Journal of Cosmetic and Regenerative Medicine

Background: Lentigines, particularly solar lentigines, are common benign pigmented lesions arising predominantly on chronically sun-exposed skin. Although medically benign, they frequently generate significant cosmetic concern and may impair self-image, especially when numerous, enlarging, recurrent, or distributed over highly visible facial and acral sites. Established treatment options include topical depigmenting agents, cryotherapy, chemical peels, pigment-specific lasers, and intense pulsed light (IPL). However, selected patients desire more immediate lesion removal than can be achieved with topical therapy alone, while ablative approaches may produce post-inflammatory hyperpigmentation (PIH), particularly in Fitzpatrick skin types III–VI. Aim: Radiofrequency ablation (RFA) allows rapid focal lesion destruction with hemostasis and precision, whereas IPL is an established modality for treating residual dyschromia and broader photodamage. This case series and literature review evaluates the efficacy and safety of the Lee-Chan radiofrequency ablation-intense pulsed light technique for lentigines removal and subsequent pigment optimization. Methods: Three patients with extensive benign pigmented facial lesions were treated using the Lee-Chan staged protocol. The updated series comprised one patient with big lentigine and two patients with extensive predominant solar lentigines, one of whom also had background dyschromia with melasma. Because of the extensive facial involvement, radiofrequency surgical treatment was performed in two sessions separated by 4 weeks, followed by intense pulsed light (IPL) after re-epithelialization to reduce post-procedural hyperpigmentation, residual pigmentation, and generalized photodamage. Clinical outcomes included lesion clearance, textural improvement, pigment reduction, skin quality, cosmetic blending, downtime, tolerability, and patient-reported satisfaction. Results: Across the updated three cases, radiofrequency treatment achieved effective removal of the targeted benign pigmented lesions with excellent procedural control and no major complications. Subsequent IPL contributed to reduction of residual dyschromia and post-procedural pigmentation while also improving overall skin texture, pore prominence, tone uniformity, and perceived facial rejuvenation. At final follow-up, the patients showed high cosmetic acceptability, no hypertrophic scarring, and marked improvement in the treated areas, including enhanced skin glow, softening of fine wrinkles, and visible tightening in selected regions. Conclusions: The Lee-Chan RFA-IPL technique appears to be a practical and cosmetically advantageous staged approach for selected patients with extensive benign pigmented facial lesions, including solar lentigines and related seborrheic keratotic changes. Radiofrequency treatment provides immediate focal lesion removal, whereas IPL serves as a complementary modality for minimizing residual pigmentation, improving photodamaged skin, and optimizing the final aesthetic result. The updated case series further supports the value of combining lesion-directed ablation with subsequent field-based light therapy in patients concerned about scarring, hyperpigmentation, and overall facial rejuvenation. Full article

Background: The demand for noninvasive aesthetic procedures has surged, positioning microfocused ultrasound and high-intensity focused ultrasound as foundational modalities for tissue lifting and tightening. While early literature established its basic efficacy, the rapid evolution of clinical protocols, novel combinations, and expanded anatomical indications necessitates a re-evaluation of the evidence. Methods: A systematic critical review was conducted to evaluate recent literature between year 2024 and year 2026 within MEDLINE, PubMed, and Ovid databases.. Data extraction focused on study design, primary clinical outcomes, safety profiles, and methodological limitations. Evidence was synthesized chronologically and thematically, with all included studies were rigorously classified according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence (March 2009) to appropriately stratify the current clinical landscape. Results: Fifty-seven studies met the inclusion criteria. Recent evidence robustly supports the efficacy of microfocused ultrasound for mild-to-moderate facial and cervical laxity. Emerging literature highlights successful integration with injectable biostimulators, dermal fillers, and other energy-based devices. Furthermore, expanded indications, including superficial skin quality improvements and body contouring, show promise. The safety profile remains highly favorable, characterized predominantly by transient erythema and localized edema, though rare reports of significant ocular or neurological complications underscore the importance of anatomical precision. Conclusions: Microfocused ultrasound remains a versatile and highly effective noninvasive modality in aesthetic medicine. While optimal outcomes are consistently observed in lower face and neck lifting, future research must prioritize standardized protocols for novel body indications, long-term follow-up for combination therapies, and rigorous anatomical guidelines to mitigate rare adverse events. Full article

