Enhancement of Facial Rejuvenation Through a Combination of 1565 nm Non-Ablative Fractional Laser with 30% Supramolecular Salicylic Acid

Podsumowanie

The purpose of this project is to effectively reduce the occurrence of adverse reactions such as erythema and pigmentation after non-ablative fractional laser treatment by combining 1565 non-ablative fractional laser with 30% super molecular salicylic acid, providing patients with a safer new method of facial rejuvenation treatment.

Streszczenie

The 1565 nm non-ablative fractional laser can effectively stimulate collagen regeneration, achieving the effect of skin rejuvenation and anti-aging. In recent years, it has been widely used in dermatology, especially in facial rejuvenation, treatment of stretch marks, and acne scar treatment, with significant results. However, after the 1565 nm non-ablative fractional laser treatment, patients may experience short-term erythema and edema. The inflammation after treatment may also cause pigmentation, making it difficult for some patients to accept. This article introduces a treatment method of 1565 nm non-ablative fractional laser combined with 30% super molecular salicylic acid for facial rejuvenation, effectively reducing posttreatment erythema and post-inflammatory pigmentation. The method includes specific treatment steps and the respective endpoint reactions of each step. The method starts by selecting appropriate energy parameters for the 1565 nm non-ablative fractional laser treatment, followed immediately by the application of 30% supramolecular salicylic acid. The treatment should be stopped when a frosty reaction occurs. The purpose of this project is to provide patients with a safer new method of facial rejuvenation treatment.

Wprowadzenie

Facial aging usually refers to the changes that occur after aging, such as bone shrinkage and deformation, soft tissue relaxation and sagging, increased skin pigmentation, and wrinkles, among which the aging of the skin is the most obvious¹. The causes of facial aging are divided into exogenous and endogenous factors. Exogenous aging is caused by gravity, UV radiation, air pollution, smoking, excessive alcohol consumption, and malnutrition, among other factors². Endogenous aging is mainly an inevitable aging process caused by genetics and age. With the pursuit of a beautiful image by those seeking beauty, various technologies and treatment concepts have emerged. Among them, photonic beauty treatments have developed rapidly in the treatment of facial aging in recent years. According to statistics from the International Society of Aesthetic Plastic Surgery, the number of patients undergoing photonic beauty treatments in the United States in 2020 increased by 15.2% compared to 2019³.

Currently, there are various laser devices available for treating skin aging. These lasers are primarily used to reduce wrinkles and improve enlarged pores and can be categorized as ablative or non-ablative lasers. Non-ablative lasers, such as different wavelengths of erbium-doped glass (Er:Glass) lasers (1540 nm, 1550 nm, 1565 nm), are representative instruments for this purpose, with the ResurFX fiber optic laser being the most commonly used. The 1565 nm laser emitted by ResurFX can stimulate dermal collagen remodeling while maintaining the integrity of the epidermis. It has shown good efficacy and high safety for the treatment of periorbital wrinkles⁴. A prospective study has confirmed that non-ablative fractional lasers can improve various facial skin concerns, such as laxity, wrinkles, and coarse pores, among Asian patients, and the patients were satisfied with the treatment outcomes⁵. However, posttreatment complications such as pain, erythema, edema, crust formation, inflammatory hyperpigmentation, and acne eruptions were reported in 100% of cases treated with non-ablative fractional lasers. Currently, in order to alleviate the adverse reactions during and after non-ablative fractional laser treatment, methods include a topical anesthetic ointment that can be applied before treatment to improve treatment tolerance, and an adequate cold compress after laser treatment can shorten the duration of erythema and edema⁶. However, these treatments have limited effects in reducing pain and erythema edema and still cannot make all patients accept non-ablative fractional laser treatment.

