The Aestheticians Journal Digital January'26 Issue

Total Pages : 40 January 2026 Vol 18* Issue - 12 100

Safe and Aesthetic Clearance of

Xanthelasma with Radiofrequency Ablation

Thulium Laser 1927 nm: An Effective

Solution for Enlarged Pores and Acne Scars

Collagen Induction Therapy: A Safe and

Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications

Black Peel: A Modern Therapeutic Approach

for Inflammatory Acne

High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

Contact Details:- 9821638932 I

Email :- viepharmallp@gmail.com

EXECUTIVE EDITOR & PUBLISHER Dom Daniel

CORPORATE OFFICE 22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA. EMAIL: theaestheticiansjournalindia@gmail.com Website: www.theaestheticiansjournal.online

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Advancing Aesthetic Care for the Winter Season Welcome to the New Year edition of The Aestheticians Journal. As winter gradually sets in, the skin undergoes multiple challenges—dryness, sensitivity, flare of acne, and delayed healing— making this season a crucial time for mindful and evidence-based aesthetic care. This issue has been thoughtfully curated to address these seasonal concerns while highlighting advanced, clinically relevant aesthetic solutions.

We begin with an in-depth review of Thulium Laser 1927 nm, focusing on its efficacy in managing enlarged pores and acne scars, an increasingly popular choice for texture refinement with minimal downtime. Complementing this is an article on the Black Peel, exploring its role as a modern therapeutic option for inflammatory acne, especially useful during winter when conventional treatments may need modification.

The article on Collagen Induction Therapy highlights its safety, efficacy, and growing role in regenerative skin resurfacing. Complementing this, the discussion on High-Intensity Focused Ultrasound (HIFU) for submental fullness provides valuable insights into non-invasive chin contouring and lower face rejuvenation, expanding the scope of aesthetic dermatology practice.

Additionally, we present a practical and safe approach to the Aesthetic Clearance of Xanthelasma using Radiofrequency Ablation, emphasizing precision and patient satisfaction.

We hope this edition enriches your clinical practice and inspires confident, season-appropriate aesthetic care. Happy reading and wishing you a successful and fulfilling year ahead.

Thanks & Cheers

- Dom Daniel All rights reserved. Reproducing in any manner without prior written permission prohibited.

Published for the period of January 2026

Cover Model: Gargi Kundu

Executive Editor & Publisher

Contents CONTENTS

Thulium

Laser

1927 nm:

An Effect

ive Solutio

n for Enlarg

Thul An Effe ium Laser 19 ctive So 27 nm Pores an lution for En : larged d Acne Scars ed Pores

and Acne

Scars

Dr. Amees

06 Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars

ha Mahaj

MD (Der matology an ) Consultan t Cosm etic Derm Amritsar, atologist Punjab

Introduct

A

Dr. Ameesha Mahajan, MD (Dermatology)

06 6 Januar

y 2026

ion

cne vulgaris remains (AV) Histo one of logical most studies challenging prevalent the that have show FTL n conditions dermatolo and disrupted treatment caus es a but post-acne , often result gical corne um, temp intact stratu ing in scarring m cause orary that can of the uppe alteration significant r derm and is, and cosmetic post-procedure psychologic rapid The manageme al distress. The fractional recovery. and its nt of delivery promotes sequ acne collagenes pattern with adva elae has evolved dermal remo is and deling technology ncements non-l in adjac esional in laser , offeri ent invasive skin, and effec ng minimally enhancing overa thereby options. tive thera appearanc ll textu Among peutic re and e of laser these, fractional can also help the skin. syste prominenc ms have of AV, with treatmFTL gained by the ent promote e for their which thermal ability dermal effec to appro can extend while to a depth t ximat minimizing remodeling of damage to reach ely 400 µm, and down epidermal the infunsufficient recent of seba breakthrou time. dibulum ceous A seba treatment gh in follicl es the the ceous gland enlarged of skin rejuve s—resultin and destructio nation, pores, g in n of Cutib scars is acnes. the 1927 and acne acterium thulium fiber laser nm fractional ablative, Comparat (FTL), a nonThis wavelight-based investigateive studies moda length d the have specific demonstra lity. safety efficacy tes 1927 of fractional and characteris water abso nm thuliu non-ablativ e targeting tics, enabling rption versu m laser s precise (FTL) fractional structures of superficial 2940 nm derm ablative Er:YA al for damage with minimal acne scarr G laser (FEL) therm to adjac ing, highli ent tissue al the poten ghting tial of s. effec FTL tive, and less as a safe, invasive

Collag

en Induct

ion Therap y: A Safe

and Effect

Colla A Safe gen Inductio Resurfa and Effective n Therapy: cing Te Regene ch rative Aesthe nique with Ex tic Appl ications panding ive Regen

erative

12 Collagen Induction Therapy: A Safe and Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications

Resur

facing

Techni

que with

Expan

ding Aesthe

tic Applic

ations

Dr. Alekya

Singap MBBS, ore DDVL, FAM, FPD (Manipal) , AMPH (USA), FDM (UK (ISB) Founder and Chie ), MBA f Derm The Skin atologist Sensé Clin Hyderab ics ad Introduct

C

Dr. Alekya Singapore, MBBS, DDVL, FAM, FPD (USA), FDM (UK), MBA (Manipal), AMPH (ISB)

12 12 Januar

y 2026

ion

ollagen induction therapy epidermis. microneedcommonly know (CIT), injurie These s n as invasive ling, is a proliferativinitiate inflam microminim procedure dermatolo ally phases, e, and remomatory, gical ultimately deling widesprea that has improved skin textu resulting in acceptanc gained and aesthetic d re, e and clinic in mech elasticity. Owin thickness, due to al pract its effica anism, g to ice cy, safet effectivene microneed this y, cost- has been ling Compared ss, and versatility. in the manawidely empl with oyed devices gement energy-bas scars, and deep fine lines of acne ed peels, and wrink chemical dyschromia, les, associate microneedling striae and photo distensae d with aging is effects, minimal fewer adverse transient micro . Additionally, the epidermal disruption channels during the of the created downtime, barrier, and transderm procedure shorter enhance making al option drug for a broad it an attractive further expa delive patients. ry, applicatio nding its thera The techn spectrum of ns. peutic the use conc Altho ique involv of es for ept of controlled ugh the controlled fine needles to scar modu skin injury skin, which micro-injuries create trace lation d back in the can be activa to ancie natural modern wound-heate the body microneed nt practices, leading ling casc ’s in the ling emer early ged neoelasto to neocollag ade, obse rvations 1990s follow enes genesis, ing remodeling that and dermis, without tattooing . pigment al The basis of led to biological improveme microneed nt. scar ability This the way ling lies insight to in its for the paved of grow stimulate the th release structured need development while presefactors and cytokines A major miles ling techniquesof rving the tone occu .

1997 surroundin with the rred in g the introd dermal roller, whichuction of allowed

High-Int

ensity

Focused

Ultrasou

nd (HIFU)

High-In tensity Focuse (HIFU) A Comp for Submen d Ultrasound ta re to Chin hensive Aest l Fullness: he Contou ring an tic Approach Rejuven d Lower Facia ation l for Submen

tal Fullness

: A Compre

hensive

16 High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

Aesthet

ic Approac

h to Chin

Contour

ing and

Lower

Facial

Dr. Surabh

i Sharma MD, DNB , MRCP UK (SCE Dermatolo ), Gold gist, Trich Medalist Founder ologist & Cosm and etologist Dermalook Medical Director s Skin Clini Meerut, c Uttar Prad esh Introduct

F

Dr. Surabhi Sharma, MD, DNB, MRCP, UK (SCE), Gold Medalist

ion

acial aesth significantl etics are deposition y influe by the , nced definition mandibular weakening contour of the of septum, Submental the chin and and of skin and loss neck. elasticity fullness, excess angle, increase caused fat resulting by this preplatysm accumulation in subm in the fullness, sagg al ental ing and is a comm submental region, jawline defini loss on aesth resulting etic contributin tion. 2 Addit of from aging concern ional g facto predisposi hyperactivi rs includ , gene tion, tic ty of e and factors neck perio lifestyle ral and musc such as This cond weigh remodeling ulature, mand ibular ition disrup t gain. facial harm tissue laxity and age-related ts lower ony by soft anterior distorting submental . Beyond aesth cervicomen etics, the fat can promoting tal angle impact self-percep negatively , and contr soft tissue tion laxity, psychosocial ibuting and well-being. 3 to an overweight appearanc aged or The chin plays a e. 1 Double in lower central chin defor role mity is clinic identified and overa facial aesth by ally etics ll facial mentocerv an increase balance. in the Anatomically, ical angle it comp formed , the angle mandible, rises the between muscles, a line from cervical pads, each skin, and point to the fat and the the ment and funct influencing its shape anterior on ion. The In a norm facial plane forms mandible the found ally conto . ation of this angle ured face, and jawlin the range chin e and consi s from 95°. Progr body, sts of the 80° mental essive submental to angle protuberan and ramu fat ce, s. The shapes the lower body facial profile

16 16 Januar

y 2026

Safe and

Aesthetic

Cleara

nce of

Xanth

Safe an Xanthe d Aesthetic Cl lasma with Ra earance of Ablatio diofrequency n elasm

a with

Radio

freque

ncy Ablati

on

Dr. Sweth

a Jain MD (Der matology ) Consulta nt Derm atologist Dr. Swe tha Skin Care Cent Mumbai re

