Skin rejuvenation and skin tightening, a review of available treatments
In recent decades, there has been a revolution in energy-based treatment options for skin scarring, rejuvenation, and tightening. One of the most promising developments has been the introduction of fractional laser treatment (Fraxel). Fractionated systems deliver laser energy in a grid-like pattern, creating microscopic columns of ablative and/or coagulative damage termed microthermal zones (MTZs), which stimulate collagen remodeling. The incorporation of fractional laser treatment (fraxel) into energy-based devices has allowed less destruction to surrounding tissues, leading to desired results with the minimization of unwanted side effects, leading to both ablative and non-ablativee laser devices becoming desirable treatment options for cutaneous scarring and rejuvenation. Given their impressive results, newer fractional laser treatment options, including picosecond lasers, quality-switched (QS) lasers, and combined ablative and nonablative lasers, are being investigated for the treatment of these common skin conditions. The following review addresses the current and emerging topics on fractional laser treatment of skin scarring and rejuvenation based on the device type, including ablative, nonablative laser, QS laser (lutronic spectra), picosecond, and hybrid fractional lasers (HFLs). Additionally, newer energy-based fractional devices, such as radiofrequency (RF) (ultrashape) with and without microneedling (infini) and the use of fractionated technology for drug delivery. Fractionated lasers Treatment options for cutaneous scars and skin rejuvenation have evolved significantly since the rise in popularity of ablative lasers in the 1990s. Newer treatment options, including ablative fractional lasers and nonablative fractional lasers (FRACTIONAL LASER), have garnered favor, given the milder side effect profile in comparison with traditional fully ablative lasers. Ablative fractional lasers Acne scarring FRACTIONAL LASERs were developed in an attempt to achieve the efficacy of traditional ablative lasers with the milder side effect profile of fractional technology. Although a single treatment produces less dramatic, albeit noticeable, results than traditional fully ablative lasers can, multiple treatments result in greater clinical improvement.2 Currently, there are 3 types of FRACTIONAL LASERs available for scar treatment: the 10600-nm carbon dioxide (CO2), the 2940-nm erbium:yttrium aluminum garnet (Er:YAG), and the 2740-nm yttrium scandium gallium garnet (YSGG) lasers. FRACTIONAL LASER is associated with the increased risk of both protracted erythema and postinflammatory hyperpigmentation (PIH) in darker skin types, which has led many clinicians to prefer a longer series of NFRACTIONAL LASER treatments over FRACTIONAL LASER treatments to achieve similar results with a lower risk of side effects. Multiple studies support the efficacy of the fractional CO2 laser in acne scars. The overwhelming majority of these studies investigate the utility of these lasers in atrophic facial scars. While NFRACTIONAL LASERs typically require multiple sessions to achieve modest to marked efficacy, 1 FRACTIONAL LASER treatment alone can rival that of multiple NFRACTIONAL LASER treatments. Three studies (42 total patients) have shown that a single treatment with a fractional CO2 laser can result in an overall improvement of greater than 50%.3 A high-fluence, low-density setting has been shown to be more efficacious than a low-fluence, high-density setting. Similar to the fractional CO2 laser, the fractional Er:YAG and the YSGG have been shown to produce comparable rates of improvement in atrophic acne scars after multiple treatments. FRACTIONAL LASER (13 studies) in the treatment of facial acne scarring. For FRACTIONAL LASERs, improvement ranged from 26% to 83% for 1 to 3 treatments, whereas for FRACTIONAL LASERs, improvement ranged from 26% to 50% for 1 to 5 treatments. Regardless of which FRACTIONAL LASER is used, the potential for scar improvement is greater with FRACTIONAL LASER than with FRACTIONAL LASER. In addition, the time interval between treatments does not impact efficacy. In a study comparing two fractional CO2 treatments at 1- versus 3-month intervals, no difference in scar improvement was noted between groups.8 FRACTIONAL LASERs also have lasting effects on scar appearance. Ortiz et al conducted a follow-up study on 10 patients who had previously received fractional CO2 treatments. Patients were seen at 1 and 2 years after the treatment and were found to maintain an average of 74% improvement in scar appearance in addition to preserved patient satisfaction rates.
