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Non-invasive 3d High Resolution Imaging And Scarless 0.33mm Microbiopsy For Ultrastructural And Molecular Analysis Of Laser Treated Facial Skin
Yucel Akgul, MD PhD1, Christine Wamsley1, Mikaela Kislevitz, BSN, RN1, Karen Lu, MD2, John Hoopman, CMLSO1, Jeffrey Kenkel, MD1.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2University of Texas Medical Branch, Galveston, TX, USA.

PURPOSE Currently, the outcomes of aesthetic facial treatments are limited to patient-reported satisfaction and patient, clinician, or observer rating scales. These assessments are highly subjective and incapable of evaluating skin function and structure below the superficial epidermis. The purpose of this study was to determine the practicality of non-invasive 3D imaging and 0.33mm microbiopsy methods for the objective assessment of facial skin following laser treatment. In addition, we evaluatedskin repair following microbiopsy extraction. METHODS Twelve patients received a single facial treatment with a 1470nm/2940nm laser. Assessments were performed before treatment, seven days, three weeks, and three months post-treatment. VISIA imaging was used to assess skin texture. High-resolution, non-invasive 3D skin imaging- ultrasonography and optical coherence tomography (OCT)- were used to measure epidermal/dermal thickness, blood flow, surface roughness, wrinkle depth and attenuation coefficient. 0.33mm diameter microbiopsies were collected for histological and gene expression evaluation. In order to assess scar formation following microbiopsy, fifteen subjects were randomized to receive no biopsy, biopsy on the left nasolabial fold, or biopsy on the right nasolabial fold. Six blinded raters assessed subject facial photos at baseline, one month, and three months post-biopsy to evaluate for a visualized scar. RESULTS The non-invasive measurements were able to detect significant changes after treatment in a variety of parameters, including improvements in skin surface, a decrease in attenuation coefficient at 3 weeks (p<0.05), and an increase in blood flow 0.5mm to 0.7mm deep during the 5 day- to 3 week-period following treatment. (p<0.05). Microbiopsy analysis revealed an increase in epidermal hyaluronic acid expression assessed by immunostaining and increased expression of inflammatory genes IL-1 beta at seven days post-treatment compared to untreated or three months post-treatment. No subjects exhibited scar formation post-biopsy. There was no visible evidence at the biopsy site seven days after the procedure, and OCT imaging showed a complete closing of the column created by the biopsy punch approximately 48 hours post-biopsy. At both one-month and three-months post-biopsy, six blinded photography reviewers were unable to determine whether a scar was present based on statistical analysis. CONCLUSIONS Non-invasive imaging successfully provides objective measurements of skin structure, texture, and blood flow to assess the effectiveness of facial skin rejuvenation treatments. Furthermore, microbiopsies can objectively evaluate the effects of these treatments at molecular level without scarring or pain. A single treatment with the 1470nm/2940nm laser significantly improved skin appearance at three weeks following treatments without significant changes in the tissue at the molecular level, as assessed by microbiopsy.


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