24 Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation

Introduct

X

Dr. Swetha Jain, MD (Dermatology)

24 24 January

2026

ion

anthe las palpebrarum a . . . . . . . . . . . syste m (XP) mic the lipid is Xanth most form of abnormali comm elasma with a cutaneous xanth on a palpebraru ties. localized prevalence oma, m is 1.1% variant, confined of abou in typically to the t occu men, and women and rring withoeyelids and 0.3% rates often in of to 4% reaching ut in up pathoother body involvement especially certain popu sites. gene lations, The their fourthamong indivi the accu sis centers duals around and fifth mula in Clinically, decades. within macr tion of lipids yellowish XP presents ophages, as soft, to foam cell papu leadi les, plaqu nodules ng formation. contributin situated es, A key on the predomin or mechanica g factor is medial repetitive antly l stres with occa upper s on the eyelids, periorbital the lowe sional exten microvasc fragile sion to during blink r lids. ulature ing. Cont flat or Lesions the orbic mildly ractio ularis elevated, may be eleva or multi oculi trans n of ple, and tes solita iently semisolid often exhib ry and with intravascular press aging, consisten or rarely calca it a integ the endo ure, rity cy. reous thelial predilectio A weakens. of these capillaries distributio n and symmfemale susc This eptibility age-relate are charan across the etrical extra d vasation eyelids promotes xanthelasmcteristic. A of pseudo- lipoproteins plasma also deve a pattern perivascu into the surro may lar and unding procedureslop following tissues, subc utaneous culm surgeries , such as ocular deve lopment. 1,2 inating in Xanthomasinvolving silico retinal XP ne oil. represent deposits localized The extravasa lipid-rich of cholestero tion lipoprotein s into the of plasma skin or material withinl and and subcutane perivascu the of lar and may subcutaneous the eyelid ous tissue tissues be asso perm s creat ciated es a with lipid issive envir accumula onment for tion within

Black

Peel: A

Moder

n Therap

eutic Appro

Black Pe Approa el: A Modern ch for Inflam Therapeutic matory Acne Dr. ach for

Inflam

Kanika

Pop

Introduct

A

Dr. Kanika Popli, MD (Dermatology)

30 30 January

January 2026

y Acne

MD (Der li matology ) Founder and Con sultant Kanayaa Dermatolo Skin Clin gist ic Gorakhpu r, Uttar Pradesh

30 Black Peel: A Modern Therapeutic Approach for Inflammatory Acne

4

mator

2026

ion

cne vulgaris chronic, is inflammato a papules, pustu ry mate pilosebac disorder of rial, and les with purul eous unit the or individuals ent deep that cysts exceeding er nodules globally, affects diam significant eter.

5 mm These psychoso dermatological with derm in can al injury cial and It is hyperpigm , post-inflam cause estimated implication matory entation, approxim to impa s. scarring. ately Acne ct and world’s 9.4% typically of the sebaceous population as the gland-rich affects such , ranki eight as the ng skin disea h most face, neck areas prevalent and uppe , ches r back predomin se. Although t spec .

The trum antly acne adolescen arises neonatal includes varia clinical nts and infan than 85% ce—affecting during cong tile acne like lobata, of more teena , acne confined acne gers— acne it fulminans to this mechanica often age groupis not acne , , occu persi , pational chloracne particularly sts into adult and exco riée, , hood, among acne and Notably, drug-indu women. acne—the latter ced constitute adult fema often le acne to corticoster linked all acne s nearly two-t oids, androgens hirds of lithium, isonia -relat emphasizin ed cons zid, and ultations, While these phenytoin , considera g its chron . icity and histopathologic entities share Clinically, ble healthcare al featu burden. acne vulga res with ris, categorize acne lesion s are etiology, seve they differ or inflam d as non-inflam in rity, and syste matory, mato mic asso distribution, distinct each exhib ry ciations. 1,2 morpholog iting The and seve ical featu pathogene res is lesions rity. Non-inflam include multifacto sis of acne matory open (blackhea rial, intricate ds), mark comedones interaction involving follicles genetic ed by s amon dilated susceptib keratin, filled with g ility, horm oxidized influ ence s—p and close onal (whitehea artic andr ogen d ds), wher comedones s—e nviro ularl y..... ... opening factors e the follicu nme ntal. is block such lar ultrav and kerat ed by as humi .... iolet in. sebum dity, encompas Inflammato exposure, pollution, ry lesion s as and erythemat s stress, and well as dieta ry habit ous includ come s, ing certa dogenic agen in cosm ts etics

Rejuven

ation

Editorial Board Dr. Ameesha Mahajan

MD (Dermatology) Consultant Cosmetic Dermatologist Amritsar, Punjab

Dr. Alekya Singapore

MBBS, DDVL, FAM, FPD (USA), FDM (UK), MBA (Manipal), AMPH (ISB) Founder and Chief Dermatologist The Skin Sensé Clinics Hyderabad

EDITORIAL BOARD

Dr. Swetha Jain

MD (Dermatology) Consultant Dermatologist Dr. Swetha Skin Care Centre Mumbai

Dr. Kanika Popli

MD (Dermatology) Founder and Consultant Dermatologist Kanayaa Skin Clinic Gorakhpur, Uttar Pradesh

Dr. Surabhi Sharma

MD, DNB, MRCP, UK (SCE), Gold Medalist Dermatologist, Trichologist & Cosmetologist Founder and Medical Director Dermalooks Skin Clinic Meerut, Uttar Pradesh

January 2026

5

Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars

Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars Dr. Ameesha Mahajan

MD (Dermatology) Consultant Cosmetic Dermatologist Amritsar, Punjab

Introduction

A

cne vulgaris (AV) remains one of the most prevalent and challenging dermatological conditions, often resulting in post-acne scarring that can cause significant cosmetic and psychological distress.

The management of acne and its sequelae has evolved with advancements in laser technology, offering minimally invasive and effective therapeutic options. Among these, fractional laser systems have gained prominence for their ability to promote dermal remodeling while minimizing epidermal damage and downtime.

A recent breakthrough in the treatment of skin rejuvenation, enlarged pores, and acne scars is the 1927 nm fractional thulium fiber laser (FTL), a nonablative, light-based modality.

This wavelength demonstrates specific water absorption characteristics, enabling precise targeting of superficial dermal structures with minimal thermal damage to adjacent tissues.

6

January 2026

Histological studies have shown that FTL treatment causes a disrupted but intact stratum corneum, temporary alteration of the upper dermis, and rapid post-procedure recovery.

The fractional delivery pattern promotes collagenesis and dermal remodeling in adjacent non-lesional skin, thereby enhancing overall texture and appearance of the skin. FTL can also help with treatment of AV, by the thermal effect which can extend to a depth of approximately 400 µm, sufficient to reach the infundibulum of sebaceous follicles and sebaceous glands—resulting in the destruction of Cutibacterium acnes.

Comparative studies have investigated the efficacy and safety of fractional non-ablative 1927 nm thulium laser (FTL) versus fractional ablative 2940 nm Er:YAG laser (FEL) for acne scarring, highlighting the potential of FTL as a safe, effective, and less invasive

Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars

alternative for improving postacne scars in diverse skin types.1,2 Case Report -1 A 32-year-old female presented with concerns of enlarged facial pores, post-acne scarring, and uneven skin texture. She had Fitzpatrick skin type IV-V and a history of recurrent acne, now resolved. She had taken one session of Microneedling Radiofrequency for her scarring one year back which had led to triggering of her acne. Since then she had not taken any laser treatments apart from a basic skincare routine clinical examination revealed multiple shallow atrophic acne scars— primarily rolling and superficial boxcar types—along with visibly enlarged cheek pores, irregular texture, and mild postinflammatory erythema. One inflammatory papule was noted, while the rest of the skin was free of active acne. The findings were symmetrical on both sides of the face but more prominent on the left cheek, as reflected in the provided images. Based on this assessment, the patient underwent a 1927-nm Thulium fractional laser resurfacing protocol aimed at improving superficial scars, reducing pore size, enhancing epidermal renewal, and stimulating collagen remodeling. After one session, the patient showed clear improvement, with a visible reduction in pore size, smoother texture, softened superficial scars, decreased erythema, and an overall healthier, more even & brighter complexion (Figure 1). The before-and-after images demonstrated a striking contrast in pore visibility and

scar depth across the facial halves, confirming effective epidermal resurfacing and early dermal remodeling achieved through Thulium laser treatment.

Before treatment

After one session of treatment Figure 1: Visible skin rejuvenation with improved texture and tone Case Report -2 A 28-year-old female presented with complaints of enlarged pores, post-acne scarring, and dull, uneven skin texture. Clinical examination revealed multiple superficial atrophic acne scars—mainly rolling and shallow boxcar—along with diffuse erythematous papules, post inflammatory hyperpigmentation due to acne and enlarged pores on both cheeks. Patient was on isotretinoin 5 mg since 2 months. The skin was otherwise healthy, with no active cystic acne, only papules.