Hypertrophic scars and keloids
While steroid injections, and more recently the injection of 5-Fluorouracil (5-FU), remain a mainstay in the treatment of keloids and hypertrophic scars FRACTIONAL LASER is gaining momentum in this arena due to its proven efficacy. In a consensus statement by Anderson et al in 2014 regarding the use of lasers in scarring, a panel of experts concluded that FRACTIONAL LASERs should be considered in the first-line management of HYPERTROPHIC SCARS and/or traumatic scars. The literature addressing scar types other than atrophic acne scars is not as robust; however, a split-scar, randomized controlled trial of 30 patients (18 with keloids with HYPERTROPHIC SCARS) treated with 4 sessions of fractional CO2 at 6-week intervals showed a significant reduction in the Vancouver Scar Scale (VSS) scores at 3 months, which remained stable at 6 months on the treated side as compared with nontreated. The VSS is based on the grade of pigmentation, vascularity, pliability, and height of scars. The pliability of the scars was markedly improved, but scar height was the least improved trait after treatment.13 The thickness of scars plays a role in how they respond to FRACTIONAL LASER. One study of 15 raised burn scars (11 HYPERTROPHIC SCARS, 4 keloids, mean scar age 8.1 years) showed that fractional CO2 improved the Patient and Observer Scar Assessment Scale (POSAS) and the VSS for HYPERTROPHIC SCARS but not for thicker keloids after 3 treatment sessions every 4 to 6 weeks. HYPERTROPHIC SCARS on the limbs responded better than those on the face or trunk. Authors purported that the dermal penetration depth of the laser light (400 to 1,000 μm) was insufficient to reach the depth of the scar tissue in the treated keloids, leaving deeper fibrosis untreated. They further suggested that keloids may need to be treated using the stack parameter (on the DEKA: 30 W, 800 μm spacing, 800 μs dwelling time, stack 1 during the first session, followed by 30 W, 300 μm spacing, 800 μs dwelling time, stack 1 in the following 2 sessions), with higher stacks (3 to 4) to increase the depth of ablation.
Surgical and traumatic scars
Surgical and traumatic scars show significant improvement in appearance when treated with FRACTIONAL LASER. A study of 18 patients with burn scars treated with 3 monthly sessions of FRACTIONAL LASER CO2 showed a mean VSS decrease from 8.5 at baseline to 4.9 posttreatment, with a significant reduction of the POSAS score.16 Multiple small case reports support the efficacy and low side effect profile of FRACTIONAL LASER in the treatment of burn scars Previously, it was thought that waiting several months before laser treatment of traumatic scars was ideal, but now early intervention as soon as reepithelization is complete is best. Postlaceration scars treated with FRACTIONAL LASER at 4 weeks after repair showed improvement on all elements of the VSS in 1 study involving 15 facial lacerations.20 While scars with contracture are a rare but known side effect of FRACTIONAL LASERs, most notably after treatment of the neck,21 these laser devices may also be employed in the treatment of scar contractures related to burn and trauma. It is important to use settings with lower energies when treating areas of the face because they are at greater risk for scarring.
Traditional ablative resurfacing, specifically with CO2, has long been considered the gold standard for skin rejuvenation and scar treatment. The introduction of the revolutionary FRACTIONAL LASERs naturally led to the later development and use of FRACTIONAL LASERs in 2007. In order to more closely mimic the superior results of traditional ablative resurfacing while maintaining a milder side effect profile. Improvements can be seen in mild to moderate wrinkles, skin laxity, pore size, skin texture, and skin tone of the face, neck, and chest. The efficacy of FRACTIONAL LASERs in skin rejuvenation and the treatment of photoaging and skin laxity is now well established. In an early study by Rahman et al,23 significant clinical improvement was appreciated in 30 patients after 1 to 2 full-face and neck treatments with a fractional CO2 laser (Fraxel Re:pair) with a range of energies and densities. Moderate to significant improvement was seen in wrinkles, skin laxity, texture, pigmentation, and vasculaturity. Further studies have continued to substantiate such efficacy. Tierney and Hanke prospectively studied the clinical benefits of 2 to 3 treatments of a different fractional CO2 laser (Smartxide DOT; Calenzano, Italy) in 45 patients (Fitzpatrick Skin Types I-III). They showed a mean improvement of 50.3% in skin laxity, 48.5% in skin texture, 53.9% in dyschromia, and an average 52.4% improvement in overall cosmetic outcome. Collagen remodeling has been shown to continue for at least 3 months after treatment. Full-face resurfacing with FRACTIONAL LASERs has a shorter recovery period and milder side effect profile than fully ablative resurfacing. In general, the aesthetic results of FRACTIONAL LASERs do not match those of the fully ablative lasers in regards to wrinkles and photoaging. However, the FRACTIONAL LASERs may theoretically produce superior skin-tightening results in comparison with the traditional ablative laser due to the greater depth of ablation created by the fractional technology. While few truly comparative studies exist between the 2 methods, several studies have shown the marked skin-tightening effects of FRACTIONAL LASER. For example, Tierney and Hanke showed a 57% mean improvement in skin tightening of the neck after 1 to 2 treatments with an FRACTIONAL LASER. To achieve optimal results, FRACTIONAL LASER treatments may be combined with surgical procedures, such as facelifts, or with other energy-based devices. While the notable results achieved with FRACTIONAL LASERs are well known at this time, the notable developments in their use include their safe but cautious application to very delicate facial sites and nonfacial sites. FRACTIONAL LASERs can be safely used for treatment of the eyelids, neck, and chest. One prominent strength for the FRACTIONAL LASERs has been periorbital rejuvenation and eyelid tightening. Lower eyelid laxity is due to a combination of dermatochalasis with festooning caused by a redundant orbicularis oculi muscle and its overlying fat and skin.
