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A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation
Abstract
The use of visible or near infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths and thus compounding their distinct stimulation of cellular components is proposed.Objective. To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin.
Thirty-one subjects with facial rhytids received nine light therapy treatments using the Omnilux LED system. The treatments combined wavelengths of 633 nm and 830 nm with fluences of 126 J/cm(2) and 66 J/cm(2) respectively. Improvements to the skin surface were evaluated at weeks 9 and 12 by profilometry performed on periorbital casts. Additional outcome measures included assessments of clinical photography and patient satisfaction scores.
Key profilometry results Sq, Sa, Sp and St showed significant differences at week 12 follow-up; 52% of subjects showed a 25%-50% improvement in photoaging scores by week 12; 81% of subjects reported a significant improvement in periorbital wrinkles on completion of follow-up.
Omnilux combination red and near infrared LED therapy represents an effective and acceptable method of photo rejuvenation. Further study to optimize the parameters of treatment is required.
... Most studies assessing the effect of PBM on facial rejuvenation have used red light [19][20][21][22][23][24][25][26][27][28][29]. However, a large part of these studies involved small sample sizes and did not compare the results to an untreated control group, making the assessment of the clinical effectiveness of treatment difficult. ...
... Phototherapy with LED is currently used for a broad spectrum of medical and esthetic dermatological conditions [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]36]. In esthetics, LED is indicated for the treatment of mild facial photoaging, thin wrinkles and altered skin texture, but is not indicated as replacement therapy for the loss of volume, facial contour, skin flaccidity or deep wrinkles. ...
... In esthetics, LED is indicated for the treatment of mild facial photoaging, thin wrinkles and altered skin texture, but is not indicated as replacement therapy for the loss of volume, facial contour, skin flaccidity or deep wrinkles. Red (660 nm) and near infrared LEDs have the capacity for deeper tissue penetration than lower wavelengths and are therefore often used to reach dermal structures [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. ...
The present study investigated the effects of different photobiomodulation application frequencies on facial rejuvenation. Ninety-five women 45 to 60 years of age participated in the study. A red LED mask (660 ± 10 nm, 6.4 mW/cm², 8.05 J/cm², 5.02 mW, 21 min) was used, with the analysis of two different time intervals between applications. Group 1 received three weekly applications and Group 2 received two weekly applications for four weeks (total: 12 and eight sessions, respectively). The control group received sham photobiomodulation twice per week for four weeks. The participants were unaware of the allocation to the different groups. Three standardized photographs were taken before and after treatments for assessment using the Wrinkle Assessment Scale (WAS) by three specialists blinded to the allocation and period of the photograph. The Image J software was used by a researcher blinded to allocation and period of the photograph to measure wrinkles in the forehead, glabellar as well as right and left periorbital regions. Patient satisfaction was determined using the FACE-Q questionnaire. The data were analyzed statistically with the significance level set at 5% (p < 0.05). No significant differences among the groups were found with regards to the WAS. In the ImageJ assessment, significant reductions were found in the length of the glabellar and right periorbital wrinkles in the groups treated with photobiomodulation compared to the control group (p < 0.001). Participant satisfaction rates using FACE-Q were 79.6% and 73.4% in Groups 1 and 2, respectively, with significant differences in comparison to the control group (p = 0.001 and p = 0.034, respectively). The quantity of PBM sessions did not significantly alter the positive results achieved in terms of the satisfaction of the participants with their facial esthetics or the photographic assessments performed 30 days after treatment. Thus, two weekly sessions seem to be sufficient for improving patient satisfaction.
... Photoacceptors in the skin, mainly cytochrome C oxidase, accept photons from light and induce downstream effects to promote improved skin appearance [21]. Numerous studies demonstrated PBM is effective for skin rejuvenation [19,[22][23][24][25][26]. RL and NIR light-emitting diode (LED) face masks improve skin texture, tone, wrinkles, and dyspigmentation [19,[22][23][24][25][26]. ...
... Numerous studies demonstrated PBM is effective for skin rejuvenation [19,[22][23][24][25][26]. RL and NIR light-emitting diode (LED) face masks improve skin texture, tone, wrinkles, and dyspigmentation [19,[22][23][24][25][26]. Home LED devices are inexpensive, non-invasive, easy to use, reusable, available over the counter, and have minimal side effects. ...
... Nine participants were female (81.81%). The mean age was 28.82 (range [23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Five participants selfidentified as White (45.45%), three as Asian (27.27%), one as Black/African American (9.10%), one as Two or More Races (9.09%), and one as Other (9.09%). ...
The under-eye region is an area of significant cosmetic concern. Photobiomodulation (PBM) has emerged as an effective, safe, inexpensive, and convenient treatment for skin rejuvenation. Herein, we aim to evaluate the safety and efficacy of a LED under-eye device for under-eye rejuvenation, as measured by objective and patient reported outcomes. Eleven participants self-administered treatment using a commercially available LED device emitting red (633 nm) and near infrared (830 nm) light for six weeks. Standardized photographs and questionnaires were administered at baseline and six weeks. Photographic digital analysis indicated an improvement in under-eye wrinkles at six weeks compared to baseline, with a reduction in wrinkle score from 20.05 to 19.72. However, this finding was not statistically significant. Participants self-reported consistent improvements in under-eye wrinkles, texture, dark circles, bags, pigmentation, and erythema. All participants reported a high degree of comfortability, ease of use, and satisfaction with the eye device. The participants noted no moderate or severe adverse events and few reports of transient expected outcomes such as mild erythema. The participants’ self-reported improvements and high user satisfaction, and the device’s favorable safety profile, highlights the benefits of at-home LED devices for under-eye rejuvenation. Future randomized controlled trials with larger sample sizes could further establish the safety and efficacy of at-home LED under-eye treatments.
... Thus, these cellular mechanisms of photobiomodulation in the treatment of acne, such as the modulation of inflammation, antimicrobial effects, and the regulation of the activity of the sebaceous glands, together with the non-thermal and non-invasive nature of photobiomodulation, offer a novel, safe and well-tolerated strategy to address this common dermatological problem. Table 1 summarizes the clinical trials studying PBM in the treatment of wrinkles [95][96][97][98][99][100][101][102]128]. Most studies focus on RL, NIR, and amber light (AL), a light of 590 nm close to red light [95][96][97][98][99][100][101][102]128]. ...
... Table 1 summarizes the clinical trials studying PBM in the treatment of wrinkles [95][96][97][98][99][100][101][102]128]. Most studies focus on RL, NIR, and amber light (AL), a light of 590 nm close to red light [95][96][97][98][99][100][101][102]128]. RL has shown improvement in wrinkles and signs of photodamage when applied alone [36] in repeated sessions. ...
... Histologically, a decrease in aging damage, such as an increase in type I collagen and a slight decrease in metalloproteinases, was observed. The combination of RL and NIR [96,97,99] was evaluated, and a significant improvement in wrinkles, smoothness, and skin firmness was observed. RL, NIR, and their combination [98] were compared, and RL was found to be more effective in reducing blemishes and dark stains since NIR showed higher effectiveness in improving skin elasticity and wrinkles. ...
Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.
... The notable outcomes include increased adenosine triphosphate production, modulation of reactive oxygen species, reduction of pro-inflammatory cytokines like interleukin (IL)-1β, IL-6, and tumor necrosis factor-α, activation of transcription factors, changes in collagen synthesis and angiogenesis, and improvements in blood circulation [22]. Prior research has demonstrated the efficacy of LEDs in reducing inflammation, pain, and edema through these mechanisms [20,23]. Owing to their relatively low cost and safety compared with that of lasers, LEDs are used worldwide in various fields. ...
... revealed the absence of any adverse events after the application of high-density LED irradiation therapy, and the risk associated with high-density LED irradiation therapy devices was considered low. In several other studies conducted using LEDs for skin lesions, the side effects were either mild or not reported [21,23]. The depth of tissue penetration depends on the tissue type. ...