Given her concerns, she underwent treatment with the 1927-nm Thulium fractional laser, targeting epidermal remodeling, pore reduction, and collagen stimulation. The procedure was performed under topical anesthesia, and standard post-laser care, including barrier repair moisturizers and photoprotection, was advised. After January 2026

7

Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars

the treatment session, the patient showed visible improvement, as seen in the before-and-after images (Figure 2). There was a marked reduction in pore size, significant softening of acne scars, fading of erythematous lesions, and overall smoother, more refined skin texture. A significant reduction in the papular acne lesions was also observed. The results demonstrated effective epidermal resurfacing and early collagen remodeling with minimal downtime. This case highlights the efficacy and safety of the Thulium 1927-nm laser for improving enlarged pores and mild-to-moderate acne scarring in young female patients.

Before treatment

After one session of treatment

Figure 2: The patient showed visible improvement Mechanism of Action of Thulium Laser (1927 nm) The 1927 nm fractional thulium fiber laser (FTL) represents an innovative, non-ablative laser modality that selectively targets water as its primary chromophore. At this wavelength, there is minimal absorption by melanin and hemoglobin, making it safe and effective for diverse skin phototypes. The FTL creates microscopic thermal zones (MTZs) at depths of approximately 200–400 µm, primarily confined to the epidermis and superficial papillary dermis, thereby preserving the integrity of the surrounding tissue. Histological studies have demonstrated that FTL exposure results in a disrupted but intact stratum corneum, temporary changes in the stratum spinosum and dermoepidermal junction, and mild coagulative necrosis in the superficial dermis. This controlled injury triggers a wound-healing cascade characterized by inflammatory cell recruitment, fibroblast activation, neocollagenesis and dermal remodeling.2,3,4,5,6 The depth of coagulative effect (~400 µm) is sufficient to reach the infundibulum of sebaceous follicles and sebaceous glands, leading to the destruction of Cutibacterium acnes and reduction of inflammatory lesions. Additionally, this controlled microthermal damage initiates follicular remodeling and sebaceous gland shrinkage, thereby improving both inflammatory and noninflammatory acne lesions. The fractional delivery of laser energy 8

January 2026

allows surrounding non-lesional skin to act as a reservoir for rapid re-epithelialization, ensuring minimal downtime and faster recovery. This dual action— antimicrobial and remodeling— underpins the efficacy of the 1927 nm FTL in acne and acne scar and enlarged pores management.2,3,4,5,6 Fractional Thulium Laser (FTL) Treatment Protocol The thulium-doped fiber-based fractional laser system, was used in the present study. It emits laser energy at a 1927 nm wavelength, delivered through a flexible optical fiber connected to a fractional handpiece that divides the primary laser beam into multiple microbeams. The device can be operated in both continuous & stamping mode.

The spot size can be adjust in different shapes upto 20x20 mm. Spot density in our cases was et at 49PPA with power setting kept between 3-8 W and energy per pulse ranging between 6-12 mJ. Prior to treatment, all subjects underwent thorough facial cleansing, followed by the application of a lidocaine topical anesthetic cream under clingfilm occlusion for 30 to 50 minutes which was then removed & dried. In each session, the entire area of the affected cheeks and chin was covered in the continuous mode, started at an energy setting of 6mJ per pulse. A second pass was given at the same of higher energy, depending on patient tolerance and clinical endpoint. The desired clinical endpoint was the appearance of diffuse erythema and mild edema, accompanied by a gentle warmth sensation post-treatment. Right after the

Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars

procedure, topical mometasone and fusidic acid combination was applied. Post procedure application of exosomes, polyribonucleotides can also be done to further augment results as FTL enhances drug delivery to the dermis.

Patients were instructed to avoid scrubbing or exfoliating for at least 48 hours post-procedure but were permitted to gently cleanse the face as needed.

All participants were advised to maintain their daily skincare routine, emphasizing regular moisturization and broadspectrum UVA/B sunscreen (SPF ≥30) use. During the post procedure period, mild scabbing & crusting is expected for 3-7 days. After the scabs fell off, patients were advised to restart basic skincare active likes hyaluronic acid and vitamin c serums in the morning and retinol serum, followed by moisturizer at night.

Discussion Acne vulgaris frequently leads to post-acne scarring, which poses a therapeutic challenge and significantly affects patients’ psychosocial well-being. Early intervention is essential to prevent scar formation and to achieve optimal outcomes.

Conventional treatments such as chemical peels, microneedling and ablative lasers have shown varying success rates but are often associated with downtime, discomfort and risks of postinflammatory hyperpigmentation (PIH), particularly in darker skin types. The 1927 nm fractional thulium laser (FTL) offers a nonablative, safe, and effective alternative for both acne and acne scars. Compared to fractional ablative Er:YAG laser

(2940 nm FEL), which ablates the epidermis and induces deeper dermal remodeling, FTL provides superficial, controlled coagulation with less risk of adverse effects and faster healing. Studies, including the first prospective clinical trial by Lu and Cai, have demonstrated that both FTL and FEL significantly improve atrophic acne scars, with FTL offering superior tolerability and minimal downtime.

Histopathological analyses have shown reduction in sebaceous gland size, increased dermal collagen deposition, and decrease in atrophic scar depth following FTL therapy.

Additionally, the thermal stimulation of dermal fibroblasts induces the expression of matrix metalloproteinases (MMP-1, MMP-13) and transforming growth factor-beta 3 (TGF-β3), facilitating collagen remodeling and tissue regeneration.

Controlled microthermal damage also downregulates peroxisome proliferatoractivated receptor gamma (PPARγ), further promoting collagen synthesis. Studies, including the first prospective clinical trial by Lu and Cai, have shown that both FTL and FEL significantly improve atrophic acne scars, with FTL offering superior tolerability and minimal downtime. Clinical trials have reported 26–50% improvement in acne scars after three FTL sessions at 4–6-week intervals, along with significant reduction in ECCA scores and minimal adverse effects.

Recent advances in aesthetic dermatology have introduced new alternatives for managing pigmentary dysfunctions and photoaging.

Among these

innovations, the 1927 nm fractional thulium laser stands out for its unique combination of ablative and non-ablative properties, ensuring precise epidermal penetration. This mechanism promotes cellular renewal, pigment reduction, and collagen stimulation, resulting in smoother and rejuvenated skin with excellent tolerability.

An integrative review assessing the safety and efficacy of this laser demonstrated significant benefits in treating melasma, scars, and overall skin rejuvenation, with minimal adverse effects and high patient satisfaction. When compared to other technologies such as Er:YAG and Alexandrite lasers, the thulium laser showed shorter recovery times and fewer side effects, enhancing its appeal for aesthetic applications. The 1927 nm fractional thulium laser represents a powerful addition to the therapeutic armamentarium for acne and acne scarring. By leveraging precise water-based tissue targeting and fractional delivery, it achieves effective follicular remodeling, collagen induction, and microbial reduction with minimal downtime. Future welldesigned, large-scale clinical trials with histopathological correlation are warranted to further elucidate the molecular mechanisms and optimize treatment protocols for diverse skin types.2,3,4,5,6,7 Conclusion The 1927 nm fractional thulium laser (FTL) is a significant advancement in treating acne, scars, enlarged pores, pigmentary disorders, and photoaging. Its nonablative, water-targeting January 2026

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Thulium Laser 1927 nm: An Effective Solution for Enlarged Pores and Acne Scars

technology enables precise skin remodeling with minimal downtime and excellent safety.

FTL provides dual benefits— reducing Cutibacterium acnes and stimulating collagen and

sebaceous gland regulation, improving both inflammatory and noninflammatory acne. Clinical evidence shows sustained improvement, high patient satisfaction, and faster recovery compared to ablative lasers like Er:YAG. Overall, the 1927 nm FTL is a safe, effective, and versatile tool, offering promising results for comprehensive skin rejuvenation and acne management.

References 1. Chun S. I. (2024). A Novel Treatment of Acne Vulgaris Using a 1927 nm Fractional Thulium Laser: A Case Series.

Clinical, cosmetic and investigational dermatology, 17, 1931–1942. https:// doi.org/10.2147/CCID.S468326 2. Lu, K., & Cai, S. (2022). Efficacy and safety comparison between 1927 nm thulium laser and 2940 nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial. Lasers in medical science, 37(3), 2025–2031. https://doi. org/10.1007/s10103-021-03465-0 3. Huang S-L, Ye D, Xue H, Wang Z-Y, Yang M-Y, Qiao S-M, et al. 1927nm fractional thulium fiber laser combined with 30% salicylic acid for the treatment of acne

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and acne scars: a prospective, randomized, and split-face study. Lasers Surg Med. 2023; 55: 829–837. https://doi.org/10.1002/ lsm.23708 4. Bhat YJ, Rehman F, Hassan I, Krishan K, Daing A, Yaseen A, et al. Fractional laser resurfacing for acne scars: Our experience at tertiary care hospital of North India. J Cutan Aesthet Surg 2023;16:42-8 5. Chun SI. A Novel Treatment of Acne Vulgaris Using a 1927 nm Fractional Thulium Laser: A Case Series. Clin Cosmet Investig Dermatol. 2024;17:1931-1942 https://doi.org/10.2147/CCID.S468326 6. Gupta, A., Kaur, M., Patra, S., Khunger, N., & Gupta, S. (2020). Evidence-based surgical

management of post-acne scarring in skin of color. Journal of Cutaneous and Aesthetic Surgery, 13(2), 124– 141. https://doi.org/10.4103/JCAS. JCAS_154_19 7. da Silva Sardinha, M., & de S B Monteiro, M. S. (2025). Evaluation of the safety and efficacy of the thulium 1927 laser in aesthetic health: an integrative review. Journal of Cosmetic and Laser Therapy, 27(3), 77–86. https://doi.org/1 0.1080/14764172.2025.2483703

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(AN ISO 9001:2015 Certified Company) Corporate Office: 324, Plot No-12, Vardhaman Big V Plaza, Road No-44, Community Centre, Pitampura, 11 January 2026 New Delhi -110034. Tel: +91-11-27018166, 47562736 Space-Inspire hub Western heights, J.P. Road, Opp., Gurudwara Four Bunglows, Village, Ambivali, Andheri West, Mumbai, Maharashtra- 400053. Tel.: +91-22-61984543, Email: rowancare@gmail.com, Web: www.rowanbio.in

Collagen Induction Therapy: A Safe and Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications

Collagen Induction Therapy: A Safe and Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications Dr. Alekya Singapore

MBBS, DDVL, FAM, FPD (USA), FDM (UK), MBA (Manipal), AMPH (ISB) Founder and Chief Dermatologist The Skin Sensé Clinics Hyderabad Introduction

C

ollagen induction therapy (CIT), commonly known as microneedling, is a minimally invasive dermatological procedure that has gained widespread acceptance in aesthetic and clinical practice due to its efficacy, safety, costeffectiveness, and versatility.

