Journal of Cosmetic and Regenerative Medicine

Background: Dermal fillers have emerged as one of the most popular minimally invasive aesthetic procedures worldwide. While generally safe, catastrophic neurological complications including cerebral stroke represent rare but devastating adverse events. Stroke following facial filler injection occurs through arterial embolization, with filler material traveling retrogradely through facial vessels to intracranial circulation. This complication has been increasingly documented with various filler types including hyaluronic acid, autologous fat, poly-L-lactic acid, and calcium hydroxylapatite. This review provides a comprehensive analysis of literature on dermal filler-induced cerebral stroke published from 2021 to 2025. Methods: A systematic literature search was conducted using MEDLINE, PubMed, and Ovid databases for articles published between January 2021 and February 2025. Thirty-four studies were identified and analyzed, encompassing case reports, case series, retrospective studies, systematic reviews, and comprehensive literature reviews. All studies were classified according to the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence (March 2009). Results: The literature revealed multiple anatomical pathways for retrograde arterial embolization, with the glabella, nose, nasolabial fold, and forehead identified as highest-risk zones due to rich anastomotic connections between facial and ophthalmic arteries. Hyaluronic acid and autologous fat were the most commonly implicated agents. Clinical presentations ranged from isolated unilateral blindness to devastating bilateral cerebral infarctions, with middle cerebral artery territory most frequently affected. Outcomes were generally poor despite aggressive interventions including thrombolysis, mechanical thrombectomy, and hyaluronidase administration. Mortality and severe permanent disability were common. Prevention strategies emphasized detailed anatomical knowledge, recognition of danger zones, appropriate injection techniques including aspiration, use of blunt cannulas, and immediate recognition of warning signs. Conclusion: Dermal filler-induced cerebral stroke represents one of the most catastrophic complications in aesthetic medicine, with devastating neurological outcomes and significant mortality. Despite advancements in emergency management protocols, prevention remains paramount. Enhanced practitioner education, rigorous adherence to safety protocols, and immediate recognition of embolic phenomena are essential for reducing this life-threatening complication. Full article

Picosecond (PS) lasers represent a major advancement in dermatologic laser technology, providing highly efficient clearance of various benign pigmentary disorders (BPDs) primarily through photomechanical disruption of melanin granules and laser-induced optical breakdown (LIOB). These mechanisms enable finer pigment fragmentation and accelerated macrophage-mediated clearance while markedly reducing collateral thermal injury compared with conventional nanosecond systems. Asian skin, accounting for approximately 59.7% of the global population, exhibits distinctive melanogenic instability that predisposes individuals to a wide spectrum of BPDs associated with significant cosmetic and psychosocial burden. Traditional quality-switched (QS) lasers achieve reasonable efficacy but carry elevated risks of post-inflammatory hyperpigmentation (PIH), hypopigmentation, burns, and textural changes in this phototype, often necessitating conservative parameters that compromise outcomes. PS lasers overcome these limitations by utilizing lower fluences and ultra-short pulse durations, conferring a favorable “less irritation, more efficacy” (LIME) profile ideally suited to Asian patients. This narrative review summarizes current evidence on PS laser applications for common Asian BPDs, incorporating verified studies published between 2020 and 2026 on novel wavelengths, optimized protocols, and comparative clinical outcomes. Full article

