic devices. With proper care and technique, some mechanized endodontic devices can produce adequate canal preparations.
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A new method of subcuticular underming for the treatment of depressed cutaneous scars and wrinkles is introduced. To define the newly coined term "Subcision" and to describe this minor surgical procedure for treating depressed scars and wrinkles. A tri-beveled hypodermic needle is inserted through a puncture in the skin surface (hence, "incisionless" surgery), and its sharp edges are maneuvered under the defect to make subcuticular cuts or "-cisions." The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms in the course of normal wound healing. This technique is useful in treating a variety of cutaneous depressions, including scars and wrinkles.
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Acne is usually considered a disorder of adolescence, and a number of studies have examined the prevalence of this condition in the adolescent population. There are, however, relatively few data on the prevalence of acne in the adult population. A community-based study was carried out to investigate the current prevalence of facial acne in adults. Seven hundred forty-nine persons older than 25 years were examined for facial acne by means of the Leeds acne-grading technique. A degree of facial acne was recorded in 231 women and 130 men, giving an overall prevalence of 54% (95% confidence interval [CI], 49-58) in women and 40% (95% CI, 35-45) in men (P <.001). The acne observed in volunteers consisted principally of physiological acne, but clinical facial acne (grade > 0.75) was recorded in 3% (95% CI, 1.2-4.8) of men and in 12% (95% CI, 9-15) of women (P <.001). The prevalence of acne did not substantially decrease until after the age of 44 years (P <.001). This study shows a prevalence of clinical facial acne in women of 12%, which is likely to persist into middle age.
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This review presents and evaluates the evidence of the effectiveness of laser resurfacing for facial acne scars. Primary studies of all types of design in any language were identified from MEDLINE, EMBASE, the Cochrane database, Science Citation Index and various internet sites. Studies were accepted if they included patients treated by any laser for atrophic or ice-pick acne scars. The quality of the studies was assessed and data extracted by two independent researchers. There were no controlled trials but 14 case series were found which reported the effects of either the carbon dioxide or erbium:YAG laser. All of the studies were of poor quality. The types and severity of scarring were poorly described and there was no standard scale used to measure scar improvement. There was no reliable or validated measure of patient satisfaction; most improvement was based on visual clinical judgement, in many cases without blinded assessment. The inaccurate use of ordinal scales meant that any improvement was impossible to quantify with any validity, although the evidence suggested that laser treatment had some efficacy (a range in individual patients of 25-90% for both the carbon dioxide laser and the erbium:YAG laser). Changes in pigmentation as a side-effect were common (in up to 44% of patients), although lasting only a few weeks. Laser resurfacing technology is increasingly used in clinical practice to treat acne scars. Despite the poor quality evidence, it is plausible that there is some improvement of acne scarring; there is insufficient information, however, for patients to make informed decisions on whether to opt for treatment and there is not enough evidence to compare the two types of laser. There is a particular lack of information about the psychological effects of acne scar improvement. Good quality randomized controlled trials are needed with standardized scarring scales and validated patient outcome measures in order to assess the effectiveness of laser resurfacing in this group of patients.