Compared with energy-based devices and deep chemical peels, microneedling is associated with fewer adverse effects, minimal disruption of the epidermal barrier, and shorter downtime, making it an attractive option for a broad spectrum of patients. The technique involves the use of fine needles to create controlled micro-injuries in the skin, which activate the body’s natural wound-healing cascade, leading to neocollagenesis, neoelastogenesis, and dermal remodeling.

The biological basis of microneedling lies in its ability to stimulate the release of growth factors and cytokines while preserving the surrounding

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epidermis.

These microinjuries initiate inflammatory, proliferative, and remodeling phases, ultimately resulting in improved skin texture, thickness, and elasticity. Owing to this mechanism, microneedling has been widely employed in the management of acne scars, fine lines and wrinkles, dyschromia, striae distensae and photoaging. Additionally, the transient microchannels created during the procedure enhance transdermal drug delivery, further expanding its therapeutic applications.

Although the concept of controlled skin injury for scar modulation can be traced back to ancient practices, modern microneedling emerged in the early 1990s following observations that tattooing without pigment led to scar improvement. This insight paved the way for the development of structured needling techniques.

A major milestone occurred in 1997 with the introduction of the dermal roller, which allowed

Collagen Induction Therapy: A Safe and Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications

standardized needle penetration and more predictable outcomes.

Over the past two decades, technological advancements have transformed microneedling from a manual procedure into a sophisticated modality, with the advent of automated pens, radiofrequency-assisted microneedling, and combination treatment protocols. Today, microneedling is a wellestablished component of dermatologic and aesthetic practice, supported by an expanding body of clinical and experimental evidence. Its ability to treat multiple indications across different skin types with a favourable safety profile has contributed to its global popularity.1,2 Mechanism of Action Microneedling exerts its therapeutic effects by creating controlled micro-injuries within the skin, primarily targeting the dermis while preserving the integrity of the epidermis.

These micro-injuries initiate a highly regulated wound-healing cascade that results in collagen induction, neovascularization, and dermal remodeling, collectively improving skin texture, elasticity, and overall appearance. The biological response to microneedling occurs in three overlapping phases: inflammatory, proliferative, and remodeling.

The inflammatory phase begins immediately after needle penetration. Disruption of the dermal microenvironment leads to platelet activation and the recruitment of neutrophils and macrophages.

These cells release key growth factors, including transforming growth factor-β (TGF-β), platelet-

derived growth factor (PDGF), and connective tissue growth factor.

These mediators initiate fibroblast activation and signal the start of extracellular matrix synthesis.1,2 This is followed by the proliferative phase, characterized by fibroblast migration and proliferation. Activated fibroblasts synthesize collagen (predominantly type III initially), elastin, and glycosaminoglycans.

Simultaneously, keratinocyte migration supports epidermal repair without significant epidermal disruption. A provisional fibronectin matrix forms within days, providing a scaffold for organized collagen deposition. During this phase, angiogenesis is also stimulated, leading to neo-vascularization and improved dermal perfusion, which enhances nutrient delivery and accelerates tissue repair.1,2 The final remodeling phase may continue for several months. During this stage, collagen type III is gradually replaced by stronger collagen type I, resulting in increased tensile strength and dermal thickness.

Enhanced expression of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and fibroblast growth factor (FGF) supports sustained angiogenesis and epidermal–dermal signaling.

The net effect is long-term dermal remodeling, scar softening and improvement in wrinkles and skin laxity. An additional proposed mechanism of microneedling involves microinjury-induced changes in electrical potential within the skin. These demarcation currents are believed to enhance cellular migration, cytokine release, and fibroblast activity, further augmenting collagen synthesis and tissue regeneration. Microneedling also creates transient microchannels in the stratum corneum, significantly enhancing transdermal drug delivery. This allows improved penetration of topical agents such as growth factors, peptides, and platelet-rich plasma, amplifying therapeutic outcomes.1,2 Overall, microneedling acts as a potent yet minimally invasive modality that harnesses the skin’s intrinsic regenerative capacity through mechanical, biochemical, and bioelectrical mechanisms.

Figure 1: Collagen Induction Therapy January 2026

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Collagen Induction Therapy: A Safe and Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications

Clinical Applications1,2 Microneedling, or collagen induction therapy, is a versatile dermatological procedure with wide-ranging clinical applications. Its efficacy is attributed to controlled dermal micro-injuries that stimulate collagen synthesis, elastin production, neovascularization, and enhanced transdermal drug delivery.

1. Acne and Other Scars • Highly effective in atrophic acne scars, particularly rolling, boxcar, and macular scars.

• Best outcomes are seen in mild-to-moderate scars; icepick and severe scars often require combination therapies such as subcision, chemical reconstruction, or lasers.

• Improves surgical, traumatic, and post-burn scars by promoting collagen remodeling and reducing scar density.

• Offers higher patient satisfaction and a lower risk of post-inflammatory hyperpigmentation compared to lasers and chemical peels, especially in darker skin types.

2. Skin Rejuvenation and Aging • Reduces fine lines and wrinkles by stimulating neocollagenesis and dermal thickening.

• Improves skin texture, tone, and firmness, leading to a smoother and more youthful appearance.

• Useful for treating open pores and mild-to-moderate skin laxity of the face, neck, arms, abdomen, and thighs.

3. Pigmentary Disorders • Effective as an adjunct in melasma and periorbital 14

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hyperpigmentation by disrupting pigment deposits.

• Enhances penetration and efficacy of topical agents such as vitamin C, tranexamic acid, and retinoids.

• Emerging role in stable vitiligo as part of combination therapy.

4. Hair Disorders • Beneficial in androgenetic alopecia in both males and females by stimulating dermal papillae and increasing scalp vascularity.

• Useful in stable alopecia areata as an adjunct therapy.

• Results are enhanced when combined with platelet-rich plasma (PRP) or growth factor serums.

5. Stretch Marks and Body Applications • Improves striae distensae by inducing collagen production and skin remodeling.

• Effective for cellulite and post-liposuction skin tightening, improving texture and firmness.

6. Transdermal Drug Delivery • Creates transient microchannels in the stratum corneum, enhancing delivery of topical drugs, peptides, growth factors, PRP, and cosmeceuticals.

7. Emerging Indications • Investigational use in hyperhidrosis through sweat gland disruption, requiring further clinical validation.

Discussion Collagen induction therapy (CIT), or microneedling, has gained prominence as an effective and biologically sound resurfacing modality based on the principle of controlled dermal injury and subsequent

wound healing. Unlike ablative techniques, CIT produces a non-confluent, non-ablative pattern of injury that stimulates regeneration while preserving epidermal integrity. This unique mechanism underpins both its clinical efficacy and favourable safety profile. The therapeutic benefit of microneedling is primarily mediated through the release of multiple growth factors, including vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), and transforming growth factor-β (TGF-β).

Among these, the TGF-β family plays a pivotal role in collagen remodeling. Experimental animal studies have demonstrated a preferential upregulation of the anti-fibrogenic TGF-β3 isoform following needling, as opposed to the pro-fibrogenic TGF-β1 and TGF-β2 isoforms. This selective stimulation is critical, as TGF-β3 promotes regenerative healing and the formation of a physiological, basketweave collagen lattice typical of normal skin, rather than the parallel collagen bundles characteristic of scar tissue.

Temporal expression patterns further support this mechanism, with TGF-β1 and β2 showing only transient upregulation, while TGF-β3 remains elevated for several weeks, facilitating sustained remodeling.3,4 Microneedling induces VEGF upregulation, promoting angiogenesis, improved oxygenation, and enhanced keratinocyte function, thereby supporting dermal repair and scar remodeling. It also modulates inflammatory

Collagen Induction Therapy: A Safe and Effective Regenerative Resurfacing Technique with Expanding Aesthetic Applications

and pigmentary pathways, with increased IL-10 and reduced melanocytestimulating hormone, explaining improvement in dyschromias and the low risk of post-inflammatory hyperpigmentation.

