Cover micrograph: The cover image is based on the article Decoding the Mechanisms of Pigment Reduction and Skin Rejuvenation Induced by Picosecond Laser: Insights From a Porcine Model by Hao Wang et al., https://doi.org/10.1002/lsm.70084.
Cover micrograph: The cover image is based on the article Decoding the Mechanisms of Pigment Reduction and Skin Rejuvenation Induced by Picosecond Laser: Insights From a Porcine Model by Hao Wang et al., https://doi.org/10.1002/lsm.70084.
To objectively quantify early and mid-term facial tightening after dual-wavelength Er:YAG/Nd:YAG laser treatment in Chinese women using three-dimensional (3D) imaging.
In this prospective observational study, 13 women with lower facial aging underwent four full-face treatment sessions of dual-wavelength Er:YAG/Nd:YAG (Fotona 4D) at 1-month intervals. Standardized 3D facial images were obtained at baseline and at 1 week, 1, 3, and 6 months after completion of the final treatment session. The primary objective outcomes were vertical displacements (mm) of predefined periocular and midfacial landmarks relative to baseline. Secondary outcomes included Wrinkle Severity Rating Scale (WSRS) scores for nasolabial folds and VISIA pore scores, evaluated at baseline and at 3 and 6 months. Adverse events were recorded.
3D analysis demonstrated significant early and mid-term tightening in the lateral periorbital region. The vertical distance from the lateral canthus to the nasal base decreased by approximately 0.50–0.63 mm at 1 week and by 0.60–0.63 mm at 3 months bilaterally (all p < 0.05), with partial rebound but persistence of mild improvement at 6 months. The highest point of the zygomatic bone showed a delayed, mild elevation that peaked around 1–3 months. WSRS scores for nasolabial folds decreased by about 1 grade at 3 and 6 months on both sides (all p < 0.001). VISIA pore scores improved from 4.97 ± 0.36 at baseline to 3.37 ± 0.43 at 3 months and 3.73 ± 0.54 at 6 months (both p < 0.001). Only transient erythema and edema were observed.
Dual-wavelength Er:YAG/Nd:YAG laser tightening produced early and mid-term improvements in periocular and midfacial laxity, as captured by 3D landmark displacement, with concomitant improvements in wrinkles and pores. 3D imaging provides a sensitive, objective tool to visualize region-specific dynamic responses to energy-based facial rejuvenation.
To summarize the scientific rationale for the use of the monopolar radiofrequency tissue tightening system (monoRF) for the prevention of dermal aging (termed prejuvenation).
This narrative review summarizes the basic science of dermal aging and monoRF-induced collagen remodeling and neocollagenesis. Studies supporting the mechanism of action of monoRF treatment and its use for prejuvenation are reviewed.
Dermal aging is largely attributed to the accumulation of fragmented collagen and depleted collagen levels. Collagen remodeling and neocollagenesis may be induced by monoRF treatment, resulting in immediate tissue tightening and subsequent collagen production, respectively. Preliminary data and expert opinion suggest that early and repeated intervention with monoRF may prevent progressive skin laxity via synergistic and cumulative effects.
MonoRF treatment shows potential as a prejuvenation strategy, with preliminary evidence supporting that it induces collagen remodeling and neocollagenesis. Future research should focus on long-term, prospective studies to determine the preventive benefits of consistent annual treatment for aging.
Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.
This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment.
Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.
PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that predominantly affects the genital region, but can also manifest in other areas of the body. Extragenital LS is often less responsive to standard treatments, necessitating alternative modalities. Herein, we describe the case of a young adult man with a 7-year history of an enlarging sclerotic plaque on the right thigh, refractory to high-potency topical corticosteroids and intralesional triamcinolone.
The patient underwent three sessions of fractional CO2 laser combined with platelet-rich plasma (PRP) therapy over 6 months. Pre- and post-treatment biopsies were performed to investigate histologic changes associated with the healing response.
The treatment resulted in near-complete flattening of the plaque and resolution of dermal sclerosis. A post-treatment biopsy confirmed diminished collagen hyalinization, restoration of elastic fibers, and increased fibroblasts and neovascularization. No recurrence was observed at 1-year follow-up.
This case highlights the potential role of fractional CO2 laser combined with PRP as an effective therapeutic option for recalcitrant extragenital LS. Further studies are warranted to validate this combined approach.
To explore the related influencing factors of hematoporphyrin monomethyl ether photodynamic therapy (HMME-PDT) for port-wine stain(PWS) and evaluate the relationship between dermoscopic vascular patterns and treatment efficacy.
Retrospective analysis of 182 PWS patients (November 2017 to November 2023) who received HMME-PDT. Among them, 51 patients had dermoscopy before treatment. Demographic (age, gender), clinical (lesion location, colors, size, treatments), and dermoscopic data (vascular patterns) were collected. Efficacy was assessed via pre-/post-treatment photos (classified as complete regression, good improvement, slight improvement, or no improvement), and adverse reactions were recorded. SPSS 26.0 was used for statistical analysis.