... The longer the wavelength, the higher is the penetration. Several studies have high-lighted that combining LED wavelengths is more effective than using a single wavelength to treat skin lesions [22,23,27]. Hence, we opted for infrared wavelengths to reach the joint effectively and chose a combination of LED wavelengths. ...
Objective:
To assess the safety and effectiveness of high-density light-emitting diode (LED) irradiation therapy in patients with hand osteoarthritis (OA) and compare the pre- and post-intervention symptoms.
Methods:
Twenty-three patients with hand OA underwent eight sessions of high-density LED irradiation therapy directed at the five most painful areas in the finger joints. Each session lasted for 18 minutes; and the sessions were conducted twice a week, for 4 weeks. We evaluated the degree of pain using the visual analogue scale, ring size, and passive range of motion (flexion+extension) for two most painful joints from the baseline to post-therapy (weeks 4 and 6).
Results:
High-density LED irradiation therapy significantly reduced the pain posttreatment compared with that observed at the baseline (p<0.001). Although improvements were observed in ring size and joint range of motion at 4 and 6 weeks, they were not statistically significant (p>0.05). No adverse events were observed.
Conclusion:
We examined the safety and effectiveness of high-density LED irradiation therapy in reducing pain and hand swelling and improving joint mobility in patients with hand OA. These results suggest that high-density LED irradiation therapy has the potential to be an important strategy for managing hand OA.
... Instead, they induce photobiomodulatory reactions. They also stimulate fibroblast proliferation, collagen synthesis, and extracellular matrix and growth factor production [13][14][15]. In an in vitro study, irradiation of human fibroblasts and skin samples with 640 nm plus 830 nm LED light at 0.5 mW/cm 2 for 10 min increased LOXL1, ELN, COL1A1, and COL3A1 gene expression and procollagen type I and elastin protein expression [16]. ...
... Several clinical studies have confirmed that the application of LED/IRED light at 600-660 nm and 800-860 nm has anti-wrinkle and anti-aging effects by stimulating cells in the dermis and epidermis. Additionally, 600-650 nm and 800-860 nm LEDs for collagen synthesis have been shown to increase the number of fibroblasts in the human dermis and the synthesis of collagen and elastin proteins [10,13,17]. ...
Background
Light‐emitting diode (LED) light sources have become an increasingly popular choice for the treatment and rejuvenation of various dermatological conditions.
Aims
This study aimed to evaluate the effects of neck rejuvenation, patient satisfaction, and the safety of LED application to the neck in an Asian population.
Methods
This was a multicenter, randomized, double‐blind, sham device study. Seventy participants were enrolled in the study. The participants wore the home‐use LED neck device for 9 min a day, 5 times a week, for a total of 60 sessions. The Lemperle Wrinkle Scale (LWS) and Global Aesthetic Improvement Scale (GAIS) were used to evaluate the results of both investigators and participants. The thyroid gland was examined using ultrasonography to evaluate the safety of the investigational device.
Results
The percentage of participants with improved LWS at Week 12 was significantly higher in the study group. Additionally, the percentage of participants with improved LWS was significantly higher in the study group at Weeks 8, 12, and 16. The LWS at Week 12 corrected with baseline values was found to be significantly different between the two groups. GAIS showed significant differences at 8, 12, and 16 weeks in the investigators' evaluation but not in the participants' evaluation. Repeated‐measures analysis of variance at Weeks 4, 8, 12, and 16 also confirmed a significant difference between the two groups only in investigator assessment. No significant thyroid‐related complications were observed.
Conclusion
LED application to the neck may be considered a satisfactory and safe procedure for neck rejuvenation.
... While UVB rays lead to erythema and sunburn (6), UVA rays penetrate deeper into the skin and are responsible for the generation of reactive oxygen species (ROS), dermal damage, and photoaging (7). Blue and infrared light raise more controversy as they are used in dermatological practices, such as the treatment of psoriasis, rosacea and actinic keratosis (8)(9)(10)(11)(12)(13). However, recent research confirms that artificial visible light (VIS) induces oxidative stress and tissue damage, causing signs of early photoaging (14,15). ...
... The UVA source consisted of a sun simulator SOL 500, equipped with the H1 filter lens (22). For the preliminary studies in monolayer, the UVA doses chosen were 2. 5,5,6,7,8,9,10,15, and 20 J/cm 2 . For studies in the FT skin models, the UVA doses chosen were 10, 20, 30, and 40 J/cm 2 . ...
Introduction
Exposure to solar radiation can cause a range of skin damage, including sunburn, erythema, skin carcinogenesis, the release of reactive oxygen species (ROS), inflammation, DNA damage, and photoaging. Other wavelengths beyond UVB, such as UVA, blue light, and infrared radiation, can also contribute to the harmful effects of solar radiation. Reconstructed full-thickness human skin has the potential to serve as effective predictive in vitro tools for evaluating the effects of solar radiation on the skin. The aim of this work was to evaluate the damaging effects of UVA, blue light, and infrared radiation in a full-thickness skin model in terms of viability, inflammation, photoaging, tissue damage, photocarcinogenesis.
Methods
Full thickness skin models were purchased from Henkel (Phenion FT; Düsseldorf, Germany), and irradiated with increasing doses of UVA, blue light, or infrared radiation. Different endpoints were analyzed on the tissues: Hematoxylin-eosin staining, inflammation mediators, photoaging-related dermal markers and oxidative stress marker GPX1, evaluated by real-time quantitative PCR, as well as photocarcinogenesis markers by Western Blot.
Results and Discussion
The results showed differential responses in cytokine release for each light source. In terms of photoaging biomarkers, collagen, metalloproteinases 1 and 9, elastin, and decorin were modulated by UVA and blue light exposure, while not all these markers were affected by infrared radiation. Furthermore, exposure to UVA and blue light induced loss of fibroblasts and modulation of the photocarcinogenesis markers p53 and p21. In conclusion, the presented results suggest that the various wavelengths of solar light have distinct and differential damaging effects on the skin. Understanding the differential effects of UVA, blue light, and infrared radiation can serve as a valuable tool to investigate the efficacy of photoprotective agents in full thickness skin models.
... Home-based PBM has gained popularity as a treatment modality for patients as it offers safe, effective, cost-efficient, and convenient options with minimal downtime compared to office-based or surgical procedures [5]. Studies demonstrate that PBM may be effective for skin rejuvenation [1,[6][7][8][9][10][11]. Skin rejuvenation treatments aim to improve the overall appearance of the skin by reducing the appearance of fine lines and wrinkles and improving skin texture, skin tone, and dyspigmentation. ...
... Other studies using the Omnilux ™ LED system with wavelengths of 633 and 830 nm demonstrated positive investigator and participant rated responses to the treatment of sun damage [10,11]. In a different study also using the Omnilux ™ LED system with 633 and 830 nm wavelengths, profilometry results revealed statistically significant improvement in skin root mean square roughness, roughness average, maximum profile peak height, and maximum height of the profile, indicating effective photorejuvenation [9]. One randomized, prospective, double-blind, placebo-controlled, self-reporting study evaluating the efficacy of 1072 nm for skin rejuvenation found that 52-57% of participants were able to accurately identify improvement in fine lines and rhytids in the areas of skin that received treatment [17]. ...
Home-based photobiomodulation is a popular treatment modality for patients seeking non-invasive aesthetic treatment. Studies demonstrate that photobiomodulation is effective for skin rejuvenation, which is aimed at improving the overall appearance of the skin by reducing fine lines and wrinkles and improving skin texture, skin tone, and dyspigmentation. Most current skin rejuvenation research focuses on treatments in women. However, men’s aesthetics remains an underserved market. A combined red light (RL) and near-infrared (NIR) light-emitting diode (LED) has been designed specifically to target male skin, which may have different physiological and biophysical properties compared to female skin. Herein, the safety and efficacy of a commercially available RL and NIR (633, 830, and 1072 nm) LED array designed to be worn as a face mask was assessed. Primary outcomes included adverse events and facial rejuvenation as determined by participant-reported satisfaction scales and quantitative digital skin photography and computer analysis after 6 weeks of treatment. The participants reported overall favorable results and improvements in all individual categories, were satisfied with the treatment, and would recommend the product to others. The participants perceived the greatest improvement in fine lines and wrinkles, skin texture, and youthful appearance. Photographic digital analysis demonstrated favorable improvements in wrinkles, UV spots, brown spots, pores, and porphyrins. These results support the use of RL and NIR to treat male skin. Advantages of the LED facemask include its safety, efficacy, convenient home-based use, minimal associated downtime, simple operation, non-invasiveness, and appreciable results in as few as 6 weeks.