Use of standardized medical dermarollers creates uniform microchannels within the papillary dermis, stimulating neocollagenesis and neoangiogenesis, leading to gradual improvement in acne scars and photoaged skin with minimal downtime. An important advantage of collagen induction therapy over ablative laser resurfacing is its excellent safety profile. Preservation of the

epidermal barrier reduces the risk of infection, pigmentary alteration and scar exacerbation. Reported adverse effects are generally mild and transient, including erythema, swelling and bruising, with rare cases of post-inflammatory hyperpigmentation or herpes simplex reactivation. Overall, collagen induction therapy represents a rational, evidence-based approach to scar remodeling and skin rejuvenation. Its ability to promote regenerative healing, rather than fibrotic repair, combined with procedural simplicity and safety, makes it an attractive option for managing acne scars, non-atrophic scars, and photoaging across diverse skin types.3,4 Conclusion Collagen induction therapy is a safe, minimally invasive, and costeffective modality with wide-ranging applications in dermatology and aesthetic practice. By harnessing the skin’s innate wound-healing mechanisms, it effectively improves scars, wrinkles, texture, and overall skin quality. Continued technological advancements, refined techniques, and combination therapies have enhanced its efficacy and safety, firmly establishing microneedling as a cornerstone of modern aesthetic medicine with expanding therapeutic potential.

References 1. Nair, Pragya A.; Tandel, Jinal.

Microneedling: A Means of Collagen Induction Therapy. Journal of Dermatology and Dermatologic Surgery 25(2):p 4953, Jul–Dec 2021. | DOI: 10.4103/jdds. jdds_126_20 2. Jaiswal, S., & Jawade, S. (2024).

Microneedling in Dermatology: A

Comprehensive Review of Applications, Techniques, and Outcomes. Cureus, 16(9), e70033. https://doi.org/10.7759/ cureus.70033 3. Iosifidis, C., & Goutos, I. (2019).

Percutaneous collagen induction (microneedling) for the management of non-atrophic scars: literature

review. Scars, burns & healing, 5, 2059513119880301. https://doi. org/10.1177/2059513119880301 4. Satish Doddaballapur, Microneedling with Dermaroller. Journal of Cutaneous and Aesthetic Surgery - Jul-Dec 2009, Volume 2, Issue 2, DOI: 10.4103/09742077.58529

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MUMBAI- 21st December'2025

Hands-on Workshop on Facial Injectables Standardizing Excellence in Advanced Facial Injectable Techniques

AESTHETICCON Mumbai, held on December 21st, 2025, the One-Day Hands-on Workshop on Facial Injectables offered participants DASIL certification. This workshop comprehensively covered key aesthetic modalities, including Bio-Remodeller, Skin Booster, Botulinum Toxin Type A and Threads. Attending Dermatologists gained valuable practical experience through structured hands-on sessions, supported by informative presentations and LIVE DEMONSTRATIONS. This integrated approach significantly enhanced clinical understanding, technical skills, and confidence in performing facial injectable procedures.

The event featured esteemed Dermatologists viz Bio-Remodellers and Skin Boosters discussed

by Dr. Pallavi Sule, with emphasis on their role in improving skin quality and rejuvenation. The clinical applications of Botulinum Toxin Type A, including technique and safety considerations, were addressed by Dr. Abhay Talathi. Threads procedure, as an integral component of minimally invasive facial rejuvenation, were elaborated by Dr. Dattatray Sonawane.

Lecture on Bio-Remodeller & Skin Booster by Dr. Pallavi Sule, Faculty.

Each of the faculties through Live demonstration showcased their expertise as they patiently guided the participants during the HandsOn session. The event concluded with the distribution of DASIL Certificate of Attendance to the participants.

Lecture on Botulinum Toxin Type A by Dr. Abhay Talathi, Faculty.

Hands on session by Dr. Pallavi Sule

Lecture on Threads by Dr. Dattatray Sonawane, Faculty.

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Hands on session by Dr. Abhay Talathi

understanding, ultimately contributing to improved patient outcomes in facial aesthetic treatments.

Hands on session by Dr. Dattatray Sonawane

Peer Recommendations to Colleagues: Participants expressed a strong intention to recommend the AESTHETICCON workshop to colleagues, reflecting high satisfaction with the educational content, hands-on training, and overall arrangements and facilities. This positive response is expected to extend the impact of the event, positioning it as a valuable educational resource in Aesthetic Dermatology.

Feedback: Dr. Srishti Nepal (Mumbai): “I found the Facial Injectables Workshop excellent, with the latest advances explained clearly and in a wellstructured way.”

Dr. Rituparna Basumatary (Mumbai): “The Facial Injectables Workshop was excellent, with a clear focus on practical clinical points and a well-structured hands-on approach.”

Wrap up Session

Overview of Participant Responses and Impact from the AESTHETICCON Workshop Overall Rating: The event received highly positive feedback, with 33% of participants rating it as “excellent” and 60% as “very good.” Participants appreciated the effective combination of theoretical concepts with practical hands-on training, which enhanced understanding, procedural confidence, and clinical skills.

Satisfaction with Workshop Expectations: The workshop successfully fulfilled participants expectations, with strong satisfaction noted regarding its structure, content, and hands-on practical approach, in alignment with current Aesthetic Dermatology standards.

Impact of Practical Learning on Facial Injectables Procedures: Participants gained the skills and confidence to incorporate advanced facial injectable techniques like including Bio-Remodellers, Skin Boosters, Botulinum Toxin Type A, and Threads procedure into their clinical practice.

The inclusion of live demonstrations and expert guidance further strengthened procedural

Dr. Jothsna Sirivelu (Hyderabad): “The workshop was very good, and I particularly appreciate the sessions on bio-remodelling injectables and botulinum toxin.”

Dr. Deepti Kataria (Ambala): “I rate the session as very good and appreciated the interactive nature of the event and the opportunity for actual hands-on experience, which enhanced my procedural understanding and confidence.”

Dr. Neha Koganti (Hyderabad): “Limited number of participants facilitated effective oneto-one interaction with the faculty, significantly enhancing the quality of learning and overall experience.”

Stay connected: The journey towards excellence in aesthetic dermatology education continues. Stay tuned for AESTHETICCON Mumbai 2026, where innovation and expertise come together! @AESTHETICCON — Where Meets Aesthetic Innovation

January 2026

Dermatology

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High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation Dr. Surabhi Sharma

MD, DNB, MRCP UK (SCE), Gold Medalist Dermatologist, Trichologist & Cosmetologist Founder and Medical Director Dermalooks Skin Clinic Meerut, Uttar Pradesh Introduction

F

acial aesthetics are significantly influenced by the contour and definition of the chin and neck.

Submental fullness, caused by excess fat accumulation in the preplatysmal submental region, is a common aesthetic concern resulting from aging, genetic predisposition, and lifestyle factors such as weight gain.

This condition disrupts lower facial harmony by distorting the anterior cervicomental angle, promoting soft tissue laxity, and contributing to an aged or overweight appearance.1

Double chin deformity is clinically identified by an increase in the mentocervical angle, the angle formed between a line from the cervical point to the menton and the anterior facial plane.

In a normally contoured face, this angle ranges from 80° to 95°. Progressive submental fat 18

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deposition, weakening of the mandibular septum, and loss of skin elasticity increase this angle, resulting in submental fullness, sagging and loss of jawline definition.2 Additional contributing factors include hyperactivity of perioral and neck musculature, mandibular remodeling and age-related soft tissue laxity. Beyond aesthetics, submental fat can negatively impact self-perception and psychosocial well-being.3 The chin plays a central role in lower facial aesthetics and overall facial balance.

Anatomically, it comprises the mandible, muscles, skin, and fat pads, each influencing its shape and function. The mandible forms the foundation of the chin and jawline and consists of the body, mental protuberance, angle and ramus. The body shapes the lower facial profile

High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

and supports the lower teeth.

The mental protuberance determines the forward projection of the chin, influencing whether it appears recessed or prominent. The mandibular angle affects jawline definition, with sharper angles creating a more angular appearance and softer angles a rounder contour. The ramus connects the mandible to the skull and determines jaw width and contour. The overall shape and prominence of the mandible are influenced by genetic and environmental factors, including aging and hormonal changes. A welldefined mandible contributes to a balanced and proportionate facial appearance, whereas a weak or recessed mandible may lead to facial imbalance. The chin is demarcated superiorly by the labiomental crease, laterally by the labiomandibular grooves, and inferiorly by the submental cervical crease. A smooth, wellprojected chin and jawline are considered aesthetic ideals and can significantly influence psychosocial well-being.4,5 Management of submental fullness and chin contouring is therefore a key focus in contemporary non-invasive aesthetic interventions.

Understanding the anatomical, physiological, and etiological factors underlying submental fat accumulation, soft tissue laxity, and chin morphology is essential for planning effective treatments.

Non-invasive modalities such as high-intensity focused ultrasound (HIFU) allow targeted reduction of submental fat, improvement in skin laxity,

restoration of jawline definition, and enhancement of overall lower facial aesthetics, thereby improving patient satisfaction.

Case Report A 47-year-old male presented with concerns of submental fullness, diminished jawline definition, and progressive lower facial sagging, adversely affecting his facial profile and self-confidence.