Nonfacial sites have a relative paucity of adnexal structures and vascular supply in comparison with the face, which leads to an increased risk of side effects, such as dyspigmentation, scarring, and infection.32,33 Therefore, treatments must be cautiously pursued with conservative settings, such as decreased density. Nonfacial indications beyond neck and chest rejuvenation that have shown benefit with FRACTIONAL LASERs include hand rejuvenation and, most recently, vaginal rejuvenation. The vulvovaginal region is not exempt from the effects of aging. Decreasing levels of estrogen cause thinning and atrophy, loss of elasticity, and loss of functionality of the vaginal mucosa, leading to dryness, itching, burning, dysuria, and dyspareunia.34-36 FRACTIONAL LASERs can play a role in stimulating the tissue to restore structure and function. In a large study of 386 patients, 3 treatments with a fractional microablative CO2 laser showed a resolution of the aforementioned symptoms in a majority of patients.34 Much of the improvement was appreciated even after the first treatment. Histological studies have confirmed a successful remodeling of the vaginal mucosa, with a thickened epithelium with increased glycogen content, as well as increased collagen in the lamina propria. Vaginal laser treatments are tolerated with minimal pain, while vulvar treatments can be more uncomfortable. While a single treatment with FRACTIONAL LASERs is often sufficient to show a significant benefit, studies performed multiple treatments to obtain optimal results. The efficacy of a single FRACTIONAL LASER treatment can certainly be operator dependent and contingent on various treatment parameters, such as fluence, pulse duration, and density. Aggressive treatment parameters in order to achieve maximum efficacy must be balanced with the heightened risk of side effects.
Safety and adverse events
While FRACTIONAL LASERs offer a milder safety profile than fully ablative lasers, unwanted side effects can still occur. The expected effects of FRACTIONAL LASER lasers include erythema, edema, and scaling that last for 3 to 14 days and typically resolve by 2 weeks.2,3 Unwanted side effects include hypo- or hyperpigmentation, acneiform eruption, herpes reactivation, scarring, and persistent ulceration. Higher fluences have been associated with higher procedural pain scores.39,40 Small case series reporting scarring located on the neck or ectropion, preceded by infection or nonhealing ulcers, have been described. PIH is a substantial risk when treating darkly pigmented patients, as multiple studies performed in Asian patients conclude. PIH rates in darker skin types III, IV, and V have been as high as 50%, 55.5%, and 92%, respectively, after fractional CO2 treatment.PIH has been associated with higher-density settings.
