The Efficacy and Safety of Fractional CO₂Laser Combined with Topical Type A Botulinum Toxin for Facial Rejuvenation: A Randomized Controlled Split-Face Study

Abstract

Objective. We evaluated synergistic efficacy and safety of combined topical application of Botulinum Toxin Type A (BTX-A) with fractional CO2 laser for facial rejuvenation. Methods. Twenty female subjects were included for this split-face comparative study. One side of each subject's cheek was treated with fractional CO2 plus saline solution, and the other side was treated with fractional CO2 laser plus topical application of BTX-A. Patients received one session of treatment and evaluations were done at baseline, one, four, and twelve weeks after treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index. Results. BTX-A combined with fractional CO2 laser sides showed higher physician's global assessment score, subject satisfaction score, roughness, skin hydration, and skin elasticity compared to that of fractional CO2 plus saline solution side at 12 weeks after treatment. TEWL and erythema and melanin index showed no significant differences between two sides at baseline, one, four, and twelve weeks after treatment. Conclusion. Topical application of BTX-A could enhance the rejuvenation effect of fractional CO2 laser.

The Effect of Botulinum Toxin Type A on Expression Profiling of Long Noncoding RNAs in Human Dermal Fibroblasts

“…QRT-PCR was applied to verify the result of microarray analysis. We learned from other studies that BoNTA can regulate cell proliferation and collagen synthesis; the mechanisms may play important roles in skin rejuvenation effects of BoNTA [ 32 – 34 ]. The RNAs chosen for qRT-PCR confirmation meet at least one of two following criteria: 1: the RNAs being at least 2-fold differently expressed in BoNTA treated groups in comparison with the control group according to the data analysis; 2: the RNAs that had been proved in other studies to have a relationship with biological functions such as cell proliferation and collagen synthesis.…”

“…We speculated significant change of expression of these RNAs in a time-dependent manner after BoNTA treatment which may be of some clinical significance. Zhu et al conducted one clinical experiment and found that topical application of BoNTA could enhance the rejuvenation effect of fractional CO 2 laser; they also found that best results of skin detection were in the last observation point at 3 months after treatment [ 34 ]. Zhu et al also performed another clinical study and found that intradermal BoNTA injection showed its best rejuvenation results in the last observation point at 12 weeks after treatment as well [ 44 ].…”

“…These studies not only showed the positive effects of BoNTA on HDFs for remodeling skin but also implied the importance of HDFs. In 2016, Zhu et al proved that topical BoNTA application could enhance the rejuvenation effect of fractional CO 2 laser, further indicating that BoNTA can refine skin texture via improving the activity of HDFs [ 10 ]. But until now, the molecular mechanisms through which BoNTA could affect HDFs are still not completely understood.…”

Ablative fractional carbon dioxide laser combined with intense pulsed light for the treatment of photoaging skin in Chinese population

“…The barrier dysfunction of the skin is mainly manifested by increased TEWL and decreased hydration of the skin. [ 23 , 24 ] It has been reported that TEWL was significantly increased at 3 days after AFL treatment and recovery to the normal level at 4 weeks after therapy. [ 25 ] In this study, we found that skin hydration and TEWL at 1 month after AFL combined with IPL was similar to those before the treatment, and was not significantly different from those after IPL treatment alone, suggesting that AFL in combination with IPL does not significantly impair skin barrier function.…”

A Comparative In Vivo Study on Three Treatment Approaches to Applying Topical Botulinum Toxin A for Crow’s Feet

“…The treatment also results in very high (>90%) patient satisfaction scores [ 28 – 30 ]. Two studies have used a fractional ablative laser to create microscopic columns in the epidermis and dermis that permitted BoNTA molecules to reach the superficial orbicularis oculi in the lower dermis [ 31 , 32 ]. Although the fractional ablative laser combination with BoNTA was successful, its operation is more complicated and cost is higher than injections [ 32 ].…”