... 10,13 A few published clinical trials have assessed the effect of PBM on rejuvenation. 12,[14][15][16][17][18][19][20][21][22] However, most of them have evaluated red PBM when compared with a nontreated control, compared or associated with infrared wavelengths, or where there was no comparison with a control group. Hence, clinical trials considering these limitations and those designed to reduce the risk of bias are still needed. ...
... 20 Moreover, lower irradiance (6.4 mW/cm 2 ) was more efficient than higher irradiance (50-105 mW/cm 2 ), 13 and the lower radiant exposure (3.8 J/cm 2 ) produced better results than higher radiant exposure (66-1266 J/cm 2 ). 15,17 Longer treatment protocols (>4 weeks) when considering the abovementioned parameters should be evaluated in additional clinical trials. The Corneometer was used to measure the cutaneous capacitance in the periocular region to evaluate hydration. ...
Objective: This study aimed to evaluate red and amber light-emitting diode protocols for facial rejuvenation at the same light dose. Background: The demand for minimally invasive cosmetic procedures to address skin aging has grown throughout the world. In vitro red and amber photobiomodulation (PBM) has been shown to improve collagen synthesis. Meanwhile, red PBM has already been studied in clinical trials; however, a comparison of the use of different wavelengths at the same light dose to reduce periocular wrinkles has not yet been performed. Methods: This split-face, randomized clinical trial recruited 137 women (40-65 years old) presenting with skin phototypes II-IV and Glogau photoaging scale types II-IV. The individuals received 10 sessions for 4 weeks of red (660 nm) and amber (590 nm) PBM (3.8 J/cm2), one at each side of the face. The outcomes, measured before and after the treatments, were the periocular wrinkle volume measured by VisioFace® RD equipment; hydration measured by the Corneometer CM 825; skin elasticity measured by the Cutometer Dual MPA 580; and quality of life determined by adapted versions of validated questionnaires [Melasma Quality of Life Scale-Brazilian Portuguese (MelasQoL-BP) and Skindex-29]. Results: There was a significant reduction in wrinkle volume after red (31.6%) and amber (29.9%) PBM. None of the treatments improved skin hydration and viscoelasticity. Both questionnaires showed improvements in participants' quality of life. Conclusions: PBM, both at red and amber wavelengths, is an effective tool for rejuvenation, producing a 30% wrinkle volume reduction. The technique has strong potential in patients with diabetes or those presenting with keloids, conditions for which highly inflammatory rejuvenating procedures are not indicated. Clinical trial registration number: REBEC-6YFCBM.
... An external gel was used as a photosensitizer, the active substance of which is N -dimethylglucamine chlorine E6, obtained by extracting chlorophyll A from the marine microalgae spirulina and its subsequent chemical transformation using an original technology [6]. To activate the photodynamic reaction, red laser radiation in the range of 660±2 nm was used [10]. For the purpose of a personalized approach, the concentration of the photosensitizer gel was determined for the patient at various exposures (Table No. 1, Fig. 1 -a, b, c, d, e). ...
Purpose of the Study: To evaluate the effectiveness of photodynamic therapy in the treatment of post-acne scars. Materials and Methods: We have presented a clinical case of the correction of post-acne with photodynamic therapy after a preliminary course of systemic retinoids. A 23-year-old patient with a 10-year history of acne lesions was diagnosed with severe acne complicated with atrophic scars and dyschromia. Results: The use of photodynamic therapy with an external gel, a photosensitizer based on chlorin E6, proved to be highly effective in correcting the post-acne complications. The use of a personalized approach when determining the exposure of the gel on the skin established its highest concentration after 10 minutes and the optimal duration of irradiation within 10 minutes. As a result of treatment, there was a restoration of skin color and a decrease in the depth of atrophic scars. Conclusions: This case is of interest to dermatologists/aesthetic physicians, since an effective method of using photodynamic therapy with a topical photosensitizer gel in the correction of post-acne scars was proposed.
... IR LED treatment can penetrate the skin between 5 and 10 mm and has been used to treat wounds, ulcers, cutaneous scleroderma and has even been shown to treat cellulite [29][30][31][32]. A study by Russell et al. showed that exposing patients to a combination of different LED wavelengths was more effective than monotherapy [33]. A prospective, placebocontrolled, doubleblind study using LEDs emitting R (633 nm) and IR (830 nm) light radiation was conducted by Lee et al. [34]. ...
Background. Bell’s palsy is a spontaneous paralysis of the facial nerve (i.e. cranial nerve VII). It presents with muscle weakness leading to facial asymmetry, with a drooping corner of the mouth, loss of the ability to whistle, blink, close the eyelid, purse lips or grin. The forehead on the affected side becomes smooth and the patient is not able to frown or raise eyebrows. Objective. The aim of the study was to evaluate the effect of combined electrophysical and physiotherapeutic methods on accelerating recovery from facial nerve palsy. Material and Methods. The authors describe two cases of Bell’s palsy, treated with simulta-neous application of electrophysical agents, in the form of an extremely low-frequency elec-tromagnetic field (ELF-EMF) and high-energy LED light, and physiotherapy modalities, i.e. proprioceptive neuromuscular facilitation (PNF) and kinesiotaping (KT). Results. After four weeks of electrophysical and physiotherapeutic treatments, a fully satis-factory and stable therapeutic effect was achieved. Conclusions. The interdisciplinary therapy using ELF-EMF + LED combined with PNF and KT treatments proved to be effective in accelerating recovery from facial nerve palsy. Further studies are needed to establish appropriate protocols.
... O comprimento de onda de 630 -700 nm correspondem à luz vermelha e é utilizada para acelerar o processo de cicatrização de feridas 9 . A seleção do comprimento de onda apropriado é fundamental na ledterapia devido à especificidade terapêutica de cada comprimento de onda 10 . O espectro na luz vermelha apresenta uma das maiores penetrações tissulares, cerca de 2 a 3 mm 9 . ...
A técnica de preenchimento com uso de ácido hialurônico tem sido amplamente utilizada para rejuvenescimento e remodelação facial. O aumento crescente da utilização dessa técnica traz consigo cada vez mais a ocorrência de efeitos não desejáveis. Nessas situações a opção terapêutica mais eficaz atualmente é a aplicação da enzima hialuronidase, capaz de degradar o ácido hialurônico. Não foram encontrados estudos que abordam a resolução de intercorrências com uso de ácido hialurônico sem aplicação injetável da enzima hialuronidase. O objetivo desse trabalho foi relatar um caso de tratamento alternativo para o acúmulo do ácido hialurônico. Foi proposto o uso da ledterapia associada à massagem local e aplicação tópica de pomada de hialuronidase e valerato de betametasona. O uso da pomada de hialuronidase foi indicado pelo período de uma semana, associada à massagem local, a enzima atua reduzindo a resistência do tecido, alterando a permeabilidade intercelular e auxilia a dispersão de substâncias. Na ledterapia foi utilizado o comprimento de onda de 660 nanômetros (nm), correspondente ao espectro da luz vermelha, ela apresenta uma das maiores penetrações tissulares e é capaz de induzir bioestimulação, tem ação anti-inflamatória e efeito fototérmico. O resultado final foi aprovado pela paciente, uma vez que houve redução do acúmulo de produto antes visível no local de aplicação. A terapia proposta foi resolutiva e satisfatória, considerando a pequena quantidade de ácido hialurônico aplicado.
... 18,27 Several studies have shown that exposing patients to a combination of LED wavelengths is more effective than monotherapy. [28][29][30][31][32] However, we have not found a similar design to compare our results in the literature. Most studies compare IPL with other lasers but not with LEDs. ...
