Research Article

Skin Laxity Treatment Using Near Infra-Red: Clinical Results in 30 Women

by Arminda Avdulaj*

San Luca Medical Clinic, Rruga e Kavajës 50, Tiranë 1001, Albania.

*Corresponding author: Arminda Avdulaj, San Luca Medical Clinic, Rruga e Kavajës 50, Tiranë 1001, Albania.

Received Date: 17 December 2023

Accepted Date: 16 January 2024

Published Date: 22 January 2024

Citation: Arminda Avdulaj (2024) Skin Laxity Treatment Using Near Infra-Red: Clinical Results in 30 Women. Ann Case Report 09: 1602. https://doi.org/10.29011/2574-7754.101602

Abstract

Background: The use of minimally invasive aesthetic treatments to reduce the signs of aging has gained popularity over surgical therapies in recent years. Near Infrared (NIR) offers a safe, non-ablative alternative for skin rejuvenation, providing both thermal and non-thermal properties. Aims and Objectives: Here, we report a study to evaluate the efficacy and safety of using a NIR module for immediate improvement in skin tone without the need for recovery. Materials and Methods: Thirty healthy women received one treatment session for skin laxity using a NIR module. Improvement was assessed by the physician using the Global Aesthetic Improvement Scale (GAIS) and satisfaction was assessed by the patients using a Likert scale. The relationship between smoking status and treatment outcomes was also evaluated. Pain and side effects were monitored. Results: The mean GAIS score was 8.1 ± 0.5 (mean ± SD) and the mean patient satisfaction score was 8.0 ± 0.7 (mean ± SD). There was a strong positive association between physician assessment and patient satisfaction (r=0.62). The t-test indicated no statistically significant difference between the measures (p-value=0.42). There was no significant association between smoking status and treatment outcomes, (p-value = 0.82). No pain or adverse events were reported. Conclusion: This study demonstrates the safety and efficacy of NIR treatment for immediate improvement in skin appearance.

Keywords: Near-Infrared; Non-Ablative; Non- Invasive; Cosmetic Dermatology

Introduction

The process of skin aging, which manifests as pigment abnormalities, wrinkles, and skin laxity, is determined by both genetic and environmental factors. Genetic factors contribute to decreased production of proteins in the dermal extracellular matrix as dermal fibroblasts age. Environmental factors are mainly related to prolonged exposure to radiation from the sun, which promotes the degradation of collagen fibers [1] leading to reduced skin elasticity and ultimately the formation of fine lines and wrinkles [2,3]. The effects of sun exposure on the skin have been studied extensively, and it is well known that Ultraviolet (UV) radiation has enough energy to break chemical bonds and cause photochemical reactions that can lead to skin cancer, aging, and weakening of the immune system. In contrast, the effects of Infrared (IR) radiation on humans have been less studied. The influence of Near-Infrared (NIR) radiation, which accounts for 54.3% of the solar radiation reaching the Earth, has been found to have a dual effect on the skin, beneficial up to a certain threshold and potentially harmful beyond [4].

In cosmetic dermatology, resurfacing treatments that use light energy are designed to intentionally cause controlled damage to the skin to stimulate new collagen formation and promote skin rejuvenation [3,5]. These treatments are classified as either ablative or non-ablative. Ablative skin resurfacing, considered the gold standard in skin rejuvenation, involves the removal of the epidermis and partial thickness of the dermis to achieve skin rejuvenation. However, these procedures are painful, carry risks, and often require a lengthy recovery period. Non-ablative therapies induce thermal damage in the dermis, subsequently initiating a cascade of inflammatory events, including fibroblast proliferation and upregulation of collagen expression, resulting in skin tightening and improvement of skin laxity [2]. Although limited in efficacy, the non-ablative strategy, which includes laser, light, and radiofrequency devices, is associated with reduced risk and shorter recovery time [1]. The healing benefits of NearInfrared (NIR) light on humans have been well documented in the literature [4], and early data indicate that it provides immediate skin tightening with a short recovery time and minimal risk [6].

The current retrospective cohort study examines the use of a NIR module for immediate but temporary improvement in skin tone without the need for recovery. We aim to evaluate whether the procedure is a safe and effective solution for patients who are willing to accept modest improvement in exchange for minimal downtime and risk.