Background: The integration of Janus kinase inhibitors into dermatologic practice has fundamentally transformed the management of complex, immune-mediated cutaneous diseases. Originally pioneered for rheumatologic and hematologic conditions, these targeted therapies have rapidly expanded into dermatology, offering unprecedented efficacy for conditions such as atopic dermatitis, alopecia areata, and vitiligo. However, the rapid proliferation of both topical and systemic Janus kinase inhibitors requires a careful synthesis of their evolving efficacy profiles, long-term safety data, and novel applications beyond their initial regulatory approvals. Methods: A comprehensive literature review was performed to capture the most recent advancements and critical evaluations in this domain. Studies published between 2024 and 2026 within MEDLINE, PubMed, and Ovid databases were systematically reviewed. The gathered literature was analyzed to extract data on drug efficacy, post-marketing safety, and emerging indications. All included studies were rigorously classified according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence (March 2009) to appropriately stratify the current clinical landscape. Results: Fifty-eight contemporary articles met the inclusion criteria, encompassing a diverse array of systemic reviews, pharmacovigilance reports, and clinical observations. The strongest evidence supports JAK inhibitors in atopic dermatitis and alopecia areata, where randomized trials, meta-analyses, and real-world studies show rapid symptom control, high clinical response rates, and acceptable short- to medium-term safety. Evidence is also substantial for vitiligo, particularly topical therapy for facial disease, and for chronic hand eczema with topical delgocitinib as an effective steroid-sparing option. Moderate-to-lower level evidence suggests benefit in psoriatic arthritis, inflammatory nail disorders, granuloma annulare, lichen sclerosus, autoimmune bullous diseases, scarring alopecia, and other refractory inflammatory dermatoses. Safety signals across studies include acne, herpes zoster, mild infections, laboratory abnormalities, and the need for individualized cardiovascular, malignant, and reproductive risk assessment before treatment initiation and during longitudinal dermatologic monitoring in practice. Conclusions: Janus kinase inhibitors represent a paradigm shift in dermatologic therapeutics, offering highly effective, targeted interventions for refractory skin conditions. Nevertheless, their optimal utilization demands meticulous clinical judgment, balancing potent immunological blockade against comprehensive, long-term safety surveillance. Full article

Background: Facial overfilled syndrome has emerged as a significant complication in aesthetic medicine, driven by the exponential increase in the use of soft tissue fillers. Characterized by anatomical distortion, loss of natural facial contours, and dynamic impairment, this syndrome poses profound physical and psychological challenges. Despite its growing prevalence, standardized definitions, diagnostic criteria, and management protocols remain insufficiently codified. Methods: A comprehensive evaluation of peer-reviewed literature was conducted using MEDLINE, PubMed, and Ovid databases to identify studies published from 2022 to 2026. A total of 46 publications were included, encompassing clinical trials, observational studies, imaging reviews, and expert consensus guidelines. These studies were critically appraised and classified according to the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence (March 2009). Results: Recent evidence demonstrates a paradigm shift toward recognizing the multifactorial etiology of overfilled syndrome, involving mismatched rheological properties of fillers, practitioner misjudgment, and patient body dysmorphic tendencies amplified by social media. Advanced imaging modalities, particularly high-resolution ultrasound and magnetic resonance imaging, have proven pivotal in objective diagnosis and image-guided treatment. Management strategies are evolving from empiric hyaluronidase administration to precision, ultrasound-guided enzymatic dissolving, combined with surgical interventions for non-hyaluronic acid fillers or severe anatomical distortions. Conclusions: Facial overfilled syndrome represents a complex iatrogenic entity requiring a multidisciplinary approach. The integration of meticulous anatomical knowledge, targeted imaging, and ethical patient counseling is paramount for prevention. Future research must prioritize standardized diagnostic frameworks and longitudinal safety data to refine corrective protocols and restore facial identity. Full article