Clinical assessment revealed moderate localized adiposity in the submental region with early skin laxity, resulting in a softer, poorly defined mandibular contour. As the patient preferred a non-surgical modality with minimal downtime, DOT High-Intensity Focused Ultrasound (HIFU) was selected for treatment. This modality delivers focused thermal energy to the deep dermis and superficial musculoaponeurotic system (SMAS), inducing neocollagenesis, reducing submental fat, and achieving lifting and contouring without needles or incisions. A single treatment session was performed targeting the submental area and lower face. Treatment parameters included 470 shots at a depth of 4.5 mm and 300 shots at a depth of 3 mm, following meticulous pre-procedure marking. The procedure was well tolerated without anesthesia or downtime. At follow-up, the patient demonstrated marked reduction in submental fullness, improved jawline definition, visible skin tightening and lifting, and an overall enhancement of the facial profile.

Before Treatment

After treatment

Figure 1: Excellent clinical outcome of submental (double chin) reduction achieved following HIFU therapy Diagnosis Diagnostic evaluation of submental fullness primarily relies on a thorough clinical examination, involving meticulous visual inspection and palpation to assess the extent and distribution of subcutaneous fat, degree of skin laxity, and tone of the platysmal musculature. The assessment is performed with the patient in an upright position and the neck in a neutral posture to ensure January 2026

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High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

accurate appraisal of anatomical contours and soft-tissue characteristics.

Photographic analysis using standardized high-resolution frontal, profile, and oblique images enables precise documentation of baseline anatomy and objective comparison of post-treatment outcomes.6 Validated grading scales, such as the Submental Fat Rating Scale (SMFRS) or the Carruthers Submental Fat Rating Scale, provide an objective and reproducible method for classifying the severity of submental fullness and monitoring response over time.6 Ultrasound imaging serves as a non-invasive modality to evaluate the thickness, volume, and distribution of submental adipose tissue and to distinguish fat from adjacent glandular or lymphatic structures.7 In selected cases, Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) offers detailed assessment of deeper fat compartments, platysmal musculature, and associated soft-tissue 8 structures.

Advanced three-dimensional (3D) imaging technologies, such as 3D Vectra or Ultrascan, allow volumetric quantification of fat and contour irregularities, providing high precision for treatment planning and outcome Skin elasticity analysis.9,10 and laxity assessments using cutometers or high-frequency ultrasound further aid in determining patient suitability for non-surgical skin-tightening interventions.

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Collectively, these diagnostic tools enable accurate characterization of submental fullness and support individualized, evidence-based treatment planning.

Treatment High-Intensity Focused Ultrasound (HIFU) is a contemporary, non-invasive aesthetic modality that effectively reduces localized fat deposits and improves skin laxity. The primary mechanism involves the conversion of mechanical (acoustic) energy into thermal energy at precise focal points within the tissue.

This energy deposition induces localized tissue coagulation, collagen denaturation, and remodeling, ultimately restoring structural integrity and 11 promoting skin tightening.

Patient Selection, Indications and Contraindications All participants were of Fitzpatrick skin types III and IV, and written informed consent was provided prior to the procedure. HIFU therapy was indicated for the reduction of submental fat, improvement of skin laxity and non-invasive facial or neck contouring in patients seeking aesthetic enhancement.

High-Intensity Focused Ultrasound (HIFU) therapy carries specific contraindications that must be evaluated to ensure patient safety. Absolute contraindications include dermal implants, pacemakers or metallic devices, implantable defibrillators, pregnancy or lactation, active skin infections, cystic acne, severe systemic

illness, coagulopathies, anticoagulant or antiplatelet use, epilepsy, active vitiligo, fever, uncontrolled diabetes or liver disease, severe psychiatric disorders, significant allergies, and silicone implants. Relative contraindications include age below 25 or above 60 years, recent facelifts or laser procedures, smoking, photoaged or excessively lax skin, BMI >30, and impaired dermal healing such as keloids or connective tissue disorders.11,12 Patient Positioning and Preparation Patients were positioned in an upright or semi-upright posture with the neck maintained in a neutral alignment.

The submental region was thoroughly cleansed, and the treatment area was carefully marked to delineate target zones. Ultrasound coupling gel was applied to ensure optimal acoustic contact between the transducer and the skin surface.11,12 Procedure High-Intensity Focused Ultrasound (HIFU) was administered using transducers operating at frequencies of 4 MHz and 7 MHz, with focal depths of 3.0 mm, 4.5 mm, and, when indicated, 6.0 mm. Treatment parameters— including pulse intensity, total energy, and shot count— were selected according to manufacturer recommendations and individualized based on submental fat thickness, degree of skin laxity, and platysma

High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

tone.¹³ Before energy delivery, the submental fat layer, platysma, and overlying dermal structures were evaluated to determine the optimal treatment depth.

A generous layer of ultrasound coupling gel was applied to ensure efficient acoustic transmission. The transducer was positioned on the skin and systematically advanced across a standardized grid-mapped region to deliver focused energy to the predetermined depths. Typically, 4.5 mm depth targeted the superficial musculoaponeurotic system (SMAS), while 3.0 mm addressed the deep dermis and subcutaneous tissue.

Each pulse produced precise microthermal coagulation zones while preserving the epidermis and adjacent structures.

Patients commonly experienced transient warmth or mild discomfort, and treatment parameters were continuously monitored to avoid excessive heating or inadvertent stimulation of bony areas.13 Mechanism of Action High-Intensity Focused Ultrasound (HIFU) is a noninvasive aesthetic procedure that reduces fat accumulation and improves skin laxity through both thermal and non-thermal mechanisms. The primary nonthermal mechanism is acoustic cavitation, which generates high pressures and temperatures at targeted tissue sites, leading to localized tissue disruption.

The fundamental principle of HIFU involves the conversion of

mechanical (acoustic) energy into thermal energy at precise focal points within the tissue.

This localized thermal effect raises temperatures to 65– 75 °C at microscopic points, creating thermal coagulation points (TCPs) without damaging the surrounding structures. At temperatures above 42 °C, fibroblasts are stimulated to produce collagen, while collagen denaturation and contraction occur at TCPs, initiating tissue remodeling. These biological effects lead to tightening of the dermis, superficial musculoaponeurotic system (SMAS), and subcutaneous fat, promoting skin rejuvenation and restoration of structural integrity. HIFU probes can target multiple tissue depths (1.5–16 mm), allowing precise treatment of different skin layers while maintaining a non-invasive profile.14,15 Post-Treatment Care Following treatment, the treated area was gently cleansed, and a cold compress or soothing topical formulation was applied to minimize transient erythema and edema. Patients were advised to maintain adequate hydration, avoid direct heat exposure such as saunas or steam baths for several days, and report any unexpected symptoms. Adverse events, when present, were typically mild and transient, including temporary erythema, tenderness, or minimal swelling, resolving spontaneously within one to two weeks.12 Follow-Up

and

Outcome

Evaluation Patients were re-evaluated at 4 weeks post-procedure to assess clinical improvement in submental contour using standardized photography and, when available, threedimensional volumetric imaging.

Additional treatment sessions were considered based on clinical response, patient satisfaction, and therapeutic goals.13,16 Discussion The chin, though often overlooked in routine facial aesthetic evaluations, plays a pivotal role in defining lower facial harmony, balance, and attractiveness.

Its shape, projection, and position significantly influence facial symmetry, profile proportionality, and the overall perception of beauty. A thorough anatomical assessment of the chin requires evaluating its spatial relationship with surrounding structures, including the lips, nose, and neck. An ideally positioned chin enhances overall facial balance, whereas a retruded or under-projected chin disrupts profile aesthetics and may exaggerate the appearance of submental fullness. Several standardized analytical methods assist clinicians in determining chin projection and the need for augmentation. Goode’s method assesses chin position by aligning the pogonion—the most anterior chin point—with a perpendicular line drawn from the alar groove to the Frankfort horizontal plane. GonzalezUlloa’s analysis uses a vertical reference line through the nasion January 2026

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High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

and classifies chin deficiency into three grades based on posterior retrusion.

Silver’s method relates chin projection to the mucocutaneous junction of the lower lip, placing the ideal pogonion within 2 mm posterior to this vertical reference in females. Merrifield’s Z-angle, formed between the Frankfort horizontal plane and a line from the pogonion to the most anterior lip point, reflects ideal balance when between 75° and 85°. Legan’s analysis evaluates harmony through the angular relationship between the glabella–subnasale and subnasale–pogonion lines, with 12° being ideal. Complementary parameters such as the cervicomental angle (CMA) and mentocervical angle (MCA) further refine assessment, defining the aesthetic neck– chin contour. Importantly, the dynamic interplay between the nose and chin must always be considered, as modifying one structure can markedly influence the perceived projection of the other.5 In recent years, a wide spectrum of surgical and non-surgical modalities has been introduced to enhance chin contour and address submental fullness. Traditional surgical options—such as liposuction, genioplasty, and chin implants—remain highly effective; however, they are associated with longer recovery periods, higher costs, and potential complications including scarring, infection, nerve injury, and postoperative asymmetry.

Non-invasive techniques such 22

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as radiofrequency, cryolipolysis, and injectable lipolytic agents have gained significant popularity due to their favorable safety profiles and minimal downtime. Despite this, their efficacy may be limited by superficial penetration, variable fat reduction, or the need for multiple treatment sessions to achieve optimal results.5 Among non-invasive modalities, High-Intensity Focused Ultrasound (HIFU) has emerged as one of the most advanced and dependable technologies for lower facial rejuvenation and submental contouring.