Background: Superficial facial vascular lesions can be an aesthetic problem and a symptom of different skin diseases. Objective: It was to compare the efficacy and safety profiles of Dermalux® Tri-Wave MD, based on three combined light-emitting diodes (LEDs) technology and intense pulsed light (IPL) for reducing the excess of facial vascularization due to superficial cutaneous vascular lesions. Materials and methods: The study had a single-center, proof-of-concept, open-label, and prospective design. Two groups of adult patients were treated for facial hypervascularization, LED-Group with an LED device combining 633 and 830 nm and IPL-Group with an IPL (555-950 and 530-750 nm). Variables assessed were hemoglobin hyperconcentration (HH), hemoglobin-affected area (HAA) through Antera 3D®, and pain using the Numeric Pain Rating Scale. Results: Twenty subjects were included, 10 by group (50% female). LED-Group: Mean age 32.1 years (range, 21-46). IPL-Group: Mean age 34.5 years (range, 25-49). HH: LED-Group 100% had a moderate improvement; in the IPL-Group, 10% was moderate, and 90% was marked. HAA: LED-Group 10% had a slight improvement, 70% moderate, and 20% marked; in the IPL-Group, 100%, the improvement was marked. Seventy percent of LED-Group patients reported no pain, 30% mild; in the IPL-Group, 100% of patients reported severe pain. Conclusions: Treatment with combined red and near-infrared LEDs effectively reduced the excess of facial vascularization with moderate outcomes compared with IPL, but without secondary effects and no pain. This treatment could represent an effective, safe, and well-tolerated approach for facial vascular lesions.
... This includes the following: Task Requirements: Illuminance Glare Mood of the space Relation to the shape of space Things to be emphasised Things to hide Direction of light Interaction of daylight 2. Determine the method of lighting At this stage, consideration is given to how the light is to be delivered, e.g. will it be recessed, surface mounted, direct or indirect, or will uplighting be used, and its primary characteristics, e.g. will it be prismatic, low brightness or mellow light (Russell et al, 2005). Consideration should be given at this stage to the use of daylight to minimize the need for artificial light. ...
... Most participants showed an effect on periorbital wrinkles, with improvement in photo aging and softness scores. Mild redness in skin colour, was reported by some participants [51]. ...
The development of light-emitting diodes (LEDs) has led to an increase in the use of lighting regimes within medicine particularly as a treatment for dermatological conditions. New devices have demonstrated significant results for the treatment of medical conditions, including mild-to-moderate acne vulgaris, wound healing, psoriasis, squamous cell carcinoma in situ (Bowen’s disease), basal cell carcinoma, actinic keratosis, and cosmetic applications. The three wavelengths of light that have demonstrated several therapeutic applications are blue (415 nm), red (633 nm), and near-infrared (830 nm). This review shows their potential for treating dermatological conditions. Phototherapy has also been shown to be an effective treatment for allergenic rhinitis in children and adults. In a double-anonymized randomized study it was found that there was 70% improvement of clinical symptoms of allergic rhinitis after intranasal illumination by low-energy narrow-band phototherapy at a wavelength of 660 nm three times a day for 14 consecutive days. Improvement of oedema in many patients with an age range of 7–17 were also observed. These light treatments can now be self-administered by sufferers using devices such as the Allergy Reliever phototherapy device. The device emits visible light (mUV/VIS) and infra-red light (660 nm and 940 nm) wavelengths directly on to the skin in the nasal cavity for a 3 min period. Several phototherapy devices emitting a range of wavelengths have recently become available for use and which give good outcomes for some dermatological conditions.
... This type of therapy has demonstrated promising results in improving wrinkles and skin laxity. [103][104][105][106][107][108][109][110][111] In animal studies, it has been reported that LLLT can increase the production of collagen and bFGF. 112,113 It has also been reported that LLLT is able to increase microcirculation and vascular perfusion on skin, increase expression of PDGF and TGF-β1, and inhibit apoptosis. ...
The use of lasers for facial esthetics has a long history dating back to the 1960s. While originally clinical procedures and indications were limited to ablative therapies, over the past decade technologic advancements have expanded the applications of lasers in clinical practice. Today over 150 commercially available lasers exist on the market for various indications, including scar revisions, pigmented lesions, vascular lesions, hair removal, facial resurfacing, facial rejuvenation, fat ablation, and laser lipolysis. This chapter provides an in-depth overview of the current state-of-the-art technology and provides specific indications and guidelines regarding the use of lasers in facial esthetics.
... Alopecia may cause psychological, aesthetic, and even social issues [1,2]. Recently, photobiomodulation therapy (PBMT) has been shown to be a potential treatment in improving dermatological conditions including skin rejuvenation [3,4], acne [5,6], and hair loss [7][8][9][10]. PBMT is regarded as a treatment using low-power light irradiation under specific wavelengths and irradiation fluences on the targets [11,12]. ...
Hair loss can cause psychological distress. Here, red organic light-emitting diode (OLED) light source is first introduced as the photobiomodulation therapy (PBMT) for hair growth and demonstrated as a promising and non-invasive therapeutic modality for alopecia. OLED exhibits unique advantages of homogeneous irradiation, flexible in form factor, and less heat generation. These features enable OLED to be an ideal candidate for wearable PBMT light sources. A systematic study of using red OLEDs to facilitate hair growth was conducted. The results show that OLEDs excellently promote hair regrowth. OLED irradiation can increase the length of the hair by a factor of 1.5 as compared to the control, and the hair regrowth area is enlarged by over 3 times after 20 days of treatments. Moreover, the mechanism of OLED that stimulates hair follicle regeneration is investigated in-vivo by conducting a systematic controlled experiments on mice with or without OLED PBMT. Based on the comprehensive histological and immunofluorescence staining studies, two key factors are identified for red OLEDs to facilitate hair follicle regeneration: (i) increased autophagy during the anagen phase of the hair growth cycle; (ii) increased blood oxygen content promoted by the accelerated microvascular blood flow.
... The average dose of radiation in CBCT is in the range 2 of 9 of 20-650 µSv, depending on the size of the field of view and image resolution [7][8][9][10]. In turn, magnetic field LED therapy is a popular physical therapy modality with a high therapeutic efficacy, due to the combined effects of Extremely Low Frequency-Electromagnetic Field (ELF-EMF) and high-power light emitted by Light Emitting Diodes (LEDs), producing red light (R) (wavelength 630 nm) and infrared light (IR) (wavelength 855 nm) radiation [11][12][13][14][15]. The electromagnetic field used in this method usually has magnetic flux density of 15 µT, and frequency in the range of 180-195 Hz [16,17]. ...
Modern high-resolution volumetric tomography, commonly known as cone beam computed tomography (CBCT), is one of the most innovative imaging techniques which can provide views of anatomical structures not attainable by conventional techniques. Magnetic field LED therapy is a physical therapy method, combining the effects of the Extremely Low Frequency-Electromagnetic Field (ELF-EMF) and high-power light radiation emitted by Light Emitting Diodes (LEDs). The method has been widely applied in the treatment and rehabilitation of complications of many medical conditions, including in dentistry. The aim of this study was to use CBCT to assess the effectiveness of the simultaneous use of electromagnetic field and LED light in the physical therapy of paranasal sinusitis. Treatments employing the electromagnetic field combined with LED light were administered to a 39-year-old female outpatient of the physiotherapy ward for rehabilitation therapy of paranasal sinusitis. Normal sinus pneumatization was restored almost completely. Reduction in the swelling of the sinus mucosa was so significant that even the pneumatization of the ethmoid bulla was restored. Physical therapy with the simultaneous use of ELF-EMF and LED light was found to be effective in the rehabilitation of the patient with paranasal sinusitis. Positive effects of the treatment were confirmed by CBCT findings.
Background
As the elderly population continues to grow, the demand for antiaging products is increasing concurrently. On our face, wrinkles begin to form first around the eyes, where the skin is the thinnest. Previous studies have suggested that irradiating the skin with light-emitting diode (LED)/infrared emitting diode (IRED) light at 600 to 660 nm/800 to 860 nm, stimulates the cells of the dermis and epidermal tissue and is effective in wrinkle improvement and antiaging. Therefore, we aimed to evaluate the efficacy and safety of low-level light therapy masks.