Background: The integration of synthetic polymers into aesthetic medicine and personal care products has led to growing scrutiny regarding microplastics (MPs) and nanoplastics (NPs). While these materials enhance product performance, texture, and delivery, emerging evidence suggests potential adverse effects on cutaneous health and significant environmental persistence. This review provides a comprehensive update on the presence, penetration, and toxicological impact of MPs and NPs in aesthetic medicine. Methods: A systematic literature search was conducted using MEDLINE, PubMed, and Ovid databases for studies published between January 2021 and early 2025. Keywords included “microplastics,” “nanoplastics,” “cosmetics,” and “aesthetic medicine.” Thirty articles were selected and analyzed based on the Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence. Results: Recent data confirms that MPs and NPs are ubiquitous in cosmetic formulations, including exfoliants, cleansers, and dermal fillers. Advanced imaging techniques like multiphoton tomography have demonstrated the capacity of NPs (<100 nm) to penetrate the stratum corneum and accumulate in the viable epidermis. Biological studies indicate that internalized particles can induce oxidative stress, inflammatory cytokine release, and barrier disruption in keratinocytes. Environmental assessments reveal that aesthetic clinics contribute significantly to plastic waste burdens. However, sustainable alternatives and biodegradable microbeads show promising efficacy without the associated ecological or biological risks. Conclusions: The aesthetic medicine sector faces a critical pivot point regarding synthetic polymer use. While current evidence suggests potential dermatological risks particularly from nanometric particles, the industry is increasingly adopting sustainable innovations. Standardized regulatory frameworks and continued research into long-term systemic effects are essential for ensuring patient safety and environmental stewardship. Full article

Background: Dermal fillers have become one of the most widely performed minimally invasive aesthetic procedures globally. While generally considered safe, an emerging and underrecognized complication is filler-induced alopecia, which can manifest as either nonscarring or scarring hair loss. This complication has been increasingly reported with various filler types including hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, and autologous fat. This review provides a comprehensive analysis of literature on dermal filler-induced alopecia published from 2019 to 2025. Methods: A systematic literature search was conducted using MEDLINE, PubMed, and Ovid databases for articles published between January 2019 and early 2025. Keywords included “dermal filler,” “alopecia,” “hair loss,” “hyaluronic acid,” and “filler complications.” Thirty studies were identified and analyzed. All studies were classified according to the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence (March 2009). Results: The literature revealed multiple mechanisms of filler-induced alopecia including vascular compromise leading to ischemic necrosis, mechanical pressure causing pressure-induced alopecia, inflammatory reactions, and direct follicular damage. Hyaluronic acid was the most commonly implicated filler agent, followed by autologous fat, poly-L-lactic acid, and calcium hydroxylapatite. Temporal and frontal regions were the most commonly affected anatomical sites. Treatment approaches included hyaluronidase for hyaluronic acid-related cases, hyperbaric oxygen therapy, intraarterial hyaluronidase injection, platelet-rich plasma, and autologous fat grafting with concentrated growth factors. Prevention strategies emphasized understanding vascular anatomy, appropriate injection techniques, and recognizing early warning signs. Conclusions: Dermal filler-induced alopecia represents a significant and potentially devastating complication that requires increased awareness among practitioners performing aesthetic procedures. Understanding the mechanisms, risk factors, early recognition, and management strategies are essential for minimizing this complication and optimizing patient outcomes. Full article

Background: Laser hair removal (LHR) remains one of the most frequently performed cosmetic procedures worldwide. While selective photothermolysis principles remain fundamental, recent technological innovations including rotational multi-wavelength approaches, in-motion delivery systems, and enhanced cooling mechanisms have expanded treatment efficacy across diverse skin types. This review provides a comprehensive update on LHR literature from 2023 to 2025. Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases for articles published between January 2023 and early 2025. Keywords included “laser hair removal,” “photoepilation,” and “LHR.” Forty seven studies were selected and analyzed based on Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence. Results: Recent data confirms the safety and efficacy of long-pulsed Nd:YAG 1064 nm lasers for darker skin types (Fitzpatrick IV-VI), while Alexandrite 755 nm remains the gold standard for lighter skin. Emerging evidence supports the use of rotational protocols and triple-wavelength diode systems to overcome treatment plateaus. Significant clinical applications beyond cosmetic use have been validated, including gender-affirming care, management of hidradenitis suppurativa (Level 1a evidence), and pilonidal sinus disease prevention. Paradoxical hypertrichosis remains a challenging adverse event with a prevalence of up to 18.3% in high-risk populations. Conclusion: Laser hair removal technology continues to evolve with improved safety profiles and expanded indications. Standardized protocols tailored to individual skin phototypes and hair characteristics are essential for optimizing outcomes and minimizing complications. Full article

