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Background: Lower eyelid aging is a complicated process, and for that reason, a comprehensive assessment of the lower eyelid is important before treatment., Objective: This study was conducted to analyze and assess the lower eyelid aging process between different age groups of Asian women., Methods and Materials: The authors developed the comprehensive lower eyelid age rating scale (CLEARS). The rating scale contains 3 domains and each composed of 3 items. Individuals were evaluated by the age group starting with the third decade (20-29 years) through the seventh decade (60-69 years) by 2 dermatologists working independently., Results: A total of 114 cases were evaluated. The total scores of CLEARS increased significantly between each adjacent age group. The scores of the snap test and the severity of fine lines, nasojugal groove, midcheek furrow, and eye bags increased significantly from the 3rd decade. The scores of the distraction test and the severity of palpebromalar groove and malar mound begin to increase with the 4th decade. Kappa coefficients of all items achieved moderate to substantial agreement., Conclusion: This study describes the lower eyelid aging process among Asian women by CLEARS assessment. Lower eyelid aging becomes progressively more notable beginning with the third decade., (Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Laser pretreatment of skin can be used to enable drugs used in dermatology to penetrate the skin to the depth necessary for their effect to take place., Objective: To compare the permeation of tranexamic acid after conventional non-fractionated ablative Er:YAG and CO2 laser pretreatment in a laser-aided transdermal delivery system., Materials and Methods: An erbium-doped yttrium aluminium garnet (Er:YAG) and a CO2 laser were used to pretreat dorsal porcine skin. Scanning electron microscopy was used to examine disruption of the skin surface. Confocal laser scanning microscopy was used to determine the depth of penetration of a reporter molecule (fluorescein isothiocyanate) into the skin. A Franz diffusion assembly was used to examine fluency-related increases in transdermal delivery of transexamic acid., Results: Transdermal delivery of tranexamic acid increased as Er:YAG laser fluency increased. Transdermal delivery was higher when CO2 laser pretreatment was used than when Er:YAG laser pretreatment was used, but a "ceiling effect" was present and increasing the wattage did not cause a further increase in delivery. CO2 laser pretreatment also caused more extensive and deeper skin disruption than Er:YAG laser pretreatment., Conclusion: For conventional, non-fractionated ablative laser pretreatment, the Er:YAG laser would be an optimal choice to enhance transdermal penetration of transexamic acid.

Background: Topical treatment with vitamin C has been used to treat photoaged skin and as a skin whitener, but no standard procedure exists for percutaneous delivery., Objective: To compare skin histology and the permeation of ascorbic acid 2-glucoside (AA2G) after fractional and conventional carbon dioxide (CO(2) ) laser pretreatment., Methods: The effect on porcine skin of treatment with different strengths of fractional and conventional CO(2) laser treatment was examined using scanning electron microscopy and transmission electron microscopy. Permeation of AA2G through porcine skin was tested in vitro using a Franz diffusion chamber. In vivo changes in fluorescein thiocyanate permeability in nude mice were examined using confocal laser scanning microscopy., Results: Fractional CO(2) laser treatment with four or fewer passes caused less disruption than conventional laser treatment at the same fluence. AA2G permeation using four passes of fractional laser treatment was similar to that seen with conventional CO(2) laser treatment of the same fluence. Changes in permeability and in depth of permeation were higher with conventional than fractional laser treatment., Conclusion: Fractional CO(2) laser treatment can cause similar transdermal delivery of AA2G to conventional laser treatment with less skin disruption and a different pattern of histologic change., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Background: The introduction of fractional photothermolysis (FP) for the treatment of atrophic acne scars has been proven to provide satisfactory results. For severe atrophic acne scarring, nonablative FP achieves fair improvement and takes multiple treatment sessions. Ablative fractional resurfacing provides an alternative modality with greater satisfaction., Objective: To evaluate the effectiveness and safety of the ablative fractional 2,940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser with coagulation mode for the treatment of atrophic facial acne scars in Asian skin., Methods: Thirty-four patients aged 19 to 44 (mean 34.2) with Fitzpatrick skin types III and IV, received one ablative fractional 2,940-nm Er:YAG laser treatment with an adjustable coagulation mode and were followed for 3 months. Physician evaluation and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit., Results: Almost three-quarters of the patients rated their satisfaction as good to excellent (score of 3 or 4). All patients experienced short downtime, and the incidence of postinflammatory hyperpigmentation was low (3.0%)., Conclusions: The ablative fractional Er:YAG laser with coagulation mode is recommended for the treatment of moderate to severe atrophic acne scars, with acceptable downtime and high satisfaction in Asian patients., (© 2011 by the American Society for Dermatologic Surgery, Inc.)

Background: In recent years, using the 1,064-nm Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser (QSNYL) with or without exogenous topical carbon solution application for facial skin rejuvenation has become popular in Southeast Asia, but there has not been any published clinical report discussing the rejuvenation effect of QSNYL for Asian patients., Objective: To evaluate the efficacy of QSNYL in improvement of pore size, sebaceous secretion, skin texture, and skin tone of Asian patients. We also observed whether there is any enhancement of application of topical carbon solution before the therapy., Methods: Twenty-four female patients completed four sessions of treatments at 4-week intervals. The assessment was evaluated by the patients, two independent physicians, and Canfield VISIA Complexion Analysis. In addition, we conducted a split-face study such that, in each case, topical carbon solution was applied to the right side of the face before the laser treatment., Results: All evaluations showed significant improvement in rejuvenation effect. There was no difference in improvement in skin texture even after the application of topical carbon solution in our split-face study., Conclusion: The QSNYL is a safe and effective rejuvenation modality in Asian patients. Topical carbon solution application did not enhance laser efficacy.

Background: Atrophic facial acne scars is one of the most common problems in patients with inflammatory acne. Ablative laser resurfacing has unpleasant complications and a long recovery period. Nonablative therapies yield less improvement and satisfaction. The introduction of fractional photothermolysis (FP) is an alternative treatment for atrophic acne scars., Objective: To evaluate the effectiveness and safety of a nonablative 1,550-nm erbium-doped fiber laser in the FP of atrophic facial acne scars in one treatment session., Methods: Forty-five patients (skin type III-IV, mean age 29) with atrophic facial acne scars were enrolled in the study. Each patient received one treatment of FP. Comparative photographs were taken using specific complexion analysis to identify and quantify depressed scars and texture. Physician evaluations and patient satisfaction were graded on a 4-point scale. Side effects were recorded at each follow-up visit., Results: The improvement in atrophic scars and texture after a FP treatment were significant. Twenty-seven (60%) of the patients had good to excellent results after 1 month., Conclusion: The FP of atrophic facial acne scars resulted in significant improvement even in a single treatment, with good satisfaction and unremarkable side effects.