Background: Chronic migraine represents a profound global source of neurological disability. Since the landmark trials establishing the efficacy of onabotulinumtoxinA, the therapeutic landscape has evolved rapidly, particularly with the advent of calcitonin gene-related peptide (CGRP) monoclonal antibodies. The role of botulinum toxin type A (BoNT-A) continues to be reassessed in terms of real-world durability, safety in special populations such as pregnant women and adolescents, and comparative effectiveness against newer pharmacological prophylactic agents. An updated synthesis of the literature is required to delineate the current evidence base, mechanistics, and practical positioning of BoNT-A in refractory headache management. Methods: A comprehensive literature review was conducted covering publications from year 2024 to 2026. The source framework was based on MEDLINE, PubMed, and Ovid database retrieval. Studies included systematic reviews, meta-analyses, randomized controlled trials, retrospective cohort analyses, case reports, mechanistic investigations, and narrative reviews. Emphasis was placed on efficacy, tolerability, biomarkers, pediatric applications, and treatment resistance. All included studies were critically analyzed and classified according to the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence to provide a structured hierarchy of the current therapeutic evidence. Results: Recent evidence strongly reaffirms the long-term efficacy and safety of BoNT-A in chronic migraine prophylaxis. Extensive real-world data and systematic reviews demonstrate sustained reductions in headache days and acute medication reliance. While CGRP-targeted therapies offer formidable alternatives, large-scale comparative and umbrella reviews indicate BoNT-A remains highly competitive, often serving as a reliable rescue or combination therapy. Emerging literature highlights BoNT-A’s expanding utility in medically refractory pediatric cohorts and presents reassuring, albeit preliminary, safety profiles in pregnant populations. Mechanistic studies increasingly point toward complex central and peripheral neuromodulation, supported by measurable shifts in neurochemical biomarkers. However, the literature reveals uneven methodological quality, with a reliance on retrospective registries and narrative updates highlighting the need for rigorously controlled head-to-head trials. Conclusions: Botulinum toxin type A remains a cornerstone intervention for chronic migraine. Its established safety profile, sustained real-world effectiveness, and utility as an adjunctive or rescue treatment solidify its therapeutic relevance even in the CGRP era. Current practice should continue to emphasize individualized patient selection, recognizing the robust evidence for long-term burden reduction while navigating emerging off-label applications with critical caution. Full article

Background: The term “Ozempic face” has entered both medical and public discourse to describe facial hollowing, skin laxity, wrinkling, and age-amplifying soft-tissue changes observed after rapid weight loss associated with glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy. Although the phrase is now widely recognized, the scientific literature remains heterogeneous and is composed largely of reviews, commentaries, infodemiologic studies, surveys, case reports, and small interventional series. Methods: A comprehensive review of studies published between 2024 and 2026 in MEDLINE, PubMed, and Ovid was undertaken. Forty-four articles addressing semaglutide- and GLP-1RA-associated facial, skin, perioperative, psychosocial, ethical, and therapeutic issues were analyzed. Studies were classified according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence (March 2009). Results: The available literature suggests that “Ozempic face” is best understood not as a drug-specific facial disease, but as a clinically recognizable soft-tissue phenotype resulting from rapid or substantial weight loss, often superimposed on baseline intrinsic and extrinsic facial aging. Recurrent themes across the 44 studies included midfacial deflation, temporal hollowing, periorbital skeletonization, skin redundancy, worsened rhytides, and patient dissatisfaction despite successful metabolic outcomes. Public interest in both cosmetic weight loss and facial restoration rose sharply in parallel with widespread GLP-1RA adoption. The evidence base remains dominated by lower-level studies, but emerging reports describe potential roles for topical volumizers, biostimulatory injectables, hyaluronic acid fillers, radiofrequency-based tightening, ultrasound-associated peri-procedural regimens, and preventive aesthetic planning. Ethical concerns include off-label cosmetic prescribing, drug allocation, informed consent, body-image pressure, and the risk of stigmatizing effective obesity treatment. Conclusions: “Ozempic face” is a useful descriptive term, but it risks oversimplifying a multifactorial phenomenon driven by weight-loss velocity, magnitude of adipose depletion, age-related tissue reserve, skin quality, and patient expectations. Current evidence supports a multidisciplinary approach centered on anticipatory counseling, individualized facial assessment, conservative preventive strategies, and tailored restorative management. Higher-quality prospective studies with objective imaging, standardized outcome measures, and longer follow-up are needed to define incidence, risk factors, prevention, and treatment efficacy. Full article