Background: Hair loss, particularly androgenetic alopecia and alopecia areata, represents a prevalent dermatological condition with significant psychosocial impact. Laser-based therapies have emerged as promising non-invasive treatment modalities, encompassing low-level laser therapy (LLLT), fractional ablative lasers, and photobiomodulation techniques. Recent technological advances have introduced novel wavelengths, treatment parameters, and combination approaches that demonstrate enhanced efficacy profiles. This comprehensive review examines the current state of laser therapy for hair loss, analyzing clinical outcomes, mechanisms of action, and safety considerations reported between 2023 and 2025. Methods: A systematic literature search was conducted using MEDLINE, PubMed, and Ovid databases for studies published between January 2023 and December 2025. Keywords included “laser hair loss,” “low-level laser therapy,” “LLLT,” “photobiomodulation,” “fractional laser,” “androgenetic alopecia,” “alopecia areata,” “erbium YAG laser,” and “CO₂ laser.” Studies were classified according to the Oxford Centre for Evidence-Based Medicine levels of evidence hierarchy. Forty-three studies were analyzed, including randomized controlled trials, cohort studies, case series, systematic reviews, and meta-analyses. Results: Low-level laser therapy demonstrated hair density increases of 15–40% across multiple studies, with wavelengths between 630–680 nm showing optimal efficacy. Fractional CO₂ lasers achieved 30–75% improvement in hair regrowth when combined with topical therapies, with mechanisms involving stem cell activation and enhanced drug delivery. Erbium:YAG lasers showed promising results with 40–65% response rates and favorable safety profiles. Combination approaches with minoxidil, platelet-rich plasma, or bimatoprost demonstrated superior outcomes compared to monotherapy. Common complications included transient erythema (60–90%), mild pain during treatment (40–70%), temporary shedding (15–30%), and rare cases of hyperpigmentation (2–8%). Meta-analyses confirmed significant efficacy advantages for combination therapies over single-modality treatments. Conclusion: Laser-based therapies represent effective treatment options for various hair loss conditions, with evidence supporting both low-level laser therapy and fractional ablative approaches. Combination strategies demonstrate superior efficacy compared to monotherapy. Patient selection, appropriate laser parameter selection, and realistic expectation management remain essential for optimizing outcomes. Future research should focus on standardized treatment protocols, long-term efficacy data, and identification of predictive biomarkers for treatment response. Full article

Background: Thread rhinoplasty has emerged as a minimally invasive alternative to surgical rhinoplasty for nasal aesthetic enhancement. This technique utilizes absorbable or non-absorbable threads to achieve nasal tip elevation, dorsal augmentation, and structural support without surgical incision. This comprehensive review examines the current state of thread rhinoplasty techniques, clinical outcomes, and safety profiles reported between 2018 and 2023. Methods: A systematic literature search was conducted in MEDLINE, PubMed, and Ovid databases for studies published between January 2018 and December 2023. Keywords included “thread rhinoplasty,” “PDO threads,” “non-surgical rhinoplasty,” “nasal thread lift,” and “absorbable suture nose.” Studies were classified according to the Oxford Centre for Evidence-Based Medicine levels of evidence hierarchy. Approximately 60 studies were analyzed, including prospective cohorts, case series, systematic reviews, and technique descriptions. Results: Thread rhinoplasty primarily employs polydioxanone (PDO), poly-L-lactic acid with polycaprolactone (PLLA-PCA), and pure polycaprolactone (PCL) threads. Patient satisfaction rates ranged from 62–95% at follow-up intervals of 6–24 months, with higher satisfaction at shorter intervals. PDO threads demonstrated effect duration of 8–12 months, while PLLA-PCA threads showed longer-lasting results of 18–30 months. Objective measurements revealed nasal tip elevation of 2–3 mm and nasolabial angle increases of 6–8 degrees. Common applications included nasal tip elevation, dorsal augmentation, columellar support, and nasolabial angle modification. Complications were generally minor including transient swelling (15–85%), bruising (20–45%), thread visibility (5–15%), skin dimpling (3–12%), infection (2–8%), and thread extrusion (1–5%). Combination approaches with hyaluronic acid fillers demonstrated superior outcomes compared to thread-only techniques. Asian populations constituted the predominant study demographic, reflecting cultural preferences for nasal augmentation procedures. Conclusions: Thread rhinoplasty represents a viable minimally invasive option for patients seeking temporary nasal aesthetic enhancement with mild to moderate concerns. Absorbable materials provide predictable safety profiles with reversibility advantages. Patient selection remains critical, with optimal candidates presenting thin skin, realistic expectations, and understanding of temporary effect duration. Continued research with standardized outcome measures and long-term follow-up studies would strengthen the evidence base for this evolving procedure. Full article

