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Introduction: Laser technology has fundamentally transformed the landscape of dermatology, offering nuanced solutions for skin rejuvenation and resurfacing. This paper aims to explore the spectrum of laser technologies, from ablative to non-ablative and fractional lasers, their mechanisms, benefits, and tailored applications for diverse skin conditions. As we delve into the intricacies of each technology, we also consider the scientific advancements that have made these treatments safer and more effective, promising a new horizon in skin rejuvenation., Objective: This comprehensive analysis seeks to evaluate recent advancements in laser technology for skin rejuvenation, focusing on efficacy, safety, and patient satisfaction., Methods: The selection criteria for studies in this publication focused on recent, peer-reviewed articles from the last 20 years, emphasizing advancements in laser technologies for skin rejuvenation. Our comprehensive review involved searches in PubMed, Cochrane, Scopus and Google Scholar using keywords like "skin rejuvenation," "laser technology," "efficacy," "safety," and "dermatology." This approach focused on inclusion of recent research and perspectives on the efficacy and safety of laser treatments in the field of dermatology., Results: Our literature review reveals advancements in laser skin resurfacing technologies, notably fractional lasers for minimal downtime rejuvenation, ablative lasers for precise tissue vaporization, and non-ablative lasers for coagulation effect promoting collagen with reduced recovery. Hybrid and picosecond lasers are highlighted for their versatility and effectiveness in addressing a wide array of skin concerns. The findings also emphasize the development of safer treatment protocols for ethnic skin, significantly reducing risks like hyperpigmentation and scarring, thus broadening the scope of effective dermatological solutions., Conclusion: This extensive review of advancements in laser technologies for skin rejuvenation underscores a remarkable evolution in dermatological treatments, offering an expansive overview of the efficacy, safety, and patient satisfaction associated with these interventions. Furthermore, the exploration of combination treatments and laser-assisted drug delivery represents a frontier in dermatological practice, offering synergistic effects that could amplify the therapeutic benefits of laser treatments., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Hyaluronic acid-based dermal fillers are the cornerstones of wrinkle correction and facial contour redefinition., Objective: To assess the efficacy and safety of EST LF compared with RES L for the treatment of nasolabial folds (NLFs)., Materials and Methods: In this prospective, split-face, randomized, investigator and subject-blinded trial, 45 subjects with moderate-to-severe symmetrical NLFs were randomized to EST LF on one side of the face and RES L on the other side and were followed up for 9 months. The primary end point was change in WSRS score from the baseline to Month 1 (M1). Secondary end points included changes in WSRS score at other time points, aesthetic improvement, wrinkle volume quantification, adverse events, and local tolerance., Results: The efficacy difference between EST LF and RES L at M1 was in favor of EST LF (-0.16, CI, -0.28 to -0.03]), demonstrating its noninferiority. Considering other time points, significant differences were observed at 3 and 6 months for EST LF , assessed with WSRS, GAIS, or NLF volume quantification. Both treatments were well tolerated., Conclusion: EST LF is effective and well tolerated for the treatment of NLFs., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society for Dermatologic Surgery, Inc.)

