The appearance of one's skin reflects a person's general health and is one of the main indicators of human age. 1 As skin ages, it tends to become uneven in color, roughened, lax, and wrinkled due to intrinsic and extrinsic factors (eg, photodamage). A major feature of aged skin is fragmentation of the dermal collagen matrix. Fragmentation results from the actions of specific enzymes (matrix metalloproteinases) and impairs the structural integrity of the dermis. Fibroblasts that produce and organize the collagen matrix cannot attach to fragmented collagen. Loss of attachment prevents fibroblasts from receiving mechanical information from their support, and they collapse. 2 Stretch is critical for normal balanced production of collagen and collagen-degrading enzymes. In aged skin, collapsed fibroblasts produce low levels of collagen and high levels of collagen-degrading enzymes. This imbalance advances the aging process in a selfperpetuating, never-ending deleterious cycle. 2 Many different materials, energy-based devices, and techniques have been shown to offer good results in facial rejuvenation. 3 Ablative techniques are still considered the most effective methods for improving photodamaged skin, but are associated with a prolonged recovery time and high risk of side effects. 4 The CO 2 and Er:YAG (2940 nm) wavelengths are ablative wavelengths used for many different applications including facial skin resurfacing.Ablative lasers vaporize the epidermis and part of the dermis, leaving a zone of thermal injury responsible for collagen shrinkage and remodeling. [5][6][7] Post-procedure, the epidermis has to heal, requiring at least some recovery time. Non-invasive and minimally/non-ablative methods without downtime are therefore gaining popularity in modern dermatological laser therapy. Recently, a non-ablative mode of

The histological examination method is the «gold standard» in evaluating of age-related skin changes, however in most cases biopsy is an unacceptable option by ethical reasons. An alternative option are non-invasive diagnostic methods, in which the evaluation of changes can be carried out in real time without damaging the skin. Nowadays, such methods as high-frequency ultrasound, optical coherence tomography, laser scanning confocal microscopy, magnetic resonance imaging are used. In addition to the above-mentioned methods, it is necessary to hold a standardized clinical evaluation and determination of the physiological parameters of the skin. The evaluation of age-related skin changes of face zone and neck zone before and after the application of the combined erbium and neodymium laser exposure on the «Fotona» apparatus using the «Fotona 4D» technique has been held. There were 80 examined patients aged from 32 to 66 who, after a comprehensive clinical examination, conducted 2 procedures using the «Fotona 4D» method with an interval of 1 month. There was a significant decrease in the index of evaluation of age-related facial skin changes in the process of correction, which indicates a pronounced clinical effectiveness of the proposed technique (27 points at the screening stage and 12 points at 2 months after correction). There was also a normalization of skin moisture and an improvement in relief, reduction of pore diameter and pigmentation area. Analysis of high-frequency ultrasound data showed a statistically significant increase in skin thickness, mainly due to the dermis.

The possibility of using combined erbium and neodymium lasers to correct the age-related changes in the face and neck skin by the «Fotona» apparatus using the «Fotona 4D» technique was investigated. To evaluate the results of the study in dynamics an index of age-related changes in skin was developed and applied. The results of photographic fixation and ultrasound of the facial and neck skin before and after laser procedures were also compared. It was determined, that the combination of two wavelengths of 2940 nm (erbium laser) and 1064 nm (neodymium laser) and the «Fotona 4D» technique with 4 patented technologies allows to carry out the procedure at the level of superficial, middle and deep structures of the face and neck tissues. Nowadays it is the only technology for non-invasive volumetric reconstruction and facial skin voluminisation, which is the result of a combination of synergistic methods of laser exposure. It was shown that one month after the second procedure of laser treatment, the face skin turgor increased, its dryness, pore severity, quantity and depth of wrinkles decreased, side effects and complications were absent. Ultrasound examination of the facial skin and index of age- related changes assessing in the face skin confirmed the positive dynamics of correction. Thus, the thickness of the skin in the area of nasolabial folds and superciliary arches increased by 0,5 mm (from 1,9 to 2,4 mm), derma by 0,6 mm (0,8 to 1 mm). The index of age-related changes assessing in the facial skin decreased by 10-13 points (before the procedure it was within the range of 20-24 points (average degree of age changes), after the procedure it was 11 points (mild degree of age changes). Thus, the use of combined erbium and neodymium lasers using the «Fotona 4D» technique showed a high efficiency of laser correction of age-related changes in the facial skin. Implemention of modern technologies in practice of dermatological clinics will improve skills of medical personnel on the use of laser technology.

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