Background: Melasma is a chronic acquired hyperpigmentation disorder that disproportionately affects women and individuals with darker skin phototypes. Despite numerous topical and procedural treatments, melasma remains therapeutically challenging due to high recurrence rates and risk of post-inflammatory complications. Laser therapy has emerged as a promising treatment modality, though outcomes remain inconsistent and require careful patient selection and parameter optimization. Methods: A comprehensive literature search was conducted in MEDLINE, PubMed, and Ovid databases for studies published between January 2014 and December 2025. Search terms included “melasma,” “laser treatment,” “Q-switched Nd:YAG,” “picosecond laser,” “fractional laser,” “intense pulsed light,” and related terms. Studies were classified according to Oxford Centre for Evidence-Based Medicine levels of evidence. Approximately 39 studies including randomized controlled trials, cohort studies, systematic reviews, and meta-analyses were analyzed. Results: Low-fluence Q-switched 1064 nm Nd:YAG laser demonstrated efficacy with 62–85% improvement in MASI scores, though with high recurrence rates (43–81% at 3 months). Picosecond lasers (755 nm and 1064 nm) showed comparable or slightly superior efficacy (65–75% improvement) with potentially lower complication rates. Fractional non-ablative lasers (1550 nm, 1927 nm thulium) achieved 40–70% improvement with better maintenance. Combination therapies with topical tranexamic acid or triple combination cream significantly enhanced outcomes. Common complications included post-inflammatory hyperpigmentation (15–30% in darker skin), transient hypopigmentation (10–20%), and erythema (>90%). Novel approaches including perfluorodecalin patches, platelet-rich plasma, and laser-assisted drug delivery showed promising results in preliminary studies. Conclusions: Laser treatment for melasma can provide meaningful improvement when appropriate patient selection, conservative parameters, and combination approaches are employed. Low-fluence Q-switched Nd:YAG and picosecond lasers represent first-line laser options, while fractional systems offer safer alternatives for darker skin types. Combination with topical agents, extended treatment intervals, and aggressive photoprotection are essential for optimizing outcomes and minimizing recurrence. Future research should focus on long-term maintenance strategies and standardized treatment protocols for diverse skin phototypes. Full article

Background: Laser tattoo removal has become the gold standard treatment for unwanted tattoos, with technological advancements introducing picosecond and nanosecond laser systems that offer improved efficacy and safety profiles. This comprehensive review examines the current state of laser tattoo removal techniques, focusing on clinical outcomes, complications, and innovations reported between 2019 and 2023. Methods: A systematic literature search was conducted in MEDLINE, PubMed, and Ovid databases for studies published between January 2019 and December 2023. Keywords included “laser tattoo removal,” “Q-switched laser,” “picosecond laser,” “tattoo clearance,” and “complications.” Studies were classified according to the Oxford Centre for Evidence-Based Medicine levels of evidence hierarchy. Approximately 50 studies were analyzed, including randomized controlled trials, cohort studies, case series, and systematic reviews. Results: Q-switched lasers (Nd:YAG 1064/532 nm, Alexandrite 755 nm, Ruby 694 nm) and picosecond lasers demonstrated variable efficacy depending on tattoo characteristics. Black ink showed the highest clearance rates (75–95%), while multicolored tattoos required multiple wavelengths and extended treatment courses. Picosecond lasers showed comparable or superior efficacy to Q-switched systems with potentially fewer treatment sessions. Common complications included transient erythema (90%), hypopigmentation (10–25%), hyperpigmentation (5–15%), and scarring (0.5–2%). Darker skin types (Fitzpatrick IV-VI) presented higher risks of pigmentary changes. Novel techniques including R20 protocols, perfluorodecalin patches, and combination therapies showed promising results in accelerating clearance rates. Conclusions: Modern laser systems provide effective tattoo removal with acceptable safety profiles when proper patient selection and treatment parameters are employed. Continued research into optimal wavelengths, pulse durations, and combination therapies will further improve outcomes and minimize adverse effects. Standardized protocols for different skin types and tattoo characteristics are essential for optimizing treatment success. Full article