Nonablative fractional lasers
FRACTIONAL LASERs utilize a wavelength of light in the midinfrared spectrum that penetrates into the midreticular dermis, inducing new collagen formation and tissue remodeling. These lasers create a grid of MTZs that leave intervening areas of skin unaffected. The skin adjacent to sites of laser injury remains intact, allowing for rapid postprocedural reepithelialization because of the migration of in tact cells into the damaged microcolumns. The preservation of an intact epidermis with minimal disruption of the dermal–epidermal junction decreases recovery time to an average of 3 days and leads to a milder side effect profile.2 Rapid recovery comes at the expense of efficacy because FRACTIONAL LASERs have a more modest effect on collagen remodeling,47 and multiple treatment sessions are required to reach a typically less dramatic clinical result. Acne scarring In a consensus statement by Anderson et al in 2014 regarding the use of lasers in acne scarring, a panel of experts concluded, based on clinical evidence and personal experience, that while FRACTIONAL LASERs and FRACTIONAL LASERs result in comparable improvement in acne scarring, the latter is generally more tolerable for patients, with the understanding that more treatment sessions are required.12 Multiple studies have shown that, as the first available fractional laser, the 1550-nm erbium-doped laser (EDL) decreases bleeding and postprocedure erythema, edema, infection, and scarring, as compared with its contemporary ablative counterparts. In 2 studies investigating the efficacy of EDL in acne scarring with 2 to 6 monthly treatments (82 patients, skin types I-V), 62% to 87% of patients experienced a 51% to 75% scar improvement.48,49 The average improvement increased proportionally after each treatment and did not significantly differ depending on skin type.48 More recent studies have confirmed the laser’s safety and efficacy in treating acne scarring, even in darker skin types.50 For acne scars and surgical scars located off the face, lower fluences (20 to 50 mJ) are recommended.51 The 1540-nm Er:glass has also been shown to improve atrophic acne scars in multiple trials. A large study of 87 Italian patients (skin types I-V) revealed a greater than 50% improvement in atrophic scars in 89% of patients after 3 months and in 92% of patients after 6 months.52 Similar studies in Asian patients corroborate these results.53 The Er:glass has been shown to perform best on boxcar scars (52.9% improvement), followed by rolling (43.1% improvement) and ice-pick scars (25.9% improvement).54 Hypertrophic scars and keloids While the pulsed dye laser is the nonablative energy-based device that has traditionally been used to treat HTS and keloids, fewer and smaller studies have been performed on the use of FRACTIONAL LASER for these scars. Small studies have shown mild to no significant difference in treated versus untreated HTS with the Er:glass after 4 treatments.55 While HTS and keloids have been reported as a complication of FRACTIONAL LASER, the subsequent use of FRACTIONAL LASERs like the EDL has been shown to improve the resultant elevated scars.21 Surgical and traumatic scars Surgical and traumatic scars may benefit from early treatment with FRACTIONAL LASER. One study of 27 post-thyroidectomy patients (skin types I-IV) who underwent 4 monthly treatments with the EDL at a low fluence (10 mJ), starting 2 to 3 weeks after surgery, compared the surgical scars to untreated post-thyroidectomy patients. At the follow-up, the VSS was significantly different between treated and untreated patients (1.52 versus 3.00, respectively).56 Early treatment with FRACTIONAL LASER is more effective than later treatment in improving the appearance of postsurgical scars. Laser treatments for scars had historically been postponed to a minimum of 2 to 3 months after surgery because of concerns regarding scar stabilization57; however, Park et al concluded that early treatment (within 3 weeks) was more effective than delayed treatment (within 3 to 6 months) in 65 patients with post-thyroidectomy scars treated with 3 monthly treatments of FRACTIONAL LASER.58 Fractional laser may improve scar appearance in mature scars, albeit to a lesser extent than in newly formed scars. In a randomized splitscar study in which 17 patients with mature burn scars underwent 3 monthly treatments with the Er:glass, some improvement in skin texture was noted as compared with control areas.
