Comparative Study on the Outcome of Periorbital Wrinkles Treated with Laser-Assisted Delivery of Vitamin C or Vitamin C Plus Growth Factors: A Randomized, Double-blind, Clinical Trial

Abstract

Background Despite promising results, laser-assisted drug delivery (LADD) is not yet considered as standard therapies and published data rely mainly on laboratory tests, animal experiments or cadaver skin. Objectives This double-blind, prospective, randomized clinical trial investigates the impact in topical application of vitamin C and a cosmeceutical containing growth factors (GFs) on periorbital wrinkles primarily treated with laser skin resurfacing. Material and Methods In total, 149 female patients with periorbital wrinkles were consented and randomized into two study groups, R-C (receiving vitamin C only) and R-CGF (receiving vitamin C and a cosmeceutical containing growth factors). The statistical analysis evaluated the efficacy of each treatment regimen using software readouts provided by a three-dimensional stereophotogrammetry system prior to treatment and three months after the procedure. Results were compared to confirm if there was a significant change in the skin roughness and the average depth of the wrinkles between the two groups after treatment. Results There was a significant reduction in both skin roughness and average depth of the wrinkles in the group treated with vitamin C and growth factors (p <0.01) than those treated with LADD followed by topical application of vitamin C alone. There were no cutaneous reactions or adverse systemic reactions observed in this study related to LADD with vitamin C and GFs. Conclusion Controlled laser application might have a great potential to facilitate the absorption of exogenous macromolecules by the skin. Periorbital wrinkles were reduced in both groups, but LADD using vitamin C and GFs provided significantly better results. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Scientific validation of three-dimensional stereophotogrammetry compared to the IGAIS clinical scale for assessing wrinkles and scars after laser treatment

“…In agreement with other authors, the 3D SPM system has accumulated consistent, precise and meaningful information concerning treatment-related morphologic changes and enabled a comparison of outcome 3 , 16 , 25 , 36 .…”

“…We observed some loss of data accruing from the software’s inability to interpret dark holes such as nostrils or areas containing hair strands, which impeded the 3D reconstruction of some images. Nonetheless, the biggest challenge was to establish the angle and central axis of the area to be scanned so that the precise overlap between pre and post-treatment photographs could be assured 5 , 12 , 26 , 36 . The camera has been handled only by the first author, neither have we needed to test the inter-operator reliability, nor have we necessitated to establish the coefficient of variation (CV) in the use of the equipment.…”

“…Roughness is defined as the arithmetic mean of peak-to-valley-height skin characteristics 19 , 34 , 37 and is specified by the International Organization for Standardization (ISO 3274:’96 and ISO 4287:’97). Its change is linked to the ageing process, scars, after-treatment alteration, and some pathological conditions 36 , 38 – 43 . The facial wrinkle (perioral or periorbital) was analysed using roughness and the average depth of the wrinkles as volume is not suitable for analysing this skin alteration.…”

“…The software detects and quantifies subtle differences in height, depth, width and texture of a surface 24 , 34 . Three-dimensional stereophotogrammetry has been validated as a precise, harmless, non-invasive system to monitor surface irregularities including cutaneous tumors, scars and wrinkles 1 – 3 , 21 – 33 , 36 . However, most studies lack robust statistical analysis or have not included objective documentation regarding pre and post-procedure comparison.…”

Facial Treatment with 3-O-Cetyl Ascorbic Acid for Improvement of Skin Texture: Uptake, Effectiveness, and In Vitro Carcinogenicity Assessment

“…AA is unstable and readily oxidized in the formulation of cosmetics, and it is difficult to deliver into the skin in an adequate quantity [16,17]. Consequently, considerable efforts to improve its topical application have been directed toward the development of new synthetic derivatives and novel delivery methods [18][19][20][21][22][23][24][25].…”