Materials and methods
A randomized, sham device-controlled, double-blind clinical trial was conducted at 2 institutions. Sixty Asian descent individuals between the ages of 30 and 65 years who showed type II to V skin type on the Fitzpatrick scale were included. Among participants with a score of 2 to 4 on the crow’s feet grading scale (CFGS) at rest (without expression), those who sought temporary improvement in both crow’s feet were selected. The participants were categorized into 2 groups: the experimental group, which used a device with a combination of 630 nm LED (max 10 mW/cm ³ ) and 850 nm IRED (max 10 mW/cm ³ ), and the control group, which used the sham device. Efficacy evaluation included various evaluations, including the CFGS as rated by independent raters, CFGS scores assigned by investigators, and the Global Aesthetic Improvement Scale evaluation by both investigators and the participants.
Results
After using the LED mask for 16 weeks, the CFGS score of the independent raters and investigators showed significant differences at 8, 12, and 16 weeks. In addition, considering the success criteria of this study, a comparison of independent raters showed an improvement rate of ≥69.2% (full analysis set [FAS]: 86.2%, per-protocol set [PPS]: 89.3%) and a difference of ≥49.2% from the control group (FAS: 69.5%, PPS: 72.6%). The change in scores from the baseline showed significant differences between the test group and the control groups at 8, 12, and 16 weeks for both independent raters and investigators.
Conclusion
LED and IRED phototherapies at 630 nm and 850 nm, respectively, are effective, safe, well-tolerated, and painless treatment for skin rejuvenation.
The use of photobiomodulation is well documented in the literature, with evidence of its various therapeutic applications. However, there is a gap in the biological effects of LED on different cell types. Therefore, the aim of this study was to evaluate the effects triggered by different wavelengths of LED on different cell types. For this, 2x104 cells per well of adipocytes, melanocytes, fibroblasts, and endothelial cells were cultured in 75 cm2 T-flasks (bottle brand) containing DEMEM medium (Sigma-Aldrich) supplemented with 10% fetal bovine serum (Hyclone), 1% penicillin/streptomycin antibiotic, L-glutamine, and bicarbonate (Sigma-Aldrich). T-flasks were maintained at 37°C with 5% CO2 in an oven (Thermo Scientific). For the application of phototherapy, wavelengths of 410 nm, 450 nm, 525 nm, 590 nm, 630 nm and 850 nm were used in a single application, with evaluations performed 24 hours after irradiation. The results demonstrated that high energies using red and infrared wavelengths reduced adipocyte proliferation. When low energies at the same wavelengths were used in fibroblasts, greater cell proliferation was observed. Regarding melanocytes, only the 590 nm wavelength was able to induce a response related to cell proliferation. Thus, it was possible to conclude that the biological response is dependent on both the wavelength and the amount of energy applied, and differences in light absorption were also detected depending on the cell type used.
Background
Skin aging and photoaging is a process that may appear at a relatively early age, causing an aesthetic problem. Common signs of skin aging include wrinkles, dyspigmentation, and decreased elasticity.
Aim
Aim of this article is to study the effectiveness and safety of low‐level laser therapy (LLLT) for skin rejuvenation.
Methods
Thirty Syrian female patients aged 25–50 participated in this study and were diagnosed with moderate to severe melasma and wrinkles. The patients were divided into two groups and received LLLT with a wavelength of 660 nm emitting a continuous wave. The power density and dose used were 15.6 mW/cm², and 3 J/cm² respectively, and the laser effective area was 32 cm². The evaluation was done before, during, and after 12 treatment sessions, based on photographs, in addition to the modified Melasma Area Severity Index (MASI), Pinch test, and Fitzpatrick's classification of facial wrinkling at baseline.
Results
Comparing before, and after treatment, and between the two groups, revealed a significant improvement in skin rejuvenation, with a statistical significance (p < 0.05). Additional outcome measures included assessments of patient satisfaction scores, and no adverse effects or re‐pigmentation were reported.
Conclusions
Our results suggest that LLLT may be a useful and safe therapeutic option in treating melasma, skin elasticity, and wrinkle improvement, which we advised to be integrated into treatment, and follow‐up programs in cosmetics and dermatology.
Low-level light therapy (LLLT) employs athermal and atraumatic levels of illumination, typically in the visible or near-infrared (NIR) regions of the electromagnetic spectrum, to target tissue and stimulate a clinically useful local or systemic effect. LLLT has demonstrated beneficial applications in the areas of wound healing, pain management, and various musculoskeletal conditions as well as skin rejuvenation. This chapter dives into the benefits of using LED-based devices in aesthetic applications, resulting in a safer and more convenient approach to benefit patients.
BACKGROUND
Reddit is one of the world's most popular social media platforms and is increasingly used as a health information resource for patients on topics such as red-light (RL) therapy.
OBJECTIVE
In this article, the authors present an analysis of prevalent patient questions and concerns regarding RL therapy.
METHODS
All posts on the “Hot” page of the r/redlighttherapy subreddit were analyzed and categorized.
RESULTS
A total of 930 questions from 664 posts were analyzed. The most commonly asked question category was related to product recommendations or feedback (29.7%), followed by usage instructions (15.3%), safety and side effects (12.6%), and indications and efficacy (12.3%).
CONCLUSION
Understanding patient concerns and questions about RL, as expressed on online platforms like Reddit, can help clinicians improve patient satisfaction, education, and clinical outcomes. The study offers an innovative approach by using social media to uncover valuable patient insights that might not be easily observable within clinical settings.
Background:
Photobiomodulation (PBM) therapy is an increasingly popular modality for aesthetic skin rejuvenation. PBM induces genomic, proteomic and metabolomic processes within target cells but such manipulation of cell behavior has led to concerns about oncologic safety.
Objectives:
This article presents a summary of the clinical and pre-clinical evidence for the oncologic safety of PBM for aesthetic skin rejuvenation.
Methods:
A focused systematic review was performed, wherein safety data from clinical trials of PBM for skin rejuvenation was supplemented by analyses of in vitro data using cells derived from human skin and human neoplastic cells and in vivo data of tumors of the skin, oral cavity and breast.
Results:
Within established parameters, red/near infrared light mainly enhances proliferation of healthy cells without a clear pattern of influence on cell viability. The same light parameters mainly reduce neoplastic cell proliferation and viability or else make no difference. Invasiveness potential (appraised by cell migration assays and/or differential gene expression) is equivocal. PBM does not induce dysplastic change in healthy cells. In vivo tumor models yield varied results with no clear pattern emerging. There are no relevant clinical trials data linking PBM with any significant adverse events including the finding of a new or recurrent malignancy.
Conclusions:
Current clinical and pre-clinical evidence suggests that PBM is oncologically safe for skin rejuvenation and there is no evidence to support the proposition that it should be avoided by patients who have previously undergone treatment for cancer.
Sedentary lifestyles and evolving work environments have created challenges for global health and cause huge burdens on healthcare and fitness systems. Physical immobility and functional losses due to aging are two main reasons for noncommunicable disease mortality. Smart electronic textiles (e-textiles) have attracted considerable attention because of their potential uses in health monitoring, rehabilitation, and training assessment applications. Interactive textiles integrated with electronic devices and algorithms can be used to gather, process, and digitize data on human body motion in real time for purposes such as electrotherapy, improving blood circulation, and promoting wound healing. This review summarizes research advances on e-textiles designed for wearable healthcare and fitness systems. The significance of e-textiles, key applications, and future demand expectations are addressed in this review. Various health conditions and fitness problems and possible solutions involving the use of multifunctional interactive garments are discussed. A brief discussion of essential materials and basic procedures used to fabricate wearable e-textiles are included. Finally, the current challenges, possible solutions, opportunities, and future perspectives in the area of smart textiles are discussed.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
In the last 20 years there has been an explosion of new cosmetic surgery procedures developed for a large base of office-based dermatologists, cosmetic surgeons, plastic and reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped across the globe, with practitioners in Europe, Asia, and North and South America. This is a practical, simple manual of those tricks and techniques, with input from specialists around the world. This book is aimed at practitioners who want to add new procedures to their scope of practice and learn new methods of application. A wide range of procedures, from fillers and neurotoxins to suture suspension and chemical peels, are covered here in a comparative format and accompanied by more than 200 color illustrations. In addition to detailing the procedures, chapters also cover anesthetic techniques and brands. This book is designed to be an easy and useful reference for the beginning practitioner or more senior physician.