Fractional laser have recently become the mainstay of skin rejuvenation because they have a shorter downtime and lower side effect profile but still achieve desirable results. While Fractional laser do not achieve the results of traditional ablative resurfacing, the efficacy of Fractional laser in skin rejuvenation is well established. The assortment of devices available is continuing to grow. The wavelengths of Fractional laser currently available for skin rejuvenation and tightening include 1410-nm, 1440-nm, 1540-nm, 1550-nm, and 1927-nm. Unlike the Fractional laser, in general, a series of 3 to 6 treatments is recommended for optimal results. The 1550-nm erbium-doped fiber laser was the first of its kind and continues to be one of the most prominent and most studied players in FRACTIONAL LASER rejuvenation. Initial studies revealed an 18% improvement of the wrinkle score and a 2.1% tissue shrinkage effect at 3 months after 4 treatments.1 After 3 treatments spaced 3 to 4 weeks apart, the 1550-nm FRACTIONAL LASER achieved a subjective improvement in overall facial photodamage of at least 51% to 75% in 73% of patients at 9 months.60 In the same study, the results were slightly inferior on nonfacial skin, with 55% of patients displaying at least 51% to 75% improvement of overall photodamage at 9 months. The 1540-nm has been shown to achieve comparable results. Beyond pigmentation, wrinkles, and texture, Fractional laser have also demonstrated an improvement in facial pores. Saedi et al61 reported a 17% improvement in facial pore score after 6 treatments with a 1440-nm FRACTIONAL LASER spaced 2 weeks apart. The 1927-nm thulium fiber lasers differ from the lower wavelengths in that they have a higher absorption coefficient for water. This leads to an increased ability to target the epidermis and treat more superficial processes, such as dyspigmentation.62 After 2 treatments with the 1927-nm thulium laser, 82% of patients achieved a moderate to significant improvement in photopigmentation at 1 month after treatment. There was also appreciable improvement, albeit to a lesser degree, in both fine and coarse wrinkling.\ In addition, there is a report of successful treatment of macular seborrheic keratoses with the 1927-nm FRACTIONAL LASER.64 While the improvement in pigmentation, fine wrinkles, and overall texture is well established with Fractional laser, there has been some controversy over whether the Fractional laser truly have a skin-tightening effect, despite several studies reporting this benefit. A true skin-tightening effect comes from dermal fibroplasia and wound contraction, thought to be at least partially induced by heat shock protein. The histologic studies performed have had inconsistent results. However, many of those studies that do not show evidence of significant fibroplasia employed low-energy, low-density treatments and/or only single treatments. While caution is still needed due to increased risks of side effect.
While the technology for QS lasers and the more recent picosecond lasers is primarily being used for endogenous and exogenous pigmentation correction, its use naturally expanded to the broader and sought-after goal of skin rejuvenation and tightening. Nonablative QS lasers have also adopted fractionation, and specifically, the fractional QS Nd:YAG 1064-nm laser has been shown to provide benefits in skin rejuvenation and tightening. QS Nd:YAG lasers have pulse durations in the nanosecond range and create a photoacoustic effect, contributing to an increased dermal collagen response.75 As with the other lasers, the fractionated technology allows for higher energies in each microscopic treatment zone, as well as deeper penetration. The standard QS Nd:YAG (1064-nm) laser targets melanin near the skin surface, which can lead to epidermal damage and crusting. However, the fractional QS Nd:YAG has a deeper focal point of 100 um with an expected penetration depth of up to 3.5 to 4 mm.76 This deeper penetration may lead to efficacy in dermal rejuvenation while avoiding epidermal crusting, allowing for faster healing. Fractional QS Nd:YAG (1064-nm) lasers have demonstrated an 11.3% improvement rate in superficial wrinkles at 1 month after a series of 3 treatments to the face, neck, and chest spaced at 2- to 4-week intervals.76 Gold et al77 showed that there was a greater than 60% improvement in hyperpigmentation, telangiectasias, laxity, roughness, and identifiable actinic keratoses after 4 treatments with the same laser done at 2- to 4-week intervals. These treatments are well tolerated with little to no pain and only temporary erythema lasting up to 24 hours. No other adverse events, such as dyspigmentation, edema, ecchymoses, vesiculation, crusting, or scarring, have been reported in the limited studies performed. This modality is thought to be safe for all skin types, with slightly lower fluences suggested for darker skin types
