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: 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: 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: 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: 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: 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: 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: 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: 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: 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