For centuries, patients and physicians have sought a safe and effective method for treating skin changes associated with photoaging. Currently, a variety of modalities are used to treat facial rhytids, including dermabrasion, chemical peels, and laser skin resurfacing (LSR). Although these modalities are relatively effective for rhytid reduction, epidermal disruption or removal results in an open wound that places the patient at risk for bacterial, viral, and fungal infections. Abnormal or delayed wound healing may result in skin dyspigmentation and scarring. In addition, the wound resolves with significant erythema that often lasts for weeks or months and is cosmetically troubling to patients (Figure 1). The ideal method of skin rejuvenation would achieve optimal cosmetic improvement of photodamage while minimizing wound care and the risk of adverse effects.
Interest in the reversal of facial photodamage has increased significantly among patients and physicians in the past decade. Though surgical procedures may be very effective, the associated healing time and potential risks have spurred the development of non-surgical treatments. There has also been an increasing depth of knowledge regarding wound healing and its control by growth factors as well as its modulation by the topical application of growth factors. Bioengineered tissue cultures have resulted in the ability to collect naturally occurring human growth factors in their tissue concentrations.
The objective of this study is to determine if the twice daily application of a combination of multiple growth factors to photodamaged facial skin results in any evidence of improvement after 60 days.
Fourteen patients applied a gel containing a mixture of eight different growth factors (Nouricel-MD) to photodamaged facial skin twice daily. Prior to the study and at days there were clinical evaluations of photodamage (Fitzpatrick scale), 3 mm punch biopsies and optical profilometry. Patient questionnaires were answered at 60 days.
Eleven of 14 patients showed clinical improvement in at least one facial area. The peri-orbital region showed a statistically significant improvement (p = 0.0003). Optical profilometry showed a statistically significant reduction in Ra measurement (p=0.0075) and shadowing (p=0.02), both indicating a decrease in the depth and number of textural irregularities or fine lines. Biopsies revealed new collagen formation in the Grenz zone (37% increase in thickness) and thickening of the epidermis by 27%. Eight of 14 patients felt their wrinkles were improved, while 12 of 14 felt their skin texture was improved.
The application of a mixture of topical growth factors may stimulate the repair of facial photodamage resulting in new collagen formation, epidermal thickening and the clinical appearance of smoother skin with less visible wrinkling.
Quantitative studies of the action of low-power visible monochromatic light on various cells (E. coli, yeasts, HeLa) were performed to find irradiation conditions (wavelength, dose, intensity) conducive to vital activity stimulation. The action spectra of visible light on DNA and RNA synthesis in HeLa cells have maxima near 404, 620, 680, 760, and 830 nm. Growth simulation of E. coli is at a maximum when irradiated at 404, 454, 570, 620, and 750 nm, and biomass accumulation stimulation in yeasts has a maxima at 404, 570, 620, 680, and 760 nm. Absorption of quanta is only a trigger for the rearrangement of cellular metabolism, with photosignal transduction being effected by standard cellular means such as changes in the cAMP level. Respiratory chain components are discussed as primary photoacceptors. It is concluded that "laser biostimulation" is of a photobiological nature, and low-power laser effects can be related to well-known photobiological phenomena.
Two low energy lasers, helium-neon (He-Ne, continuous wave, 632.8 nm), and gallium-arsenide (Ga-As, pulse, 904 nm), were tested for their effects on connective tissue metabolism by human skin fibroblasts in culture. The cells were subjected to laser treatment at various energy fluence, and the treatment schedule included one or two daily exposures on several consecutive days. The results indicated that procollagen production was enhanced by both lasers approximately 4-fold in average. The highest enhancement of 36-fold was noted in cultures which initially synthesized procollagen at a relatively low level, while a lesser effect was achieved in cultures which already actively synthesized procollagen. The lasers tested had no effect on the activities of collagenase and gelatinase, two proteolytic enzymes controlling the degradation of collagen, in fibroblast cultures. The increased procollagen production by either one of the lasers could not be explained on the basis of enhanced cell proliferation. Also, the viability and the ultrastructural organization of the fibroblasts remained unaltered by these lasers. Thus, the results suggest that low energy lasers, with appropriate treatment schedule, might provide a safe and efficient modality for enhancement of collagen deposition in chronic necrotic processes, as in leg ulcers and pressure sores.
Cutaneous aging includes true aging and photo-aging due to sun exposure. A decrease in epidermal turnover rate results in epidermal atrophy and delayed wound-healing. A reduction in the number of epidermal Langerhans' cells is responsible for a decrease in delayed immune responsiveness in skin observed in the elderly. Reduced numbers of fibroblasts and mast cells are typical histologic findings in aging human dermis. Collagen bundles become fragmented, less elastic and more brittle. Telomere shortening at the end of chromosomes is probably the major mechanism of cellular senescence in skin. Common skin tumors and other major age-related changes in the skin of the elderly are described.
Recently, there has been an increasing amount of interest in the application of low reactive level laser therapy (LLLT) for pain attenuation or pain removal. However, the mechanisms by which LLLI- works are not yet full understood. We measured the phagocytic rate using the luminol-dependent chemiluminescence method and a Neuroprobe 48-cell chemotaxis chamber to examine the chemical dependent motion of neutrophils with and without LLLT irradiation. This study showed that at a 15-s exposure, 15, 30, 45, and 60mW output pewers (0.225, 0.45, 0.678 and 0.9 J) shortened the peak time compared with control; peak height increased at all four output powers; and neutrophil random motion count also increased across the board. At a 30-s exposure, doses of 0.45, 0.9, 1.356 and 1.8 J caused no significant shortening of peak time compared with control, but the peak height increased significantly for output powers of 15, 30 and 45 mW. Neutrphil random motion increased for the dose of 0.45 J (15 mW). For a 60-s exposure at the same output powers as above. doses of 0.9, 1.8, 2.7 and 3.6 J respectively, neither peak time nor peak height nor neutrophil random motion count showcd any significant difference compared with the controls.
The purpose of this study was to investigate the effects of low level laser therapy (LLLT: GaAlAs diode laser: 830 nm) on serum opsonic activity, which was assessed by neutrophil-associated chemiluminescence (CL) responses to zymosan opsonized with sera irradiated in vitro with various doses of LLL. We used both lucigenin-dependent CL (LgCL) for superoxide (O2-) detection and luminol-dependent CL (LmCL) which detects myeloperoxidase (MPO)-dependent formation of hypochlorous acid in combination with an MPO inhibitor, sodium azide (NaN3). When serum opsonic activity was assessed by LgLC, NaN3 markedly enhanced the responses, suggesting that O2- accumulates due to the MPO blockade, leading to the excitation of LgCL. However, LLL-irradiation had no effects on serum opsonic activity. On the other hand, when serum opsonic activity was assessed by LmCL, NaN3 strongly inhibited the response. The effects of LLLT at different output powers were characterized by similar values, but significantly higher values were observed at the highest dose tested (60 mW for 1 min) in the absence of NaN3. Since this enhancement effect disappeared in the presence of NaN3, it was suggested that high dose LLL-irradiation probably activates opsonic activity by facilitating the degranulation of MPO from neutrophils. However, lower doses similar to those used for therapeutic purposes had no effects at any output powers tested.
Noninvasive techniques for skin rejuvenation are quickly becoming standard in the treatment of mild rhytids and overall skin toning. Multiple laser wavelengths and modalities have been used with varying degrees of success, including 532-nm, 585-nm, 1064-nm, 1320-nm, 1450-nm, and 1540-nm wavelengths.