HIFU delivers precisely focused ultrasound energy to controlled depths, targeting the dermis, subcutaneous fat, and the superficial musculoaponeurotic system (SMAS) while preserving the epidermis.

This enables simultaneous tissue tightening, lifting and selective fat reduction. Unlike radiofrequency or laser-based devices—which primarily affect superficial layers—HIFU stimulates deep collagen remodeling and neocollagenesis, ensuring long-lasting tightening and progressive contour enhancement over several months.

Additional benefits include minimal downtime, a low rate of adverse effects, and naturally refined results.14 When performed under appropriate clinical protocols, HIFU is considered a safe and effective modality for aesthetic facial rejuvenation. During treatment, patients may experience mild tingling, warmth, or transient discomfort, while post-procedural erythema, tenderness, or edema typically resolves within hours to days.

Mild tightness or soreness reflects ongoing collagen remodeling.

Pre-treatment recommendations include adequate hydration and avoidance of ultraviolet exposure; post-treatment care emphasizes avoidance of excessive heat and consistent use of broad-spectrum sunscreen. With proper energy settings and expert technique, HIFU demonstrates an excellent safety profile, with adverse effects generally limited to transient erythema, edema, or ecchymosis. By targeting multiple tissue planes to induce collagen synthesis and tissue contraction, HIFU offers a precise, durable, and minimally invasive option for improving chin contour, reducing submental fullness, and enhancing lower facial definition.14 Conclusion High-Intensity Focused Ultrasound (HIFU) represents a significant advancement in non-invasive aesthetic medicine for the management of double chin and submental fullness, as well as chin contour enhancement. By delivering focused ultrasound energy to multiple tissue depths, HIFU promotes collagen regeneration and structural tightening, leading to enhanced skin firmness and improved lower facial definition. Its safety profile, minimal downtime, and predictable clinical outcomes make it a preferred modality in facial rejuvenation.

HIFU offers durable, natural-looking results with a low incidence of complications, establishing it as a reliable, evidence-based technique for reducing double chin, achieving facial harmony, and enhancing overall aesthetic outcomes.

High-Intensity Focused Ultrasound (HIFU) for Submental Fullness: A Comprehensive Aesthetic Approach to Chin Contouring and Lower Facial Rejuvenation

References 1. Khan H, Ul Ain N, Bhatti DS, Khan J. An Assessment of the Reduction of Submental Fullness With ATX-101 (Deoxycholic Acid Injection) in the Expanded Safe Zone.

Cureus. 2023; 15(2):e35286. Published 2023 Feb 22. doi:10.7759/cureus.35286 2. Boxley SG, Lin F, Lee See N, St Rose S, Battucci S, Simonyi S. CONTOUR Australia: Condition of Submental Fullness and Treatment Outcomes with Belkyra Registry. Plast Reconstr Surg Glob Open.

2023; 11(7):e5123. Published 2023 Jul 18. doi:10.1097/GOX.0000000000005123.

3. Jalian HR, Fitzgerald R, Bowen B, Gamio S. Submental fat reduction using sequential treatment approach with cryolipolysis and ATX-101. J Cosmet Dermatol.

2022; 21(6):2437-2444. doi:10.1111/jocd.14909.

4. Cheng CKL. High-efficiency Combination Treatment of Submental Neck Fullness. Plast Reconstr Surg Glob Open.

2019; 7(7):e2306. Published 2019 Jul 25. doi:10.1097/GOX.0000000000002306 5. Harris WC, Winters R, Raggio BS. Facial Chin Augmentation. In: StatPearls.

Treasure Island (FL): StatPearls Publishing; March 7, 2024.

6. Oh JS, Choi J, Choi JW, et al. The Study of a Validated Assessment Scale for a Localized Submental Fat Volume. J Clin Med. 2023; 12(3):1226. Published 2023 Feb 3. Doi: 10.3390/jcm12031226.

7. Nasreddine H, Tlaiss Y, Hassan F, Ibrahim R. Ultrasound Assessment of Facial and Neck Aging: A Noninvasive Approach to a Minimally Invasive Treatment. J Med Ultrasound. 2024; 32(3):244-248.

Published 2024 Aug 28. doi:10.4103/jmu. jmu_175_23 8. Tsaban G, Bilitzky-Kopit A, Yaskolka Meir A, et al. The Effect of WeightLoss Interventions on Cervical and Chin Subcutaneous Fat Depots; the CENTRAL Randomized Controlled Trial. Nutrients.

2021; 13(11):3827. Published 2021 Oct 27.

Doi: 10.3390/nu13113827 9. Bernstein EF, Bloom JD. Safety and Efficacy of Bilateral Submental Cryolipolysis With Quantified 3-Dimensional Imaging of Fat Reduction and Skin Tightening. JAMA Facial Plast Surg. 2017; 19(5):350-357. doi:10.1001/jamafacial.2017.0102.

10. Hansson S, Östlund E, Bazargani F. The Vectra M3 3-dimensional digital stereophotogrammetry system: A reliable technique for detecting chin asymmetry.

Imaging Sci Dent. 2022; 52(1):43-51. doi:10.5624/isd.20210168 11. Park H, Kim E, Kim J, Ro Y, Ko J. HighIntensity Focused Ultrasound for the Treatment of Wrinkles and Skin Laxity in Seven Different Facial Areas. Ann Dermatol.

2015; 27(6):688-693. doi:10.5021/ ad.2015.27.6.688.

Submental Fat Using Triple-Layer HighIntensity Focused Ultrasound: Clinical and 3-Dimensional Imaging Analysis.

Dermatol Surg. 2021; 47(12):1595-1600. doi:10.1097/DSS.0000000000003241.

13. Goo B, Kim E, Yoon SE, et al. Efficacy and Safety of High-Intensity Focused Ultrasound (HIFU) on Reduction of Unwanted Submental Fat in Asian Patients. Aesthetic Plast Surg. 2025; 49(13):3750-3755.

Doi: 10.1007/ s00266-025-04890-0.

14. Biskanaki F, Tertipi N, Sfyri E, Kefala V, Rallis E. Complications and Risks of High-Intensity Focused Ultrasound (HIFU) in Esthetic Procedures: A Review. Applied Sciences. 2025; 15(9):4958. https://doi. org/10.3390/app15094958 15. Yao R, Hu J, Zhao W, Cheng Y, Feng C. A review of high-intensity focused ultrasound as a novel and non-invasive interventional radiology technique.

J Interv Med. 2022; 5(3):127-132.

Published 2022 Jun 22. doi:10.1016/j. jimed.2022.06.004.

16. Shek SY, Yeung CK, Chan JC, Chan HH. Efficacy of high-intensity focused ultrasonography for noninvasive body sculpting in Chinese patients. Lasers Surg Med. 2014; 46(4):263-269. doi:10.1002/ lsm.22232

12. Kwon HH, Yang SH, Choi M, Jung JY, Park GH. Tightening and Reduction of Unwanted

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NEWS

Large Spot Picosecond Laser Treatment for Pigmented Lesions A recent theoretical and early clinical analysis suggests that large-spot picosecond laser irradiation may enhance dermal pigment clearance in Asian skin while minimizing perilesional tissue exposure, provided that wavelength and target depth are appropriately matched. Using a melanosome disruption threshold energy dose model, investigators evaluated picosecond lasers at 532, 730, 755, 785, and 1,064 nm to estimate energy required for melanosome disruption and simulate collateral tissue exposure, with large spots defined as diameters greater than 4 mm. At 532 nm, spot size had minimal effect on epidermal melanosome disruption or collateral energy deposition, suggesting both small and large spots may be acceptable for epidermal lesions when safety endpoints are observed. At near-infrared wavelengths (730–1,064 nm), outcomes depended on target depth: smaller spots concentrated energy superficially for epidermal pigmentation, while larger spots favored dermal melanosomes, reducing required energy by 39–65% and lowering collateral deposition. Larger spots also minimized energy variability across dermal depths, supporting more consistent parameter selection when lesion depth is uncertain. Clinical feasibility was supported by a small case series using a 1,064 nm laser with a large spot, in which an ectopic Mongolian spot and a nevus of Ota achieved good clearance without adverse events, though higher device output may be needed for optimal efficacy.

These findings endorse a depth-guided approach to picosecond laser treatment in Asian skin, aligning wavelength and spot size with target depth to maximize efficacy while limiting perilesional exposure.

Bipolar Microneedle Radiofrequency for Postpartum Abdominal Skin Tightening The study highlights the efficacy and safety of bipolar microneedle radiofrequency (RF) technology for improving postpartum abdominal skin laxity. In an open-label, single-arm study, postpartum women with mild-to-moderate abdominal laxity underwent three treatments at regular intervals using a bipolar RF device combining a microneedle handpiece with insulated pins. Controlled subcutaneous heating delivered via fine needles enhanced dermal hyaluronic acid and elastin levels while reducing adipose tissue accumulation. Treatments involved passes at different depths and energy settings, tailored to optimize dermal remodeling. Post-procedure care included topical antibiotics and cold packs, with normal activity typically resumed within a week. Assessments conducted eight weeks after the final treatment demonstrated improvements in skin elasticity, firmness, viscoelasticity, collagen content, dermal thickness, structural remodeling, and tissue density, with only minor changes in abdominal circumference. The majority of participants reported satisfaction, citing tighter, smoother skin and reduced striae, with minimal discomfort and no serious adverse events. These findings support bipolar microneedle RF as a safe, minimally invasive approach for postpartum abdominal skin laxity and highlight the need for larger studies with longer follow-up and molecular analyses to optimize treatment parameters and clarify effects on fibroblast function.