Background: Acne vulgaris is a common chronic inflammatory disorder driven by sebaceous hyperactivity, follicular hyperkeratinization, Cutibacterium acnes proliferation, and inflammation. Although topical and systemic agents remain standard therapy, their use is often limited by irritation, antimicrobial resistance, teratogenicity, systemic adverse effects, and poor adherence. These limitations have increased interest in laser and light-based therapies as targeted, nonpharmacologic alternatives or adjuncts capable of addressing multiple pathogenic pathways. Methods: This update and critical review used structured evidence mapping of peer-reviewed publications indexed in MEDLINE, PubMed, and Ovid from 2024 to 2026. Eligible studies included randomized controlled trials, split-face trials, cohort studies, case series, systematic reviews, meta-analyses, and expert reviews evaluating lasers, light-based devices, and photodynamic therapy for active acne. Forty-two publications were included and appraised according to Oxford Centre for Evidence-Based Medicine levels to assess efficacy, safety, tolerability, and emerging treatment paradigms. Results: Recent evidence shows a transition from broad phototherapy toward mechanism-based energy devices. Sebum-selective 1726 nm lasers demonstrated promising efficacy, acceptable safety across diverse skin phototypes, and potential durability through selective sebaceous gland photothermolysis. Vascular lasers, including 577–589 nm and 585 nm systems, consistently improved inflammatory lesions and post-inflammatory erythema. Various 1064 nm Nd:YAG platforms showed benefit for inflammatory acne, deeper lesions, and early scar prevention. Solid-state dual-wavelength lasers and optimized photodynamic therapy protocols further enhanced lesion reduction, while newer cooling systems and software-assisted temperature monitoring improved procedural precision and reduced pain or pigmentary risk. Evidence from meta-analyses also supported selected combination use with isotretinoin, challenging older safety concerns. Conclusions: Laser and light-based therapies are evolving into important adjunctive and, in selected patients, alternative treatments for acne vulgaris. The strongest advances involve sebaceous targeting, vascular modulation, and safer treatment delivery across skin types. However, heterogeneity in parameters, cost, and limited long-term relapse data still restrict universal standardization. Future multicenter trials should define optimal protocols, clarify durability, and refine combination strategies to maximize efficacy, safety, and accessibility for broader adoption across routine dermatologic practice in coming years. Full article

Background: Intense pulsed light (IPL) has evolved from a vascular and pigmentary device into a versatile platform used across medical dermatology, aesthetic dermatology, scar management and ocular surface disease. Recent publications have expanded its recognized utility in rosacea, meibomian gland dysfunction, melasma, post-inflammatory dyschromia, hair reduction, scar modulation, and multimodal rejuvenation. At the same time, contemporary literature has highlighted unresolved issues regarding patient selection, parameter customization, durability of response, and long-term safety. Methods: A comprehensive literature review was conducted covering publications from 2024 to 2026 on the clinical application of IPL. The source framework was based on MEDLINE, PubMed, and Ovid database retrieval. These include randomized controlled trials, comparative studies, retrospective analyses, systematic reviews, meta-analyses, case series, case reports, translational studies, and narrative reviews. All included studies were classified according to the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence. Results: The most mature recent evidence supports IPL for erythematotelangiectatic rosacea and meibomian gland dysfunction-related ocular surface disease, where randomized trials, systematic reviews, and meta-analyses generally show improvement in erythema, telangiectasia, tear film stability, meibomian gland function, and symptom burden. Emerging data also support broader roles in facial rejuvenation, melasma, sensitive skin, hypertrophic scars, keloids, post-inflammatory hyperpigmentation, chalazion, and selected reconstructive or hair-reduction indications. Combination strategies appear particularly promising, including IPL with mesotherapy, topical tranexamic acid, collagen dressings, postoperative radiotherapy, microneedling, fractional carbon dioxide laser, corticosteroids, and gland-directed ocular interventions. However, heterogeneity remains substantial across device platforms, filters, pulse structures, treatment intervals, concomitant therapies, comparator groups, and outcome measures. Several studies are retrospective, small, or indication-specific, and some fields remain supported mainly by case-based or narrative evidence. Conclusions: Contemporary evidence positions IPL as a genuinely multipurpose therapeutic platform rather than a single-indication device. Its strongest present applications lie in vascular rosacea, ocular surface disease associated with meibomian gland dysfunction, and selected rejuvenation protocols. Broader indications are increasingly plausible, but many still require standardized protocols, longer follow-up, and higher-quality comparative trials before firm clinical algorithms can be established. Full article