Alluzience (abobotulinumtoxinA RTU; Ipsen, Paris, France and Galderma SA, Lausanne, Switzerland) is the first ready-to-use (RTU) botulinum toxin type A liquid solution approved for the treatment of glabellar lines in Europe. In this article, the authors provide consensus recommendations on the aesthetic usage of abobotulinumtoxinA RTU. Members of the International Board on Alluzience convened to develop consensus on the treatment of glabellar lines as well as other facial wrinkles based on their own extensive experience. Consensus recommendations were developed to provide practical guidelines for injection of abobotulinumtoxinA RTU. General guidance on proper assessment, treatment planning, and patient education is provided, as well as specific injection guidelines per indication. Indications covered include glabellar lines, crow's feet, horizontal forehead lines, lateral eyebrow lift, lower eyelid wrinkles, bunny lines, drooping nasal tip, perioral wrinkles, drooping mouth corners, masseter hypertrophy, hollow cheek lines, dimpled chin, and platysmal bands. These guidelines provide a practical framework to support routine injection of facial muscles with Alluzience., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: Despite the absence of Phase III clinical trial data to support their use, 3.4% of all neurotoxin treatments performed internationally for esthetic purposes in 2020 were performed in patients 65 years of age and older., Objectives: To investigate the efficacy and safety of prabotulinumtoxinA for the treatment of moderate to severe glabellar lines in the subset of Phase III clinical trial participants who were 65 years of age and older., Methods: Post hoc analyses were performed on all patients who had been treated with a single dose of 20 U prabotulinumtoxinA in the three 150-day, placebo-controlled Phase III glabellar line clinical studies. Patients were grouped by age: ≥65 years (n = 70) versus <65 years (n = 667). The endpoints of primary interest were the proportion of responders with a ≥1-point improvement from baseline at maximum frown on the 4-point Glabellar Line Scale and treatment-related adverse events., Results: For the efficacy endpoint of primary interest, responder rates among patients 65 years of age and older were numerically less than those of patients less than 65 years by an absolute mean difference of just -2.7% across all visits; none of the differences at any visit were statistically significant. The most common treatment-related adverse event was headache, occurring in 5.7% of those 65 years of age and older and in 9.7% of those less than 65 years., Conclusions: 20 U prabotulinumtoxinA administered for the treatment of glabellar lines was efficacious in patients 65 years of age and older; it was also well tolerated by this cohort., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Age-related changes of facial soft tissue cause clinical signs of facial aging such as lip atrophy, marionette lines, and an accentuated nasolabial fold. These changes can be modified using dermal fillers., Aims: To evaluate efficacy, longevity, and safety of a cross-linked hyaluronic acid-based filler with Tri-Hyal technology in the treatment of lips, nasolabial folds, and marionette lines., Materials and Methods: This prospective, multi-center trial evaluated injections of three different areas (lips, nasolabial fold alone, or with marionette wrinkles) with a soft tissue filler containing 25 mg/ml cross-linked hyaluronic acid and 0.3% lidocaine. Primary endpoint was the aesthetic correction 3 weeks after one injection session without touch-up. Follow-up was 18 months. Assessments were performed using the Global Aesthetic Score (GAS), clinical scoring based on photographic scales, high-frequency ultrasound imaging, and the Global Aesthetic Improvement Scale (GAIS)., Results: In total, 100 subjects were injected. GAS improved significantly for all treatment indications at 3 weeks (p < 0.0001). Success rates were highest for nasolabial folds (98.4%), followed by marionette lines (94.4%) and lips (73.5%). After 18 months post-injection, success was observed in 91%, 88%, and 33% of subjects injected into nasolabial folds, marionette lines, and lips, respectively. GAIS scored highest for nasolabial folds (SGAIS: 71%; IGAIS: 40%), followed by marionette lines (SGAIS: 56%; IGAIS: 33%) and lips (SGAIS: 30%; IGAIS: 22%) at 18 months follow-up., Conclusions: The filler demonstrated high efficacy and safety in all indications. Regional differences in longevity were evident. Thus, the necessity of regional retreatments should be discussed with patients before injection., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