Materials and Methods

Clinical Data

This is a report of a retrospective cohort of patients routinely treated for skin laxity on the face and neck at the Klinika Mjekësore San Luca, Tirana, Albania. The study was conducted from January 2022 to April 2023 and was approved by the Ethics Committee of the Albanian Ministry of Health (ethics number: AA-2021-01).

Informed consent for publication of results was obtained from all patients whose data are used in this report. Records of Fitzpatrick skin types II-III patients who had facial or neck skin laxity and were healthy with no major underlying medical conditions were included in the study. Data collection was conducted anonymously, including patients’ demographic and treatment characteristics such as gender, age, treatment areas, immunosuppression or other systemic disease, and smoking status. Reasons for exclusion included skin conditions or medications that could interfere with treatment; previous treatments to the same area(s) at least six months before the NIR treatments; skin type VI; pregnant, planning to become pregnant during the study, less than three months postpartum, or less than six weeks postpartum; sun exposure or artificial tanning in the 3-4 weeks before treatment. Any residual sun damage, sunburn, or artificial tanning products; active infections in the treatment area; chronic or cutaneous viral, fungal, or bacterial diseases; tattoos in the areas to be treated.

Patients were instructed to avoid topical creams for veins or pigmented lesions, to limit sun exposure, and to use sunscreen with SPF 50 or higher for the duration of the study.

Treatment procedure

Each patient received one treatment per treatment area using the NIR face applicator (Harmony XL Pro, Alma Lasers, Caesarea, Israel) with a pulse width of 6.4 cm2, a peak emission of 1300 nm, and a fluence of 20-25 watts in a continuous mode. The treated areas were photographed before, during, and after treatment, and all patients were followed for one week after the treatment.

Clinical evaluation

The physician who performed the treatment also evaluated effectiveness at the end of the treatment, as compared to the pre-treatment photos. The Global Aesthetic Improvement Scale (GAIS), which ranges between 0- and 10 (0 – no improvement, 10 – maximum improvement), was used for grading of change in the target site appearance.

In addition, patients were requested to rate their satisfaction with the treatment outcome at the end of the treatment. Satisfaction was graded on an 11-point Likert scale (0 – maximum dissatisfaction, 10 – maximum satisfaction).

Patients were requested to self-assess the pain associated with the treatment immediately after the treatment. An 11-point scale questionnaire was given to the patients to communicate their pain perception, ranging from 0 (no pain) to 10 (severe pain).

Adverse events were monitored during the treatment and at an additional one-week follow-up visit.

Statistical analysis

Descriptive statistics summarize patient characteristics. The Pearson correlation test was used to analyze the relationship between physician assessments and patient satisfaction scores, and a two-sample t-test was used to determine whether there were significant differences between them. A chi-squared test was used to examine possible associations between smoking status and treatment outcomes. Analyses were performed using the Microsoft Excel Data Analysis Tool. The significance level was set at α=0.05.

Results

Thirty eligible patients treated with NIR for skin laxity on the face and/or neck were included in this retrospective data collection study. Patients’ demographic characteristics are presented in Table 1

Characteristics*

Patients (all female)

30

Age (years)

Min, Max

21,56

Mean ± SD

37.3 ± 9.6

Smoking status

Smoking

24

Non-smoking

6

Fitzpatrick skin type

Skin type II

9

Skin type III

21

Body area

Face

25

Face and neck

5

* Values are presented as total or mean ± Standard Deviation (SD)

Table 1: Patients’ Demographics

The mean GAIS score assessed by the physician at the end of the treatment was 8.1 ± 0.5 (mean ± SD) and the mean patient satisfaction score was 8.0 ± 0.7 (mean ± SD). Figure 1 shows the percentage of patients distributed along the GAIS scale and the patient satisfaction scale.

 

Figure 1: Patient satisfaction scores and physician assessment GAIS scores, at the end of the treatment.

Analysis of treatment efficacy revealed a strong positive association between physician assessment and patient satisfaction, with a Pearson correlation coefficient of 0.62. The t-test yielded a calculated p-value of 0.42, indicating no statistically significant difference between physician assessment and patient satisfaction. Improvement of skin tightening was well seen (Figure 2-4).

 

Figure 2: Skin tightening effect observed in a 54-year-old patient, skin type III, before (A) and one week after the NIR treatment (B)

 

Figure 3: A skin tightening effect was observed in a 60-yearold patient, skin type II, before (A) and one week after the NIR treatment (B).