Background: Viral warts, also known as verrucae, are common benign epithelial proliferations caused by human papillomavirus (HPV) infection. Although benign, viral warts frequently cause significant physical discomfort, functional impairment, and psychological distress for patients. Radiofrequency ablation has emerged as an effective method for viral wart removal due to its precision and hemostatic properties, but may result in post-inflammatory hyperpigmentation, which poses an additional aesthetic challenge particularly in patients with darker skin types. Intense pulsed light therapy is an established treatment modality for post-inflammatory hyperpigmentation management. This case series and literature review aims to evaluate the efficacy and safety of radiofrequency ablation for viral wart removal followed by intense pulsed light therapy for post-inflammatory hyperpigmentation management. Methods:Three patients with clinically diagnosed viral warts were treated using radiofrequency ablation. Post-treatment, they were monitored for the development of post-inflammatory hyperpigmentation. For patients who developed post-inflammatory hyperpigmentation, intense pulsed light therapy was administered (Lee-Chan RFA-IPL technique). The outcomes were assessed based on the resolution of viral wart lesions, the degree of post-inflammatory hyperpigmentation, and patient satisfaction. A comprehensive literature review was conducted to contextualize the findings within the broader field of viral wart treatment and post-inflammatory hyperpigmentation management. Results: Three patients underwent radiofrequency ablation for viral wart removal. Complete removal of viral wart lesions was achieved in all cases without significant complications. However, all three patients developed varying levels of post-inflammatory hyperpigmentation within two to three weeks post-ablation. These patients received intense pulsed light therapy starting at four weeks post-radiofrequency ablation, administered in a series of seven sessions at three-week intervals. The post-inflammatory hyperpigmentation significantly improved in 100% (3/3) of patients after intense pulsed light therapy, evidenced by marked reduction in hyperpigmentation and high patient satisfaction rates. Both radiofrequency ablation and intense pulsed light procedures were well-tolerated with minimal adverse effects. Conclusions:The combination of radiofrequency ablation and subsequent intense pulsed light therapy (Lee-Chan RFA-IPL technique) appears to be an effective and safe strategy for managing viral wart lesions and associated post-inflammatory hyperpigmentation. Radiofrequency ablation successfully removes viral wart lesions with high efficacy and minimal risk, while intense pulsed light effectively mitigates post-inflammatory hyperpigmentation, enhancing cosmetic outcomes and patient satisfaction. This case series underscores the potential of integrating these modalities in clinical practice, offering a promising approach to optimize cosmetic results in patients with post-inflammatory hyperpigmentation. Further large-scale studies and randomized controlled trials are warranted to affirm these findings and refine treatment protocols. Full article