Background: Rosacea is a chronic inflammatory dermatosis characterized by persistent facial erythema, flushing, telangiectasia, papules, pustules, phymatous change, and ocular involvement. Although topical and systemic agents remain foundational, light- and laser-based therapies have become increasingly important because they target vascular dysregulation, inflammation, and tissue remodeling directly. Recent years have seen expansion of evidence on pulsed dye laser, potassium-titanyl-phosphate laser, intense pulsed light, neodymium:yttrium-aluminum-garnet laser, alexandrite laser, light-emitting diode systems, radiofrequency-based devices, and combination protocols. Methods: A comprehensive literature review was conducted using the 44 studies specified for inclusion, covering publications from 2023 to 2026. These articles addressed clinical efficacy, safety, mechanistic findings, ocular rosacea, skin-of-color considerations, and emerging combination strategies. All studies were classified according to the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence. Results: The current literature supports pulsed dye laser and intense pulsed light as the most extensively studied light-based options for erythematotelangiectatic rosacea, with generally favorable efficacy and acceptable tolerability. Potassium-titanyl-phosphate laser appears comparable to pulsed dye laser in selected patients, with less purpura in some studies. Nd:YAG- and alexandrite-based approaches may provide value in deeper vascular disease, papulopustular rosacea, edema, and mixed phenotypes. Radiofrequency and adjunctive medical therapy may improve comfort or broaden response, while preclinical studies suggest that certain light-based modalities can modulate inflammation, angiogenesis, skin barrier dysfunction, and lymphatic abnormalities. However, heterogeneity in device settings, treatment intervals, outcome measures, and follow-up duration limits direct comparison across studies. Conclusions: Light-based treatment has become an important pillar in modern rosacea management, particularly for persistent erythema and telangiectasia that are often incompletely controlled with pharmacologic therapy alone. The strongest contemporary evidence supports vascular-selective therapies, especially pulsed dye laser and intense pulsed light, while emerging data suggest useful roles for KTP, Nd:YAG, alexandrite, photodynamic combinations, and multimodal protocols. Future studies should prioritize standardized endpoints, longer follow-up, subtype-specific analyses, and high-quality randomized comparative trials. Full article

Background: Scar formation remains a major therapeutic challenge because scars are biologically heterogeneous and clinically diverse, ranging from atrophic acne scars to hypertrophic burn scars, keloids, post-surgical linear scars, and pigmentary scar sequelae. Over the past decade, laser- and light-based technologies have become central to modern scar management because they can selectively target vascularity, collagen architecture, surface texture, pigmentation, and contracture while also enabling transdermal drug delivery and biologic augmentation. Recent literature published from 2024 to 2026 has expanded the evidence base for ablative fractional carbon dioxide laser, pulsed dye laser, erbium:YAG laser, picosecond fractional laser, intense pulsed light, and multimodal protocols involving platelet-rich plasma, stromal vascular fraction, exosomes, botulinum toxin, fillers, and laser-assisted subcision. Methods: A comprehensive literature review was conducted covering publications from 2024 to 2026 on laser treatment for scars. The source framework was based on MEDLINE, PubMed, and Ovid database retrieval. The included literature comprised randomized controlled trials, comparative studies, retrospective cohort studies, systematic reviews, meta-analyses, case series, narrative reviews, and mechanistic reviews. All studies were classified according to the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence. Results: Current evidence supports laser therapy as an effective and generally safe modality for multiple scar phenotypes. Ablative fractional CO₂ laser remains the most frequently studied modality, particularly for acne scars, hypertrophic scars, and surgical scars. Pulsed dye laser shows consistent benefit for immature, erythematous, and vascular scars, especially burn and early post-surgical scars. Combination strategies appear increasingly favorable, including pulsed dye laser plus fractional CO₂ laser, fractional CO₂ laser plus platelet-rich plasma, and laser-assisted delivery of regenerative agents. Early intervention, especially within weeks to months of wound healing, appears advantageous for many surgical and traumatic scars. However, heterogeneity in laser parameters, timing, scar subtype definitions, outcome scales, and follow-up duration continues to limit cross-study comparison. Conclusions: Laser therapy has become a major pillar of contemporary scar management. The strongest recent evidence favors phenotype-directed and time-sensitive treatment, with early vascular targeting for erythematous scars and fractional resurfacing for textural remodeling. Combination regimens may improve outcomes beyond monotherapy in selected patients. Future studies should prioritize standardized endpoints, longer follow-up, scar subtype stratification, cost-effectiveness analysis, and high-quality comparative trials in broader skin phototypes. Full article