Among 182 PWS patients, HMME-PDT achieved an overall response rate of 77.5% (141/182), with 23.6% (43) showing complete regression, 15.9% (29) demonstrating good improvement, and 37.9% (69) experiencing slight improvement; 22.5% (41) showed no improvement. Efficacy significantly correlated with age, lesion location, color, size, and treatments (p < 0.05), but not with gender or facial partition (V1, V2, V3) (p > 0.05). Multivariate analysis identified small lesion size, facial and neck, pink and purplish red lesions as positive predictors, while fewer treatment sessions were unfavorable. Seven cases (3.85%) developed long-term adverse effects (5 scars, 2 hyperpigmentations). Dermoscopic analysis of 51 vascular patterns revealed significant efficacy differences among pattern types (p < 0.05), with type I (23.5%), type II (43.2%), and type III (29.4%) showing distinct therapeutic responses.
HMME-PDT efficacy correlates with age, lesion location, color, size, and treatments, but not gender and facial partition (V1, V2, V3). Dermoscopic vascular patterns can predict treatment response, with type I being the most effective.
To theoretically evaluate the efficacy and safety of large-spot (i.e., > 4 mm) picosecond laser treatment for pigmented lesions in Asian skin using a melanosome disruption threshold fluence (MDTF) model.
The MDTF model was applied to calculate the required fluence for melanosome disruption with 532, 730, 755, 785, and 1064 nm picosecond lasers. To assess potential complication risks, energy deposition in surrounding tissues was simulated. Additionally, a clinical case series was conducted using a 1064 nm picosecond laser with a large spot size to evaluate its feasibility for treating an ectopic Mongolian spot and a nevus of Ota.
At 532 nm, spot size had minimal impact on the required fluence for epidermal melanosome disruption and on collateral energy deposition. For 730–1064 nm wavelengths, the optimal spot size depended on the lesion depth. When targeting epidermal melanosomes, smaller spot sizes confined energy deposition to superficial layers, reducing collateral exposure. In contrast, for dermal melanosomes, larger spot sizes reduced the required fluence by 39%–65% and lowered collateral energy deposition, while also decreasing variation in required fluence across lesion depths. In the clinical validation, both dermal cases showed good clearance without adverse events, supporting the feasibility of this approach. However, increasing the energy output of laser devices may be necessary to achieve sufficient efficacy.
The theoretical analysis shows that at 532 nm, both small and large spot sizes can be effective for treating epidermal lesions. In contrast, at near-infrared wavelengths, smaller spot sizes are preferable for epidermal lesions, whereas larger spot sizes are advantageous for dermal lesions, potentially lowering the risk of complications while maintaining effective target disruption. These findings provide practical clinical guidance by clarifying wavelength- and spot-size-specific strategies according to target depth. Furthermore, the present results may help optimize treatment parameters and device specifications and inform future clinical studies using large-spot picosecond laser systems.
To evaluate the effectiveness of a structured laser safety training program and standardized competency checkoffs for physicians and physician extenders using lasers and other light-based devices in an academic plastic surgery department.
Standard operating procedure checklists were developed for two commonly used devices in our practice: an intense pulsed light (IPL) device and a 532/1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Ten participants, including three estheticians, one aesthetic surgery fellow, and six chief plastic surgery residents, underwent an in-person training demonstration followed by two competency checkoffs. Successful completion rates were recorded and analyzed.
For the IPL device, average correct completion rates improved from 89.23% to 100% (p = 0.007) across all participants. For the Nd:YAG laser, rates improved from 90% to 98.57% (p = 0.009). The residents and fellow exhibited a greater mean improvement from the initial to follow-up checkoff compared to the estheticians for both devices: 15.61% versus 8.33% for the IPL device and 13.65% versus 2.56% for the 532/1064-nm Nd:YAG laser.
A formalized, hands-on laser safety training session coupled with device-specific safety checklists significantly enhances both procedural competency and adherence to safety protocols, supporting such integration into departmental training. These tools not only improve technical skill but also bolsters confidence while promoting patient safety. Adoption of such checklist-based training initiatives across practices that utilize lasers and other light-based devices may help standardize care and reduce laser-related complications.
Retinal pigment epithelium (RPE) melanin absorbs laser energy during retinal laser therapy, potentially influencing treatment efficacy and safety. This study investigated the relationship between spot visibility threshold laser power and RPE melanin content, as measured by polarization-sensitive optical coherence tomography (PS-OCT), and examined differences in RPE melanin levels between the titration and treatment areas in subthreshold microsecond pulsing retinal laser therapy (SMPL).
Twelve eyes from 11 patients who underwent SMPL for macular edema and serous retinal detachment were included. In SMPL therapy, the threshold laser power was determined through titration outside the macula, near the vascular arcade. RPE melanin levels were evaluated based on polarimetric entropy (PE) measured by PS-OCT. The relationships between the visibility threshold laser power observed in funduscopy, RPE-PE in the titration area, and RPE-PE in three distinct macular regions were analyzed.
A significant inverse correlation was observed between visibility threshold laser power (1125.0 ± 154.5 mW) and RPE-PE in the titration area (0.50 ± 0.09; p = 0.028; adjusted R² = 0.34; linear regression). RPE-PE values in the central macular region (0.57 ± 0.07) were correlated with those in the titration area (p = 0.025; adjusted R² = 0.35) but were significantly higher (p < 0.01; Wilcoxon signed-rank test). The ratio of macular to titration RPE-PE values was 1.15 ± 0.17, with considerable interindividual variability.
The inverse correlation between individual visibility threshold laser power and RPE-PE, along with discrepancies in melanin density between the titration and macular regions, suggests that variations in RPE melanin density substantially influence the efficacy and safety of SMPL. These findings support the potential utility of PS-OCT–based RPE melanin assessment for optimizing SMPL parameters.
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