Biostimulator fillers are increasingly used in cosmetic and regenerative medicine because of their collagen-stimulating properties; however, ocular vascular occlusion remains a rare but potentially devastating complication. We report a case of isolated cilioretinal artery occlusion following periocular injection of poly-D,L-lactic acid with carboxymethylcellulose (PDLLA-CMC), with favorable visual recovery after prompt multidisciplinary treatment. A 52-year-old Chinese woman with a history of facial fat grafting, direct brow lift surgery, and previous polycaprolactone filler treatment underwent PDLLA-CMC injections to the temples and forehead. Using a 22-gauge, 50-mm blunt cannula, 3 mL of reconstituted product was injected on each side via a supraperiosteal fanning technique. Immediately after right temporal injection, she experienced dark spots in the right visual field. An emergency vascular occlusion protocol was initiated, including supine positioning, ocular massage, high-flow oxygen, topical timolol and brimonidine, oral acetazolamide and aspirin, and intravenous dexamethasone. Urgent ophthalmologic assessment demonstrated best-corrected visual acuity of 6/6 in both eyes, visible emboli within the right cilioretinal artery, inner retinal edema in the inferonasal parafoveal region on optical coherence tomography, and a corresponding paracentral scotoma on Humphrey visual field testing. Oral prednisolone and hyperbaric oxygen therapy were commenced early. Hyperbaric oxygen was delivered at 2.2–2.4 atmospheres absolute with 100% oxygen for 90 min twice daily for 2 days, followed by daily sessions for 1 week. Over 4 weeks, the patient reported progressive symptomatic improvement, while serial fundus imaging and visual field testing demonstrated embolus displacement, reduction of retinal edema, and improvement of the scotoma, with visual acuity remaining 6/6 throughout follow-up. This case highlights that isolated cilioretinal artery occlusion can occur after PDLLA-CMC injection despite recommended technique, and suggests that immediate recognition, early ophthalmologic referral, and adjunctive hyperbaric oxygen therapy may improve outcomes in non-hyaluronic acid filler-related ocular ischemic events when instituted without delay in carefully selected acute presentations. Full article

Medication-driven weight loss (MDWL), popularly termed “Ozempic Face,” has emerged as a new challenge in aesthetic medicine following the widespread use of prescription weight-loss medications, including semaglutide, liraglutide, tirzepatide, and related GLP-1/GIP receptor agonists. Although these therapies are highly effective for obesity management, rapid fat reduction may produce facial volume loss, skin laxity, contour disharmony, and accelerated signs of aging. This article examines the clinical and commercial implications of MDWL face and proposes a practical framework for aesthetic assessment and management. The manuscript integrates published evidence, international survey findings, clinical case observations, and structured treatment protocols to characterize the new aesthetic consumer profile and the evolving demand for multimodal rejuvenation. Survey data showed that 93% of respondents noticed facial changes during treatment, most commonly a slimmer face and loss of cheek fullness, often appearing within 1–6 months. The paper reviews layered treatment strategies that address muscle harmony, structural volumization, contouring, resurfacing, and skin-envelope regeneration through injectables, biostimulators, skinboosters, fat transfer, and energy-based devices such as radiofrequency, ultrasound, lasers, and neuromodulation technologies. It further emphasizes ethnic variation, noting that Caucasian patients more commonly present with hollowing and angularity, whereas Asian patients more often exhibit midface flattening and lower-face laxity, necessitating tailored treatment algorithms. Distinctions between bariatric and MDWL patients are also discussed, with bariatric patients typically demonstrating more advanced aging changes and greater reconstructive needs. The authors advocate comprehensive consultation, patient education, nutritional optimization, resistance exercise, and psychological support alongside aesthetic intervention. Overall, MDWL face represents a paradigm shift in modern practice, expanding the consumer base for injectables and energy-based devices while demanding individualized, culturally sensitive, and holistic care. Full article

The COVID-19 pandemic mandated the widespread and prolonged use of facial masks, particularly in regions with stringent public health measures like Hong Kong. This report documents two cases of auricular keloids secondary to repetitive, mask-related ear trauma, a novel complication not yet widely documented in dermatological literature. Both patients, a 32-year-old male security worker and a 32-year-old male engineer, had no prior history of keloids but developed them on their ear helices after sustained mask use. Case 1 experienced recurrent keloids despite initial treatments but achieved resolution with a multimodal approach. Case 2 was treated successfully with a combination of cryosurgery, excision, and pressure therapy. These cases highlight mechanical friction and pressure from mask straps as emerging aetiological factors for keloid formation. The success of the multimodal therapeutic approaches suggests promising avenues for managing similar complications and underscores the need for preventive strategies in occupations requiring prolonged mask use. Full article