To evaluate a combination technique using a long-pulsed, 532-nm potassium titanyl phosphate (KTP) laser and a long-pulsed 1064-nm Nd:YAG laser, separately and combined, for noninvasive photorejuvenation and skin toning and collagen enhancement and to establish efficacy and degree of success.
Prospective nonrandomized study with longitudinal follow-up.
Private dermatologic surgery and laser practice.
A total of 150 patients, with skin types I through V, were treated with long-pulsed KTP 532-nm and long-pulsed Nd:YAG 1064-nm lasers, separately and combined. For the KTP 532-nm laser, the fluences varied between 7 to 15 J/cm2 at 7- to 20-millisecond pulse durations with a 2-mm handpiece and 6 to 15 J/cm2 at 30- to 50-millisecond pulses with a 4-mm handpiece. The 1064-nm Nd:YAG laser fluences were set at 24 to 30 J/cm2 for a 10-mm handpiece. These energies were delivered at 30- to 65-millisecond pulse durations. All subjects were treated at least 3 times and at most 6 times, depending on patient satisfaction level, at monthly intervals and were observed for up to 18 months after the last treatment.
All patients were asked to fill out a "severity scale" on which redness, pigmentation, rhytids, skin tone/tightness, texture, and patient satisfaction were noted before and after each treatment. Redness, pigmentation, rhytids, skin tone/tightness, and texture were also evaluated by the physician and another observer.
After 3 to 6 treatments, 50 patients treated with the 532-nm KTP laser alone showed improvement of 70% to 80% in redness and pigmentation, 30% to 50% in skin tone/tightening, 30% to 40% in skin texture, and 20% to 30% in rhytids. Another 50 patients treated with the 1064-nm Nd:YAG laser alone showed improvement of 10% to 20% in redness, 0% to 10% in pigmentation, 10% to 30% in skin tone/tightening, 20% to 30% in skin texture, and 10% to 30% in rhytids. The third group of 50 patients treated with both KTP and Nd:YAG lasers showed improvement of 70% to 80% in redness and pigmentation, 40% to 60% in skin tone/tightening, 40% to 60% in skin texture, and 30% to 40% in rhytids. Skin biopsy specimens taken at 1-, 2-, 3-, and 6-month intervals demonstrated new collagen formation.
All 150 patients exhibited mild to moderate improvement in the appearance of rhytids, moderate improvement in skin toning and texture, and great improvement in the reduction of redness and pigmentation. The KTP laser used alone produced results superior to those of the Nd:YAG laser. Results from combination treatment with both KTP and Nd:YAG lasers were slightly superior to those achieved with either laser alone.
Background:
Histologic findings are not echoed in the visible effect in the epidermis after skin rejuvenation.
Subjects and methods:
Ten women (Group A) received five treatment sessions with a 595-nm pulsed dye laser immediately followed by a 1450-nm diode laser. Two other demographically similar groups of 10 patients each, Groups B and C, were treated with the 595-nm pulsed dye laser or the 1450-nm diode laser alone, respectively.
Results:
Good dermal collagen remodeling was observed in Group A. Overall better and faster results were seen in Group A. The 6-month clinical outcome was best in Group A followed by Group C and Group B.
Conclusions:
Wavelengths of 595 plus 1450 nm for skin rejuvenation produced good results with much higher patient satisfaction than those obtained with the 595- or 1450-nm wavelengths alone.
Quantitative studies have been performed to determine the action of low-intensity visible monochromatic light on various cells (E. coli, yeasts, HeLa, Chinese hamster fibroblasts and human lymphocytes); also irradiation conditions (wavelength, dose and intensity) conducive to vital activity stimulation have been examined. Respiratory chain components are discussed as primary photoacceptors. The possible ways for photosignal transduction and amplification are discussed. It is proposed that enhanced wound healing due to irradiation with low-intensity visible laser light (He-Cd, He-Ne and semiconductor lasers) is due to the increasing proliferation of cells.
Macrophages are a source of many important mediators of wound repair. It was the purpose of this study to see if light could stimulate the release of these mediators.
In this study an established macrophage-like cell line (U-937) was used. The cells were exposed in culture to the following wavelengths of light: 660 nm, 820 nm, 870 nm, and 880 nm. The 820-nm source was coherent and polarised, and the others were non-coherent. Twelve hours after exposure the macrophage supernatant was removed and placed on 3T3 fibroblast cultures. Fibroblast proliferation was assessed over a 5-day period.
The results showed that 660-nm, 820-nm, and 870-nm wavelengths encouraged the macrophages to release factors that stimulated fibroblast proliferation above the control levels, whereas the 880-nm wavelength either inhibited the release of these factors or encouraged the release of some inhibitory factors of fibroblast proliferation.
These results suggest that light at certain wavelengths may be a useful therapeutic agent by providing a means of either stimulating or inhibiting fibroblast proliferation where necessary. At certain wavelengths coherence is not essential.
Endogenous and sun-induced aging of the skin cause distinct morphological alterations. In this study, we have analysed the ratio of collagen III to collagen III plus I in extracts of sun-exposed (face) and sun-protected (abdomen) aged skin, as well as in collagens synthesized by fibroblasts during in vitro culture derived from actinically damaged and sun-protected skin of other subjects (face, medial aspect of the upper arm vs. abdomen, lateral aspect of the forearm). Furthermore, the amount and extent of post-translational modifications of newly synthesized collagens were determined. Chronic sun exposure of the skin does not have an impact on the quantity of collagenous proteins newly synthesized in cell culture. The proportion of collagen III in pepsin extracts of sun-damaged skin is increased relative to sun-protected skin. However, fibroblasts derived from sun-exposed skin synthesize a lower proportion of collagen III than cells from sun-protected skin. The hydroxylation of lysyl residues in newly synthesized alpha 2(I) and alpha 1(III) collagen chains is reduced by UV irradiation, whereas hydroxylation of lysyl residues in alpha 1(I) chains and of prolyl residues in alpha 1(I), alpha 2(I) and alpha 1(III) chains is unaffected by UV irradiation. These data provide circumstantial evidence to indicate that collagen synthesis is influenced independently by endogenous and sun-induced aging.
At the cellular and molecular levels, the limited ability of aged fibroblasts and keratinocytes to respond to changes in their environments fits nicely the concept of aging as inability of the organism to respond adaptively to environmental changes. Whether these molecular changes represent cumulative random genetic damage or programmed aging process cannot be determined. Nevertheless, the data correlate with the well-known differences in biologic responsiveness between newborn, young adult, and old adult cells. Thus, our findings represent a beginning from which more comprehensive understanding of molecular changes involved in cutaneous aging will evolve.
Aging of the skin is a composite of actinic damage, chronologic aging, and hormonal influences. The majority of changes associated with aging, such as wrinkles and solar lentigines ("liver spots"), are due to photoaging and reflect cumulative sun exposure as well as skin pigmentation. Classically, chronologic aging includes those cutaneous changes that occur in non-sun-exposed areas, such as the buttocks, and are observed in both men and women. A clinical example would be soft tissue sagging due to elastic fiber degeneration. In women, investigations into the effect of hormones on aging of the skin have concentrated on estrogens; in men, there have been a limited number of studies on the influence of testosterone. The latter have shown an age-dependent decrease in tissue androgens in pubic skin, but not scrotal or thigh skin. To date, age has not been shown to have an effect on androgen receptor binding, although a decrease in foreskin 5 alpha-reductase activity with increasing age has been described. In fibroblast cultures from foreskins, there have been conflicting results as to whether 5 alpha-reductase activity decreases in an age-dependent manner. Some of the skin changes that have been categorized as secondary to chronologic aging, such as decreased sebaceous gland activity and decreased hair growth, may actually represent a decline in the concentration of tissue androgens with increasing age. The influence of androgens on age-related changes in keratinocyte and fibroblast function remains speculative.