The beneficial role of subcutaneous adipose tissue in skin rejuvenation derived from its capacity to fill the under-layer volumes but also from its ability to regulate the extracellular matrix production by dermis fibroblasts. Hyaluronic acid (HA), a major component of the extracellular matrix, is a commonly used injectable dermal filler showing excellent efficiencies to maintain tissue augmentation even after its biodegradation. To improve their stability, the HA molecules can also be "cross-linked" to each other. The effects of cross-linked HA-based fillers on the dermal structure are well known. For safety reasons, most of the physicians prefer to use the blunt cannula for injections. However, evidences showed that the cannula could not be located in the dermis, but it passes through immediate hypodermis and the long-lasting effect of cross-linked HA-based fillers may be related to its effects on adipose tissue. To test whether cross-linked HA has a direct effect on human adipocytes, we treated isolated adipocytes and precursors cells from human skin donors with cross-linked HA. Biochemical and cellular analysis demonstrated that treatment by cross-linked HA showed beneficial effects on differentiated cell adherence and survival as well as reduced basal and induced lipolysis in fully mature adipocytes. Taken together, these data showed that cross-linked HA promoted cell adherence and preserved the adipogenic capacity of preadipocytes during prolonged cell culture, bringing additional evidences of the beneficial role of cross-linked HA-based fillers in maintenance of the subcutaneous fat mass. This first study could defend a preventive approach to facial volume loss during natural aging., (© 2020 Laboratoires FILLMED. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: PrabotulinumtoxinA is a 900-kDa botulinum toxin type A produced by Clostridium botulinum., Objectives: The authors sought to investigate the efficacy and safety of prabotulinumtoxinA compared to onabotulinumtoxinA and placebo for the treatment of glabellar lines., Methods: This was a 150-day, multicenter, double-blind, controlled, single-dose Phase III study. Adult patients (n = 540) with moderate to severe glabellar lines at maximum frown as assessed by the investigator on the validated 4-point Glabellar Line Scale (0 = no lines, 1 = mild, 2 = moderate, 3 = severe), who also felt that their glabellar lines had an important psychological impact, were enrolled. Patients were randomized 5:5:1 to receive a single treatment (0.1 mL injected into each of 5 glabellar sites) of 20 U prabotulinumtoxinA (n = 245), 20 U onabotulinumtoxinA (n = 246), or placebo (n = 49). The primary efficacy endpoint was the proportion of responders (patients with a Glabellar Line Scale score of 0 or 1 at maximum frown by investigator assessment) on day 30., Results: Responder rates for the primary efficacy endpoint were 87.2%, 82.8%, and 4.2% in the prabotulinumtoxinA, onabotulinumtoxinA, and placebo groups, respectively. The absolute difference between prabotulinumtoxinA and onabotulinumtoxinA groups was 4.4% (95% confidence interval [-1.9, 10.8]). Given that the lower bound of the 95% confidence interval for the difference was less than -10.0%, noninferiority of prabotulinumtoxinA vs onabotulinumtoxinA was concluded. Five patients (3 prabotulinumtoxinA, 1.2%; 1 onabotulinumtoxinA, 0.4%; 1 placebo, 2.0%) experienced serious adverse events, none of which were study drug related., Conclusions: A single treatment of 20 U prabotulinumtoxinA was safe and effective and noninferior to 20 U onabotulinumtoxinA for the treatment of moderate to severe glabellar lines., (© 2019 The Aesthetic Society.)

Background: Botulinum toxins are the treatment of choice for wrinkles in the upper third of the face., Objective: The purpose of this study was to evaluate the efficacy, safety, and subject satisfaction of abobotulinumtoxinA (ABO) for treatment of upper facial lines., Materials and Methods: Subjects aged 35 to 50 years with moderate-to-severe upper facial lines were included in this study. Subjects received a maximum of 125 s.U. ABO in at least 2 indications with optional touch-up after 2 weeks. Assessments included wrinkle severity, global aesthetic improvement, subject satisfaction, and adverse events (AEs) 1, 3, and 6 months after treatment., Results: At Month 1, 100, 94, and 93% of subjects were responders in dynamic glabellar, lateral canthal, and forehead lines, respectively. All subjects were improved 1 month after treatment, and the majority of the subjects were still improved after 6 months. After treatment, most subjects were satisfied with the appearance of their face, felt better about themselves, and agreed that the treatment made them look the way they feel. Seven subjects (22%) had 8 ABO-related AEs (mild-moderate); headache was most commonly reported (9%)., Conclusion: AbobotulinumtoxinA effectively treated upper facial lines, with high patient satisfaction. Treatment was generally well-tolerated.

