Efficacy and saftey of fractional Er:YAG versus microneedling in treatment of facial rhytides in 45-75 years old patients

Determination of the effectiveness of microneedling compared to the fractional Laser Er:YAG in the treatment of face wrinkles based on the measurement of the resonance time of the skin by reviscometer. Determination of microneedling safety in comparison with fractional laser Er:YAG in the treatment of face wrinkles.

We performed a randomized controlled trial in a split face design. 36 patients were included. Patients were assigned to receive three monthly treatments on each side of the face, one side with dermapan(microneedling) and the other with fractional Er:YAG laser. The ER:YAG laser with a 7-micron spot, a 350 microsecond pulse and a total fluence of 3.12 J per cm 2 and an energy pulse of 1 to 1.2 J with a fractional handpiece and dermapan use. Patients in the first, second, third, and 3 months follow-up sessions are evaluated by MPA-9(multi prob adaptore-9) and digital photography. Two board-certified dermatologists were asked to score the clinical outcome regarding the improvement of wrinkles and clinical appearance. Degree of clinical improvement was defined as the percentage of improvement: no response, mild response, moderate response, good response, and excellent response. A quantitative survey of the biomechanical parameters is done by a multiprobe device. For subjective evaluation, patient satisfaction is measured through the Facial Lines Outcomes Questionnaire. All undesired effects of the procedures such as edema, pain, burning, itching, erythema, were recorded. The aim of this study was to compare the safety and efficacy of microneedling and fractional ER:YAG laser in the treatment of facial wrinkles and possible complications, patient satisfaction from each of the methods, down time and the changes recorded It will be compared by a MPA-9 device.

The location of the study is dermatology clinic of Shohada'e Tajrish Hospital. Study approved by the ethical committiee of Shahid Beheshti University. The ER: YAG laser used in this study has a fractional handpiece and dermapan. The treatment area was thoroughly cleand before the procedure, lidocain ointment was aoolied at least 30 min before the treatment. Eyes were covered with a moist gauze. laser therapy was done from the hairline to the chin. Zinc oxide ointment was applied to the treatment areas immediately after the procedure. Patients were asked to re-apply zinc oxide ointment as needed. Also, they were advised to stay away from direct sun exposure. Patients were assigned to receive three monthly treatments on each side of the face, one with dermapan and the other with fractional Er:YAG laser, Photographs were taken at baseline, before each treatment session, and 3 months after the final treatment. Two board-certified dermatologists were asked to score the clinical outcome regarding the improvement of wrinkles, skin texture.The wrinkle improvement was calculated with the use of visual analog scale (VAS). Degree of clinical improvement was defined as the percentage of improvement: no response (less than 10%), mild response (10–25%), moderate response (25–50%), good response (50–75%), and excellent response (more than 75%). Outcomes were evaluated by investigators at each session and 3 months after the third treatment. A quantitative study of the biomechanical parameters is performed by a multiprobe device. For subjective evaluation, patient satisfaction was measured using the Facial Lines Outcomes Questionnaire as a percentage of satisfaction from 0 to 100. All undesired effects of the procedures such as edema, pain, burning, itching, erythema, blister, bleeding, crust, hypopigmentation, hyperpigmentation, scars, and atrophy were recorded. In summary, the aim of this study was to compare the safety and efficacy of both microneedling and fractional ER:YAG laser in the treatment of facial wrinkles and possible complications, satisfaction of patients from each of the methods, the time needed to return the skin to the original state and The changes recorded by the MPA-9 will be compared.

Subjects between 45 and 75 years old with mild to moderate facial skin rhytides at rest were included. People with: 1-Pregnant or breast feed 2-History of cuagulopathy disorder or drug 3-Facial active Infection 4-Inability to fallow up visit 5-Connective tissue disorder 6-History of skin cancer on face 7-Unrealistic expectation 8-Cosmetic procedures performed on the face in the last 6 month 9-Fitzpatrick skin phototype >III 10-Sensitivity to lidocain 11-Use isotretinoin in the last 6 month 12-History of keloid 13-Use photosensitive drug such gold and tetracyclin were excluded.

In patients who have 45 to 75 years old with mild to moderate facial skin wrinkles at rest apply fractional ER:YAG laser at one side of the face and microneedlig in the other half of the face Monthly up to three times.

Photographs were taken at baseline, before each treatment session, and 3 months after the final treatment. Two board-certified dermatologists were asked to score the clinical outcome regarding the improvement of wrinkles and skin texture. Degree of clinical improvement was defined as the percentage of improvement: no response (less than 10%), mild response (10 to 25%), moderate response (25 to 50%), good response (50 to 75%), and excellent response (more than 75%). A quantitative study of the of biomechanical parameters is performed by a multiprobe adapter-9 device. Measurements are carried out at different angles(0, 90, 180, 270) and based on the average calculated number of the comparison. For subjective evaluation, patient satisfaction was measured using the Facial Lines Outcomes Questionnaire as a percentage of satisfaction from 0 to 100. All undesired effects of the procedures such as edema, pain, burning, blister, bleeding, erythema, crust, hypopigmentation, hyperpigmentation, scars, and atrophy were recorded. In summary, the aim of this study was to compare the safety and efficacy of micrneedling and fractional ER:YAG laser in the treatment of facial wrinkles and Improvement of wrinkles, possible complications, patient satisfaction from each of the methods, the time needed to return the skin to the initial state(down time) and Changes recorded by the MPA-9, including the amount of transepidermal water loss and the time of resonance of the skin will be compared.

Deputy of Research and Technology, Shahid Beheshti University of Medical Sciences

In individuals entered into the study, one half of the face is randomly studied by laser and the other half by micronidling.

In individuals entered into the study, one half of the face is randomly studied by laser and the other half by micronidlikg, Patients are unaware of the nature of the action taken on each side of the face. Assessment practitioners are also unaware of the action taken, for example, they do not know in Patient A that they are on the right side of the laser or micronizing.

Adaptation of information recorded by the reviscometer and the clinical response along the photos of the camera, and the degree of satisfaction of the participants with the procedures performed in different patients according to skin phenotype and the response to each of the two methods listed in the study, published in the separate table

After completing the treatment and patients' fallow up

Researchers of academic institutions

All dermatologists can access the data to use procedure for their patients.

Refer to the Dermatology Research Center at Shohada e Tajrish Hospital in Tehran. Accountability will be done by Dr. Behnaz Hamedani

The request is submitted in writing.