Salicylic acid (SA) is a β-hydroxy acid extracted from willow bark, etc.⁷, with a concentration of 2% ~ 30%. SA can remove lipids between cells, reduce the adhesion of keratin-forming cells, and cause these cells to loosen and subsequently separate⁸. In addition, it has antibacterial, antifungal, and some anesthetic effects⁹. However, SA has poor solubility in water and easily precipitates in low-pH alcohol solutions and irritating solvents to the skin. To solve these limitations, supramolecular SA (SSA) was introduced. It forms water-soluble supramolecular entities in the form of intermolecular complexes through reversible non-covalent bonding and releases slowly during use, reaching maximum efficacy under low-pH conditions and reducing skin irritation¹⁰. Zhang et al.⁹. measured skin hydration, transepidermal water loss (TEWL), pH value of skin barrier-related parameters. After four treatments, TEWL decreased, while skin hydration and pH values increased. These results suggested that 30% of SSA peels did not damage the skin barrier function but improved instead.

Therefore, some scholars advocate the use of non-ablative fractional laser combined with SSA chemical peel treatment to improve problems such as large pores and acne¹¹. However, according to the author's experience, the immediate use of SSA chemical peel treatment after 1565 nm non-ablative fractional laser treatment has not been fully utilized in clinical practice, which may be due to different treatment sequences in previous clinical practice. This article introduces a new treatment method to improve the adverse reactions after 1565 nm non-ablative fractional laser treatment, combined with relevant visual aids, in order to help more patients receive 1565 nm non-ablative fractional laser treatment for facial rejuvenation.

Protokół

All procedures carried out in research involving human participants were in accordance with the approval of the Ethics Review Committee of the First Affiliated Hospital of Chongqing Medical University (Research Ethics in 2023 [2023-119]). Informed consent was obtained from the patients before undergoing the procedure.

1. Pretreatment preparation

1. Lesion selection and clinical indications
   1. Patient selection
      1. Select female patients with Fitzpatrick skin type III-IV¹² and clinical symptom quantitative score of facial aging > 9 points¹³.
      2. Exclude patients who fall into any of these categories: pregnant and breastfeeding women; patients with a history of allergy to lidocaine and/or salicylic acid; patients with malignant tumors, scars, diabetes, neuromuscular diseases, bleeding tendency, anticoagulants, glucocorticoids or immunosuppressive drugs; patients who have received laser or other treatments within the past 6 months.
   2. Patient preparation
      1. After cleaning the patient's face, use the skin detector to perform a skin test.
      2. Then, apply the compound lidocaine cream externally to the treatment area and leave it for 40 min. Afterward, wash the entire face with water and dry it with sterile gauze.
2. 1565 nm non-ablative fractional laser device parameter settings.
   1. Choose the 1565 nm non-ablative fractional laser device (ResurFX mode) (as shown in Figure 1) for comprehensive facial treatment on the patient.
   2. Set the energy level using the Energy Setting key, usually between 30-40 mJ, with the desired endpoint reaction being erythema and mild edema, which generally appear tens of seconds after treatment and, in rare cases, occur minutes later.
   3. Adjust the treatment density using the Density Setting key, usually between 200-300 spots/cm², with the desired endpoint reaction being erythema and mild edema.
3. Have the patient lie comfortably on the treatment bed, with the doctor sitting at the head end of the bed. Disinfect the entire treatment area with iodophor, remove the iodine with sterile saline, and then dry the area with sterile gauze.
4. Disinfect the treatment head of the device with a 75% alcohol pad.
   NOTE: Both the doctor and the patient should wear specific protective goggles in preparation for the treatment.