Background: Jawline reshaping by replacing volume has become an indispensable component of modern facial rejuvenation., Aim: To evaluate calcium hydroxylapatite (CaHA) for the treatment of an aging jawline in a routine setting., Methods: Five investigators enrolled 35 subjects requesting jawline rejuvenation with CaHA. Injections were performed according to investigators usual practice. Baseline and post-treatment scores were evaluated using Merz Aesthetics Scales®. Follow-up visits took place at Day 30 (Day 60 for those with touch-up at Day 30), 180, and 360. Physician and patient satisfaction, esthetic impact of treatment, and adverse events were recorded., Results: Improvements in jawline contour compared with baseline were statistically significant at each visit, with scores of 2.42 (moderate to severe sagging) at baseline, 1.02 (mild) at Day 30/60 (P≤.0001), 1.11 at Day 180 (P≤.0001), and 1.45 at Day 360 (P=.0015). Statistically significant improvements in marionette line scores were also observed. Investigators rated results as "improved" to "very much improved" in all subjects up to Day 180, and in 81% of subjects at Day 360. Satisfaction with treatment was very high. Adverse events were mostly mild and related to either the procedure or injection technique., Conclusion: CaHA is a very effective agent for restoring jawline contour in routine practice and is associated with high levels of physician and patient satisfaction., (© 2017 Wiley Periodicals, Inc.)

Background: Age-associated volume loss is now known to play an important role in the structural changes of the aging face. In the lower face, this manifests as drooping of the corners of the mouth and jowl leading to a loss of the oval jawline of youth. Jawline reshaping by replacing volume has therefore become an indispensable component of modern facial rejuvenation., Aim: Calcium hydroxylapatite (CaHA; Radiesse® , Merz Pharmaceuticals GmbH, Frankfurt, Germany) is an injectable filler with a cosmetic indication for tissue augmentation. The ability of calcium hydroxylapatite to provide immediate and long-lasting volume enhancement makes it an ideal agent for restoring an oval jawline., Method: This consensus statement has been developed to assist clinicians who would like to gain more experience in the use of volumizing agents to achieve an optimal outcome with this procedure., Results: Using the recently developed Merz Aesthetics Scale® for jawline, the consensus provides a treatment protocol for individuals at each stage of oval loss and presents a series of before and after images to illustrate the improvements that can be achieved. Specific recommendations for calcium hydroxylapatite including type of anesthesia, injection techniques, volume for injection, use in combination with other procedures, and expected duration of corrections are provided. Techniques for minimizing and managing expected problems and potential complications are also described., Conclusion: Calcium hydroxylapatite is appropriate for treating patients at any stage of oval loss., (© 2014 Wiley Periodicals, Inc.)

Background: Emervel consists of a range of 5 hyaluronic acid (HA) fillers (Touch, Classic, Lips, Deep, and Volume), with a fixed HA concentration (20 mg/mL), and various degrees of cross-linking and calibration., Objectives: To describe the current use of Emervel fillers in France., Methods: Prospective multicenter, cross-sectional, real-practice, descriptive survey, including 1,822 patients injected with Emervel fillers for face rejuvenation by 58 French physicians between September 2010 and July 2011. The injection modalities were left to the respective physician's discretion., Results: The physicians were dermatologists (52.3%), surgeons (43.8%), or general practitioners (14.1%). Nasolabial folds (NLF) with a mean severity 2.4 were mainly injected with Emervel Deep (51.0%) and Emervel Classic (36.0%) (mean volume: 1.0 mL), and primarily with the linear retrograde (LR) technique (89.3%). Marionette lines (ML), with a mean severity 2.6 were mainly injected with Emervel Deep (52.5%) and Emervel Classic (34.6%) (mean volume: 0.8 mL), and mainly with the LR technique (79.5%). More than 90% of patients had scores of 0 or 1 for erythema, bruising, edema, and pain. No serious adverse events were reported up to 15 months after the injection., Conclusion: These data could contribute to upcoming international consensus on optimal injection modalities of the Emervel range of HA fillers.