While originally intended for lasers, the concept of fractionation has since been applied to other technologies, including RF. RF uses electric current to produce thermal energy as it passes through tissue and meets resistance.89 Fractional RF (FRF) devices transmit bipolar current through electrodes in contact with the skin or via arrays of paired microneedles that penetrate the skin. Both types of devices form closed circuits of bipolar current.89 The devices with electrodes produce a pyramid-shaped distribution of thermal energy, with the smaller peak of the pyramid at the epidermis and the broader base deeper within the dermis.90 This allows for large volumes of dermal heat diffusion with minimal epidermal damage. Less than 5% of the skin surface is disrupted with 1 pass of the device.90 The high temperatures at the epidermis lead to focal ablation, while the effects within the dermis are mainly secondary to coagulative damage.90,91 The relative degree of these effects, as well as the maximal depth of tissue effect, can be tailored by adjusting parameters such as energy level, coverage, and/or density For acne scarring, a moderate improvement of 25% to 75% can be expected after 3 to 4 treatment sessions with FRF.92 Numerous studies on the use of FRF for acne scarring in darker skin types have shown it to be effective, with a relatively low risk of PIH.93- 95 While moderate improvement in acne scarring is possible, it remains to be seen how FRF compares to more well-established treatments, such as AFL. FRF has also shown efficacy in nonacne scarring. In an uncontrolled study of 95 patients with nonhypertrophic burn scars of at least 1 year in duration treated with 3 to 5 sessions at varying time intervals, there was a significant decrease in POSAS score from 53.41 to 46.35 (both observer and patient reported). There were individual improvements in the scar color, thickness, and pliability; however, no significant improvement was noted in vascularity, pain, or itch.96 FRF can be used for skin rejuvenation, which some term sublative rejuvenation.90 It most notably leads to an improvement in skin laxity, texture, and wrinkles. Specifically, Hruza et al91 found that almost 90% of patients exhibited an improvement in skin tightness, smoothness, and wrinkling after 3 treatments, with approximately half of patients achieving an improvement of 40% or greater. Among facial treatments, periorbital sites responded the most, while perioral sites had the least improvement.91 Studies have noted consistent results among all subjects.97 Because there is little epidermal disruption, FRF is generally not used for superficial pigment alteration.90 However, studies have shown an improvement in dyschromias and skin “brightness.”90,91 Most recommend a series of 3 to 6 treatments to obtain optimal improvement and rejuvenation, depending on the patients’ needs and goals.90,91,98 One can undergo an additional treatment every 3 to 4 months thereafter to maintain improvement.98 Anecdotally, many practitioners use higher energies and coverage in patients with lighter skin types and in older individuals with increased baseline damage, while using lower energies and coverage in darker skin types.90,91 There is also a lower risk for sharp demarcation lines when only treating certain cosmetic units as opposed to the whole face, which can be seen with other energy-based fractional devices.90
MFR for scarring and skin rejuvenation may be augmented by the use of RF with microneedling (RFM). Microneedling with RF includes devices with insulated microneedles that produce small, spherical thermal injury zones with coagulative damage around the tip of the needle or noninsulated microneedles that produce larger cylindrical thermal injury zones with coagulative damage spanning the dermis.99 The depth of the needles can be adjusted from a minimum of 0.5 mm to a maximum of 3.5 mm.100 The trauma to the dermis initiates wound healing and growth factor release, leading to collagen production and deposition in the upper dermis.101 Numerous studies support the utility of microneedling without the augmentation of an energy-based device in the treatment of acne and other scar types.102-105 In 3 studies involving 91 patients (skin types III-V) investigating MICRONEEDLING WITH RADIO-FREQUENCY in atrophic acne, various acne scar scoring systems consistently reported a moderate improvement in scar appearance after treatment.100,106,107 MICRONEEDLING WITH RADIO-FREQUENCY offers superior results for ice-pick and boxcar acne scars than rolling scars108 and appears to offer a more dramatic improvement in acne scarring than bipolar RF alone. FRF delivered via microneedles has also been implemented in skin rejuvenation and tightening. Six months after a single microneedle fractionated bipolar RF treatment, patients were noted to have a 25.6% mean improvement in facial wrinkles and a 24.1% improvement in facial and neck laxity.109 Other studies have substantiated significant improvements in skin laxity and wrinkles at 6 months following a single treatment with such a device. The noninsulated microneedle devices have advantages over the earlier, fully insulated microneedles. They are able to span the depth of the dermis in a single treatment and produce more effective skin tightening.99 Common adverse reactions associated with FRF and MICRONEEDLING WITH RADIO-FREQUENCY include transient pain, erythema, edema, and scabbing that resolve within 3 to 5 days.92,95,107 Prolonged erythema, edema, and purpura are rarely seen. Rare instances of acne exacerbations93 and HSV outbreaks96 have been reported. In treatment with MICRONEEDLING WITH RADIO-FREQUENCY, transient postprocedure track marks have been noted (6%).100 Reported rates of PIH are generally low; PIH occurred in only 2 out of 72 patients (3%) (skin types III-V) treated with FRF for acne scarring and resolved within 4 to 12 weeks.93,95,107 When used for skin rejuvenation and tightening, PIH was rare across all skin types.
In conclusion, with many treatment options available, you need an expert treat to help you with the skin rejuventation and skin tightening treatment of choice. Let our expert team help you.
Important notice: This post is an edited copy of “Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery,
and treating scars and skin defects” for Saedie et al. publish on LASERS, LIGHTS, AND ENERGY DEVICES: STATE OF THE ART