2. Treatment

1. Enter the treatment interface and select the ResurFX mode (as shown in Figure 2).
   1. Choose the appropriate spot size and shape, and click Ready on the instrument interface (Figure 3). Gently place the treatment head on the skin surface of the treatment area and press the Trigger button on the treatment instrument to start the treatment.
   2. After the treatment prompt sound stops, release the Trigger button, lift the handle, and select the next treatment area for treatment. Ensure that the treatment spots do not overlap. Treat the entire face for 1 time.
   3. Keep the skin area dry during the treatment process. During each energy emission process, firmly adhere the treatment head to the skin surface.
   4. Test the spot at the lower jaw or in front of the ear first, with the endpoint reaction being redness and slight edema, before performing a large-area treatment. During the entire treatment process, cover the patient's eyes with an eye mask (provided by the instrument manufacturer) to protect the patient's eyes.
2. Perform non-ablative fractional laser treatment of the face with 1565 nm energy.
   1. Minimize overlap between each spot. Different parts require different suitable parameters. For example, patients with Fitzpatrick III/IV generally require a treatment energy of 30-35 mJ and a density of 200-250 spots/cm² for the forehead.
   2. Set the treatment energy for the cheek area to 35-40 mJ and the density to 200-250 spots/cm². Set the treatment energy for the nose to 35-40 mJ and the density to 250-300 spots/cm².
   3. After the entire face is treated, click Standby on the instrument treatment interface to place the instrument in standby mode.
3. Apply 30% supramolecular salicylic acid immediately after the whole-face laser treatment.
   NOTE: The application order is generally forehead, nose, chin, cheeks, and temples.
4. Gently massage for 5-10 min.
   1. After evenly applying SSA to the entire face, gently massage in a circular motion with fingers wearing latex gloves to promote absorption.
      NOTE: The specific reaction time depends on the appearance of the endpoint reaction, which is facial redness or white frost reaction.
   2. Rinse off with water immediately when the endpoint reaction appears. If the reaction time has reached 10 min but the end point reaction does not appear, rinse off with water immediately.

3. Posttreatment care

1. Apply cold saline gauze for 30 min immediately after treatment.
2. Do not clean the face for 3 days after the treatment. Apply moisturizing and repairing products externally and pay attention to sun protection.
   NOTE: After the treatment, there may be slight scabbing on the face. It is not recommended to use sunscreen and facial makeup before the scabs fall off. Items for physical sun protection, such as a mask, hat, or parasol, can be chosen. Patients must not wash their face for 3 days but could gently wipe it with normal saline.

Wyniki

The 1565 nm non-ablative fractional laser can improve facial aging, such as pores, texture, and brown spots. However, the combination of a 1565 nm non-ablative fractional laser with SSA can effectively reduce adverse reactions such as erythema and pigmentation while improving facial aging. The right side of the patient's face was treated with a 1565 nm non-ablative fractional laser, while the left side was treated with a 1565 nm non-ablative fractional laser combined with 30% supramolecular salicylic acid. At 14 days...

Dyskusje

1565 nm non-ablative fractional laser can effectively stimulate collagen rearrangement, achieving the effect of rejuvenation and anti-aging. It is used in the treatment of facial rejuvenation, stretch marks, and acne scars¹⁴. However, after 1565 nm non-ablative fractional laser treatment, there may be obvious pain and redness immediately, and posttreatment inflammation pigmentation easily occurs, which makes it difficult for some patients to accept. In this article, we described an effective metho...

Materiały

Name	Company	Catalog Number	Comments
ResurFX fiber optic laser	Lumenis, Yokneam, Israel	M22 system	1565 nm non-ablative fractional laser
ISEMECO skin detector	Isomeco Biomedical Technology Co., Ltd.,Shanghai, China	MC-2600	Skin testing can be conducted under 5 types of spectrum
Compound lidocaine cream	Beijing Unigroup Pharmaceutical Co., Ltd., China	Guo Yao Quan Zi H20063466	This product is a compound preparation, consisting of prilocaine and lidocaine. Each gram of this product contains 25 mg of prilocaine and 25 mg of lidocaine.
30% supramolecular salicylic acid	BRODA, Shanghai Ruizhi Medical Technology Co., Ltd., China	N/A	It can be used for anti-inflammatory and repairing the skin barrier.