Background: Skin roughness, color change, wrinkles and skin laxity are the main characteristics of aging skin. Dermatologists and plastic surgeons look for a treatment that will provide both epidermal resurfacing for the improvement of skin roughness and deep volumetric heating that will trigger collagen remodeling in the dermis to reduce wrinkles and skin laxity. These goals should be achieved with minimal pain and downtime., Methods: The study included 10 subjects (Fitzpatrick's skin type 2-3) with Fitzpatrick wrinkle and elastosis scale of 5-8 (average 7.3). Treatment was done with the Fractional skin resurfacing handpiece of the EndyMed PRO multisource radiofrequency system (EndyMed Ltd, Cesarea, Israel). Treatment was repeated each month up to a total of three treatment sessions. Patients photographs were graded according to accepted scales by a board certified dermatologists. Patients' pain and satisfaction were scored using dedicated questionnaires. Doctors' satisfaction was also evaluated., Results: Post treatment skin erythema was noted in all treated patients, lasting up to 10 hours. Fifty six percent of patients reported no pain after treatment, and the rest (44%) reported minimal pain. All patients showed significant reduction in the Fitzpatrick wrinkle score. Average Fitzpatrick wrinkle score was 7.3 at baseline, 4.9 at 1 month after the first treatment, 4.2 at 1 month after the second treatment, and 4.1 at 1 month after the third treatment. The score was similar at 3 months after the third treatment with a score of 4.1. When asked at the end of three treatment sessions, all patients answered they will recommend the treatment to their friends (66% "definitely yes" and 33% "yes"). When asked the same question 3 months after the end of treatment, all patients (100%) answered "definitely yes".

Background: The periorbital region is a challenging area for injectable filler. Overcorrection and/or the use of unsuitable fillers may lead to unwanted results. As evidence for this region is limited, most physicians follow a trial and error approach., Objective: Assess the efficacy, patient satisfaction, and safety of the HA E filler range in periorbital rejuvenation., Materials and Methods: This was a multi-center, six-month, open-label study. Subjects could receive HA E Touch, HA E Classic, and HA E Deep for the treatment of tear troughs and periorbital lines at baseline, and an optional touch-up three weeks later. Global aesthetic improvement for both indications, periorbital wrinkle assessments (Lemperle Rating Scale), 3-D volume analysis (for tear troughs only), adverse events and injection site reactions were evaluated at each visit. A subject satisfaction questionnaire was performed three weeks after last injection., Results: Overall, HA E Classic and Deep were infected for tear troughs, and HA E Touch for periorbital lines. Mean aesthetic improvement in tear troughs was 1.5-2 grades for both products at each post-baseline visit, and results of the clinical evaluation were confirmed by results of 3-D volume analysis. Improvements of periorbital lines in both aesthetic outcomes and wrinkle severity were around 1.5 grades at week 3, and close to 1 grade at month 6. The majority of subjects were satisfied or very satisfied with their aesthetic outcome. Treatments of both indications were safe and well-tolerated, with only mild and transient injection site reactions reported., Conclusions: This HA E filler range is suitable for rejuvenation of the periorbital region, which leads to safe results, long-lasting efficacy and high levels of patient satisfaction.