Background: Picosecond laser technology has moved beyond its original role in tattoo clearance and now occupies a widening place in medical and aesthetic dermatology. During year 2024–2026, the literature expanded across pigmentary disorders, melasma, nevus of Ota, acne scarring, photorejuvenation, tattoo complications, and several exploratory indications. At the same time, enthusiasm has been tempered by inconsistent study quality, frequent reliance on retrospective series, and persistent concerns regarding dyspigmentation in darker phototypes. Methods: A comprehensive literature review was conducted covering publications from 2024 to 2026 on clinical application of Picosecond laser. The source framework was based on MEDLINE, PubMed, and Ovid database retrieval. Studies included systematic reviews, meta-analyses, randomized trials, retrospective comparative studies, case series, case reports, mechanistic investigations, and technology-focused reviews. All studies were classified according to the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence. Results: Recent evidence suggests that picosecond lasers are most strongly supported for selected pigmentary disorders and as an adjunctive modality in skin rejuvenation and acne scarring. Melasma remains the most controversial indication: several studies showed clinical improvement, yet high-level syntheses did not establish clear superiority over established topical regimens and underscored relapse and hypopigmentation concerns. For nevus of Ota and related dermal melanocytoses, results were generally favorable, especially in Asian populations and pediatric cohorts, although most data remained observational. Emerging reports also described use in lichen planus pigmentosus, xanthelasma, androgenetic alopecia, photodamage, argyria, and tattoo-related complications. Mechanistic work supported a dual action of pigment fragmentation and dermal remodeling, but translational gaps remain. Conclusions: Picosecond lasers have become a versatile platform with meaningful clinical utility, particularly for benign pigmented lesions, selected dermal melanocytoses, acne scarring, and rejuvenation. However, the evidence base remains uneven, with relatively few robust randomized studies and limited long-term outcome data. Current practice should therefore emphasize phenotype-specific treatment selection, conservative parameter choice in skin of color, and careful counseling regarding recurrence and dyspigmentation. Better-designed comparative trials and standardized reporting are needed to define the true comparative value of picosecond technology. Full article

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: 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: 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: 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: 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: 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: 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: 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: Carotenoderma is a benign yellow-orange discoloration of the skin caused by carotenoid accumulation within the stratum corneum. It is classically associated with excessive ingestion of carotene-rich foods or supplements and is most prominent on the palms and soles, where the stratum corneum is thickest. Although conventional carotenoids such as beta-carotene and lycopene are well recognized causes, supplement-associated carotenoderma remains underreported, particularly in relation to commercially available “skin brightening” products marketed as containing so-called colorless carotenoids. Case Presentation: We report the case of a 35-year-old woman with no significant past medical history who developed asymptomatic orange-yellow discoloration of both palms and soles after taking an over-the-counter anti-tanning supplement, over the counter colourless carotenoid pills, for one month. She denied excessive intake of carotene-rich foods, carrots, vegetable juices, or additional nutritional supplements apart from occasional melatonin. Examination demonstrated marked orange-yellow pigmentation of the palms and soles with sparing of the sclerae, face, and tendons. She was otherwise systemically well, with no jaundice, pallor, or abdominal findings. The patient also described bilateral eye floaters and dry eyes of one month’s duration after commencing the supplement. Her visual acuity and visual fields were normal at presentation, although retinal examination had not yet been performed. A diagnosis of supplement-associated carotenoderma was made clinically. The supplement was discontinued, liver function tests were arranged, the case was planned for reporting to the Hong Kong Poison Information Centre, and ophthalmology referral was made to exclude retinal toxicity. Conclusions: This case highlights that even products marketed as containing “colorless carotenoids” and promoted as unlikely to cause visible skin pigmentation may still be temporally associated with clinically apparent carotenoderma. It also underlines the importance of careful supplement history taking in patients presenting with yellow-orange discoloration of the skin, as well as the need to distinguish carotenoderma from jaundice and other systemic disorders. Ophthalmic symptoms in the setting of carotenoid-containing cosmetic supplements warrant specialist evaluation, particularly because tanning-related carotenoid agents such as canthaxanthin have been associated with retinopathy. Further pharmacovigilance and case reporting are needed to clarify the safety profile of oral skin-whitening supplements. 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