Using recently designed, commercially available, non-invasive instruments, we measured the thickness and elasticity of the skin of the face and ventral forearm in 170 women, and evaluated the effects of age and exposure to sunlight. Skin thickness decreased with age in ventral forearm skin, which has limited exposure to sunlight, but increased significantly in the skin of the forehead, corners of the eyes, and cheeks, which are markedly exposed to sunlight. Skin elasticity (Ur/Uf) decreased with age on both the face and forearm. The ratio of viscosity element to elasticity element (Uv/Ue) increased with age at all sites. However, delayed distension (Uv), immediate retraction (Ur), final distension (Uf), and immediate distention (Ue), as individual elements, decreased on the face and increased on the forearm with age. This tendency was more marked after correction for skin thickness. These results suggested the specificity of skin thickness and elasticity in the facial skin. Analysis using a four-element model showed no changes in the elasticity coefficient of Maxwell element on the forearm, but an increase on the face. This indicates quantitative or qualitative changes in elastic fibres in facial skin. Thus, sunlight appears to have a considerable effect on the thickness and physical properties of facial skin.
One of the most interesting medical conditions that now afflicts the baby boomer generation is photoaging. Clinical signs of photoaging of the skin include rhytids, lentigines, keratoses, telangiectasia, loss of translucency, loss of elasticity, and sallow color. A systematic classification of patient photoaging types has been developed by the author: type I, "no wrinkles"; type II, "wrinkles in motion"; type III, "wrinkles at rest"; and type IV, "only wrinkles." The intent is to organize the discussion of therapies for photodamaged skin to permit rational comparisons of therapies and clinical results.
Although the prevention of skin aging is a holy grail of the cosmetic and pharmaceutical industries, this venture may be misplaced. The predominant clin ical and biochemical features of aged skin are mostly attributable to photoaging rather than chronology. For instance chronic sun exposure is the major determi nant of age spots (actinic lentigines) and wrinkles.
Surgical approaches to the treatment of photoaging include face-lift, derm-abrasion, chemical peeling, collagen and botulinum toxin injections, and laser re-surfacing. These approaches all have benefit and improve the clinical features of facial photoaging.
Drug or pharmaceutical prevention and treatment of photoaged skin is still in its infancy. The main pharmaceutical approach to prevention of photoaging lies in the assiduous use of sunscreens. Recent evidence points to the importance of ultra violet A (UVA) radiation as well as ultraviolet B (UVB) radiation in the aetiology of photoaging and thus the need for sunscreens that block both UVB and UVA.
Drug treatment of photoaged skin can be categorised as antioxidants, α-hydroxy acids and topical retinoids. Of these 3 approaches only topical retinoids, particularly tretinoin (all-trans retinoic acid), have a well documented ability to repair photoaged skin at the clinical, histological and molecular level. Further more, the use of topical retinoids may actually prevent photoaging. The current interest in pharmaceutical modulation of the photoaging process has attracted considerable research into the mechanisms of photoaging and cutaneous aging. It is likely that treatment for, or prevention of, the chronological aging process may result from such research.
Cutaneous aging includes true aging and photo-aging due to sun exposure. A decrease in epidermal turnover rate results in epidermal atrophy and delayed wound-healing. A reduction in the number of epidermal Langerhans' cells is responsible for a decrease in delayed immune responsiveness in skin observed in the elderly. Reduced numbers of fibroblasts and mast cells are typical histologic findings in aging human dermis. Collagen bundles become fragmented, less elastic and more brittle. Telomere shortening at the end of chromosomes is probably the major mechanism of cellular senescence in skin. Common skin tumors and other major age-related changes in the skin of the elderly are described.
Cutaneous ageing is a complex biological phenomenon consisting of two components; intrinsic ageing, which is largely genetically determined and extrinsic ageing caused by environmental exposure, primarily UV light. In sun-exposed areas, these two processes are superimposed. The process of intrinsic skin ageing resembles that seen in most internal organs and is thought to involve decreased proliferative capacity leading to cellular senescence, and altered biosynthetic activity of skin derived cells. Extrinsic ageing, more commonly termed photoageing, also involves changes in cellular biosynthetic activity but leads to gross disorganisation of the dermal matrix. The molecular mechanisms underlying some of these changes are now beginning to be unravelled and are discussed. As these mechanisms are identified, further insights into the underlying processes of skin ageing should emerge and better strategies to prevent the undesirable effects of age on skin appearance should follow.
To determine the efficacy and safety of 0.1% tazarotene cream for the treatment of photodamage.
A 24-week multicenter, double-blind, randomized, vehicle-controlled intervention study followed by a 28-week open-label extension.
Ambulatory patients in private and institutional practice.
Of 563 patients with facial photodamage, 91% and 86% completed the double-blind and open-label phases, respectively. In the double-blind phase, 20 of 283 tazarotene-treated patients and 1 of 280 vehicle-treated patients discontinued treatment owing to adverse events.
Once-daily application of 0.1% tazarotene cream or nonmedicated vehicle cream to the face for 24 weeks. Then, all continuing patients received treatment with 0.1% tazarotene cream for another 28 weeks.
Primarily, fine wrinkling and mottled hyperpigmentation. Also, lentigines, elastosis, pore size, irregular depigmentation, tactile roughness, coarse wrinkling, telangiectasia, actinic keratoses, overall integrated assessment of photodamage, global response to treatment, patients' overall assessment of photodamage, and plasma levels of tazarotenic acid.
Compared with the vehicle, at week 24 tazarotene resulted in a significantly greater incidence of patients achieving treatment success (>or=50% global improvement) and at least a 1-grade improvement in fine wrinkling, mottled hyperpigmentation, lentigines, elastosis, pore size, irregular depigmentation, tactile roughness, coarse wrinkling, and the overall integrated assessment of photodamage (P<.01). Additional clinical improvement occurred with continued tazarotene treatment and had not plateaued by week 52. Plasma tazarotenic acid concentrations did not exceed 0.71 ng/mL.
Once-daily applications of 0.1% tazarotene cream significantly reduced multiple signs of photodamage. Plasma levels of tazarotenic acid remained below those of endogenous retinoids.
Aging of skin is a continuous process that may be enhanced by sun exposure. Photoaging may provoke changes different from aging. Epidermal changes involve thinning of stratum spinosum and flattening of the dermo-epidermal junction. The senescent keratinocytes becomes resistant to apoptosis and may survive for a long time giving time for DNA and protein damage to accumulate with possible implication for carcinogenesis. The numbers of melanocytes decrease with age with dysregulation of melanocyte density resulting in freckles, guttate hypo-melanosis, lentigines and nevi. The number of dendritic Langerhans cells also decreases with age and the cells get less dendrites and have reduced antigen-trapping capacity. Aging involves dermal changes such as damage to elastic and collagen fibers giving thickened, tangled, and degraded non-functional fibers. Collagen intermolecular cross-links are stable and essential for stability and tensile strength. Cross-links increase with age converting divalent cross-links into mature trivalent cross-links of, e.g. histidinohydroxylysinonorleucine. Two mechanisms are involved; an enzyme-controlled process of maturation and a non-enzymatic glycosylation, the Maillard reaction leading to cross-links in proteins such as in collagen between arginine and lysine. Such may be seen with age and in diabetes mellitus. However, autofluorescence studies have shown that UVR reduces collagen cross-links. Natural photoprotection involves thickening of stratum corneum by sunlight and increased pigmentation. This leads to a factor 2 increase in photoprotection from spring until after-summer. The constitutive pigmentation is independent of age and thickness of stratum corneum is likewise independent of age. The minimal erythema dose is thus the same through life, when corrected for pigmentation or measured in areas with constitutive pigmentation.
Tazarotene Cream Photodamage Clinical Study Group. Efficacy of 0.1% tazarotene cream for the treatment of photodamage: a 12-month multi-center, randomized trial
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Phillips TJ, Gottleib AB, Leyden JJ, Lowe NJ, Lew-Kaya DA, Sefton J, et al; Tazarotene Cream Photodamage Clinical Study Group. Efficacy of 0.1% tazarotene cream for the treatment of photodamage: a 12-month multi-center, randomized trial. Arch Dermatol. 2002;138(11): 1486–93.
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Lasers in Photomedicine and Photobiology
- R Pratesi
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