| FACIAL AESTHETICS | PEER-REVIEW


using lower energy and density, as scarring has been noted in these areas25


. Scarring after fractional CO2 laser


therapy is considered mainly a result of overly-aggressive treatments and a lack of technical finesse. Physicians have also recorded postoperative infections leading to scarring, although it is generally felt that these may be prevented by careful history-taking, vigilant postoperative monitoring, and/or the use of prophylactic antibiotics26, 27


. With regard to facial rejuvenation, CO2 laser light at a


10600 nm wavelength results in vapourisation with thermal denaturation of type I collagen, collagen shrinkage and later, collagen deposition. However, in very deep rhytides, acne scarring and severe elastotic changes from sun damage, fractional CO2


treatments to achieve the same results as the older lasers28 problems16, 17


treatment option, they had many post-procedural , including prolonged postoperative recovery,


pigmentary changes, and a high incidence of acne flares and herpes simplex virus (HSV) infection18, 19


. Many


patients complained of oedema, burning, and erythema that sometimes lasted for many months20, 21


. The implied


risks and long downtime made many patients reluctant to accept this method of treatment22, 23


. More recently,


fractional resurfacing lasers have addressed many of these earlier problems with benefits of faster recovery time, more precise control of ablation depth, and reduced risk of post-procedural problems8


. These lasers are


extremely versatile, in that they can be used for the treatment of facial rhytides, acne scars, surgical scars, melasma and photodamaged skin, and many have entered the market at the same time24


. With the advent of fractional laser skin resurfacing, the


number of completely ablative resurfacing cases has declined for most practitioners. However, care should be taken when treating sensitive areas such as the eyelids, upper neck, and especially the lower neck and chest, by


Care should be taken when


treating sensitive areas such as the eyelids, upper neck, and


especially the


lower neck and chest, by using


lower energy and


density, as scarring has been noted in these areas.


Figure 1 Omnilux 633 nm light for fibroblast stimulation


.


therapy requires multiple .


A number of studies have evaluated using different laser combinations in the same session in order to improve collagen deposition, with a wider zone of fibroplasia6–9, 28


Owing to the inherent risks of fractional laser skin resurfacing and its inability to deal with some evidence of chronological ageing, it was advocated to here establish the clinical effectiveness of using a multi-procedural approach to volumisation and collagen regeneration. The author used microneedling with low energy laser, and platelet rich plasma (PRP) to address these issues.


Collagen remodelling and fibroblast stimulation It is recognised that the most important rejuvenation process for photoaged skin is the collagen remodelling process, and dermal fibroblasts are known to have the most important function29


. Rejuvenation of skin injury


caused by UV light is a complex process that organically involves cytokines interacting with a number of growth factors and control proteins28


. The procedures evaluated


included PRP, microneedling, and Omnilux 633 nm near-red light, with neurotoxins as an adjunct to low-level fractional laser skin resurfacing. Cells in the epidermis


Figure 2 Blood post-centrifuge, showing the platelet layer


Figure 3 Injecting PRP in the periorbital area prime-journal.com | January/February 2013


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