Background: Injectable fillers are frequently used to restore volume and correct wrinkles in perioral region. However, evidence for perioral indications is scarce., Objective: Assess the efficacy, patient satisfaction, and safety of new range of hyaluronic acid fillers (HA E) in perioral enhancement., Materials and Methods: This was a multi-center, six-month, open-label study. At baseline, subjects could receive HA E Touch, HA E Classic, HA E Lips and HA E Deep for the treatments of lips, upper lip lines, nasolabial folds and marionette lines, and a touch-up infection was optional three weeks later. Lip Fullness Grading scale (for lips), wrinkle assessments (Lemperle Rating Scales for the remaining indications), adverse events, and local tolerance were evaluated at each visit, and 3-D volume analyses (for nasolabial folds and lips only) at each post-baseline visit. Optimal correction was defined as results obtained three weeks after last injection. A subject satisfaction questionnaire was performed three weeks after last infection., Results: Overall, HA E Lips was infected for lip enhancement, HA E Thouch and HA E Classic for upper lip lines, and HA E Classic and HA E Deep for both nasolabial folds and marionette lines. After six month, around a 1-grade improvement persisted according to the lip fullness and wrinkle assessment scales. The long duration of effect was confirmed by 3-D analyses, with 62.7-71.4 percent of volumes obtained at week 3 (optimal correction) maintained after six months. The majority of subjects (from 80% for upper lip lines with HA E Classic to 94.8% for nasolabial folds with HA E Deep) were satisfied or very satisfied with their aesthetic outcome. All products were safe and well-tolerated., Conclusions: Perioral enhancement with HA E fillers led to sustained effect in terms of lip fullness, wrinkle and 3-D volume assessments, and high subject satisfaction.

Background: Increasing volume is an important part of facial rejuvenation since volume loss is common and typically age-related. HA E Volume is a moderately firm gel designed to be injected into the subcutaneous tissue for volume enhancement., Objective: To assess the efficacy, patient satisfaction, and safety fo HA E Volume in patients with bilateral volume loss of the cheeks., Materials and Methods: This was a multi-center, six-month, open-label study. Subjects received HA E in the cheeks at baseline, and a touch-up injection was optional three weeks later. Global aesthetic improvement, cheek thickness (caliper measurements),changes in volume using three-dimensional (3-D) photo analysis, adverse events and injection site reactions were evaluated at each visit. Optimal correction was defined as results obtained three weeks after last injection. A subject satisfaction questionnaire was performed three weeks after the last injection., Results: Investigators evaluated the great majority of subjects as much or very much improved in terms of aesthetic improvement of their cheeks at week 3 and at mounts 3 and 6 (89.3%, 90.9%, and 76.4%, respectively). After six months, 65.8 percent of the correction achieved at week 3 (optimal correction) was maintained in terms of cheek thickness (caliper assessments), confirmed by 67.7 percent of the volume maintained based on 3-D volume analyses. The majority of subjects (92.1%) were satisfied or very satisfied with their aesthetic outcome. A good tolerability profile was observed., Conclusions: Treatment with HA E Volume in cheeks led to good aesthetic improvement, sustained results confirmed by caliper and 3-D volume assessments, and high subject satisfaction.

ABSTRACT Background Methods Results Conclusion The complex ecosystem of the skin microbiome is essential for skin health by acting as a primary defense against infections, regulating immune responses, and maintaining barrier integrity. This literature review aims to consolidate existing information on the skin microbiome, focusing on its composition, functionality, importance, and its impact on skin aging.An exhaustive exploration of scholarly literature was performed utilizing electronic databases including PubMed, Google Scholar, and ResearchGate, focusing on studies published between 2011 and 2024. Keywords included “skin microbiome,” “skin microbiota,” and “aging skin.” Studies involving human subjects that focused on the skin microbiome's relationship with skin health were included. Out of 100 initially identified studies, 70 met the inclusion criteria and were reviewed.Studies showed that aging is associated with a reduction in the variety of microorganisms of the skin microbiome, leading to an increased susceptibility to skin conditions. Consequently, this underlines the interest in bacteriotherapy, mainly topical probiotics, to reinforce the skin microbiome in older adults, suggesting improvements in skin health and a reduction in age‐related skin conditions. Further exploration is needed into the microbiome's role in skin health and the development of innovative, microbe‐based skincare products. Biotherapeutic approaches, including the use of phages, endolysins, probiotics, prebiotics, postbiotics, and microbiome transplantation, can restore balance and enhance skin health. This article also addresses regulatory standards in the EU and the USA that ensure the safety and effectiveness of microbial skincare products.This review underscores the need to advance research on the skin microbiome's role in cosmetic enhancements and tailored skincare solutions, highlighting a great interest in leveraging microbial communities for dermatological benefits. [ABSTRACT FROM AUTHOR]