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Jan/Feb 2017

Energy-Based Facial RejuvenationAdvances in Diagnosis and Treatment

Author Affiliations
  • 1Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Facial Plast Surg. 2017;19(1):64-71. doi:10.1001/jamafacial.2016.1435
Key Points

Question  What advances in diagnosis, prevention, and management of energy-based facial rejuvenation have been introduced in the past 5 years?

Findings  In this systematic review, facial rejuvenation treatments and devices that focus on decreasing adverse effects and improving downtime were identified: lasers, light therapy, and non–laser-based thermal tightening.

Meaning  Improved efficacy and safety with nonablative fractioned lasers and intense pulsed light has led to improved options with minimal downtime for patients with mild to moderate degree of photoaging; however, full-field resurfacing remains important for more severe photoaging and facial rhytids.


Importance  The market for nonsurgical, energy-based facial rejuvenation techniques has increased exponentially since lasers were first used for skin rejuvenation in 1983. Advances in this area have led to a wide range of products that require the modern facial plastic surgeon to have a large repertoire of knowledge.

Objective  To serve as a guide for current trends in the development of technology, applications, and outcomes of laser and laser-related technology over the past 5 years.

Evidence Review  We performed a review of PubMed from January 1, 2011, to March 1, 2016, and focused on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines including case control, case studies and case reports when necessary, and included 14 articles we deemed landmark articles before 2011.

Findings  Three broad categories of technology are leading non–energy-based rejuvenation technology: lasers, light therapy, and non–laser-based thermal tightening devices. Laser light therapy has continued to diversify with the use of ablative and nonablative resurfacing technologies, fractionated lasers, and their combined use. Light therapy has developed for use in combination with other technologies or stand alone. Finally, thermally based nonlaser skin-tightening devices, such as radiofrequency (RF) and intense focused ultrasonography (IFUS), are evolving technologies that have changed rapidly over the past 5 years.

Conclusions and Relevance  Improvements in safety and efficacy for energy-based treatment have expanded the patient base considering these therapies viable options. With a wide variety of options, the modern facial plastic surgeon can have a frank discussion with the patient regarding nonsurgical techniques that were never before available. Many of these patients can now derive benefit from treatments requiring significantly less downtime than before while the clinician can augment the treatment to maximize benefit to fit the patient’s time schedule.