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Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation

Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation Dr. Swetha Jain

MD (Dermatology) Consultant Dermatologist Dr. Swetha Skin Care Centre Mumbai

Introduction

X

anthelasma........... palpebrarum (XP) is the most common form of cutaneous xanthoma, with a prevalence of about 1.1% in women and 0.3% in men, and rates reaching up to 4% in certain populations, especially among individuals in their fourth and fifth decades.

Clinically, XP presents as soft, yellowish papules, plaques, or nodules situated predominantly on the medial upper eyelids, with occasional extension to the lower lids. Lesions may be flat or mildly elevated, solitary or multiple, and often exhibit a semisolid or rarely calcareous consistency.

A female predilection and symmetrical distribution across the eyelids are characteristic. A pseudoxanthelasma pattern may also develop following ocular procedures, such as retinal surgeries involving silicone oil.

Xanthomas represent localized deposits of cholesterol and lipid-rich material within the skin or subcutaneous tissue and may be associated with

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systemic lipid abnormalities.

Xanthelasma palpebrarum is a localized variant, typically confined to the eyelids and often occurring without involvement of other body sites. The pathogenesis centers around the accumulation of lipids within macrophages, leading to foam cell formation. A key contributing factor is repetitive mechanical stress on the fragile periorbital microvasculature during blinking. Contraction of the orbicularis oculi transiently elevates intravascular pressure, and with aging, the endothelial integrity of these capillaries weakens.

This age-related susceptibility promotes extravasation of plasma lipoproteins into the surrounding perivascular and subcutaneous tissues, culminating in XP development.1,2 The extravasation of plasma lipoproteins into the perivascular and subcutaneous tissues of the eyelids creates a permissive environment for lipid accumulation within

Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation

resident macrophages.

Once in the interstitial space, lipoproteins—particularly......

LDL—are phagocytosed by macrophages; however, when lipid influx exceeds lymphatic clearance or overwhelms intracellular regulatory pathways, progressive deposition of lipid droplets ensues. This drives the conversion of macrophages into lipid-laden foam cells, which cluster within the dermis and present clinically as the characteristic yellow plaques of xanthelasma palpebrarum.

Emerging evidence indicates that chronic low-grade inflammatory signals may amplify foamcell formation by promoting lipoprotein oxidation, impairing lipid efflux, and sustaining macrophage activation— paralleling mechanisms seen in other xanthomatous conditions linked to metabolic, infectious, or autoimmune disorders. Together, mechanical microvascular stress, endothelial fragility, impaired lipid handling, and subtle inflammatory modulation shape the localized, lipid-rich macrophage accumulation characteristic of xanthelasma palpebrarum.1,2 Xanthelasma palpebrarum creates a notable cosmetic concern due to its prominent periocular location, often leading to self-consciousness, reduced self-esteem, and a negative impact on quality of life. Although benign, its visibility can cause considerable psychosocial distress, affecting social interactions, confidence, and overall body image.

Many patients experience embarrassment or hesitation in face-to-face communication,

which may worsen as lesions enlarge, become bilateral, or recur after treatment. Consequently, addressing the cosmetic burden through effective, safe, and aesthetically favourable therapeutic options is a key component of patient-centred care, helping restore confidence and improve overall psychological well-being.

We present the case of a 65-year-old woman with long-standing xanthelasma who sought cosmetic improvement.

Case Presentation A 65-year-old female presented with bilateral, long-standing yellowish plaques on the medial upper eyelids. The lesions were asymptomatic, and her medical and family histories were unremarkable. Laboratory evaluation—including a complete lipid profile (total cholesterol, LDL, HDL, triglycerides) and liver, renal, and thyroid function tests—revealed values within normal limits, confirming normolipidemic status. After discussing multiple management options, radiofrequency ablation (RFA) was chosen based on lesion characteristics and patient preference. Under local infiltration of 2% lidocaine, RFA was performed using a fine electrode to achieve complete tissue ablation. Minor bleeding was effectively controlled with bipolar cautery. Each eyelid was treated in a separate session one week apart to minimize edema and ensure optimal healing in the delicate periorbital area. The ablated sites were left unsutured. Post-procedure care included topical mupirocin applied three times daily and strict moisture avoidance. The patient was counselled regarding signs of infection and scheduled for followup. Healing was uneventful, with complete epithelialization by 7–10 days. At the three-month review, she demonstrated smooth, wellhealed skin with excellent cosmetic improvement and no evidence of recurrence. This case highlights the safety and efficacy of RFA as a reliable treatment modality for xanthelasma palpebrarum in normolipidemic patients.

Before Treatment

After treatment

Figure 1: Excellent cosmetic outcome following radiofrequency ablation for xanthelasma palpebrarum Diagnosis The diagnostic evaluation of xanthelasma palpebrarum (XP) integrates laboratory testing and targeted imaging to identify systemic associations and define lesion characteristics. A fasting serum lipid profile after a 12-hour fast is essential, as many patients show underlying dyslipidemia. Additional investigations—liver and January 2026

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Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation

thyroid function tests, fasting glucose, and in diabetics, HbA1c—help uncover metabolic or endocrine contributors.

Ultrasound biomicroscopy may be used to assess lesion depth and echotexture, supporting treatment planning. XP is clinically graded from I to IV based on anatomical extent: Grade I involves the upper eyelid; Grade II, the upper eyelid and medial canthus; Grade III, both medial upper and lower lids; and Grade IV, diffuse bilateral eyelid involvement. Differential diagnosis includes syringomas, sebaceous hyperplasia, and necrobiotic xanthogranuloma.

When clinical uncertainty exists, biopsy reveals characteristic lipid-laden foam cells in the dermis. Systemic evaluation and additional imaging are reserved for atypical, extensive, or suspicious presentations.1,2,3 Treatment Radiofrequency ablation (RFA) was employed as the primary treatment modality and was performed under local anesthesia administered via infiltration. A fine electrode was used to achieve controlled ablation of the xanthelasma lesions, with the procedure continued until the underlying dermal tissue became visible.

Minor intraoperative bleeding was effectively managed using bipolar cautery. To ensure patient safety and allow adequate monitoring of postprocedural healing, each eyelid was treated separately at oneweek intervals. The ablated areas were left unsutured, and patients were instructed to apply a topical antimicrobial ointment three times daily while strictly avoiding moisture exposure to 28

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the treated sites.4 Eligible patients included males and females with xanthelasma palpebrarum who provided informed consent. Exclusion criteria comprised active periorbital herpetic lesions, preexisting scars, anticoagulant therapy, pacemaker presence, known allergies, keloid predisposition, and unrealistic patient expectations. Prior to the procedure, topical anesthesia was applied to ensure adequate analgesia, followed by cleansing of the treatment field with spirit and normal saline. When necessary, additional RFA sessions were performed at two-week intervals, with the full course of treatment extending up to four weeks.4 Radiofrequency ablation functions through the application of controlled medium-frequency alternating current, generally ranging from 300 kHz to 3000 kHz, which generates localized thermal energy within the targeted tissue. This thermal effect results from ionic agitation and molecular oscillation, ultimately leading to cellular vaporization and coagulative necrosis. The controlled nature of energy delivery permits precise removal of the lesion while minimizing thermal diffusion to adjacent structures, making RFA particularly advantageous for the periorbital region where tissue preservation is critical.

During the post-procedural healing phase, the treated tissue undergoes predictable fibrotic remodeling characterized by collagen deposition, contraction, and reorganization.

Concurrently, necrotic cellular debris is eliminated through

natural physiological pathways, including macrophage-mediated phagocytosis and gradual resorption. These processes collectively contribute to progressive reduction in lesion volume and improvement in contour.5 The underlying mechanism of radiofrequency ablation involves the generation of oscillating radio waves produced by increasing frequency and voltage while proportionally reducing amperage.

This configuration allows for focused energy delivery, producing a controlled thermal injury zone that is sufficient for effective tissue ablation without compromising surrounding anatomical structures.

This balance of precision, predictability, and safety underpins the utility of RFA as an effective therapeutic modality for xanthelasma palpebrarum.5 Apart from radiofrequency ablation, xanthelasma palpebrarum can be managed with systemic, topical, energybased, and surgical therapies.

Systemic therapy includes agents such as probucol, which may inhibit foam-cell formation by limiting oxidative modification of LDL cholesterol, and alirocumab, a PCSK9 inhibitor that lowers circulating LDL levels. Topical management includes chemical peels, liquid nitrogen cryotherapy, intralesional pingyangmycin, and 2% mupirocin ointment applied postoperatively to prevent infection and support healing while limiting moisture exposure.

Energy-based modalities, such as CO₂, Er:YAG, Q-switched Nd:YAG, argon, KTP, pulsed dye and diode lasers, allow

Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation

precise tissue ablation with minimal collateral damage and are selected according to lesion size, depth and anatomical location. Surgical excision, including full-thickness removal with primary closure or reconstructive flaps, provides definitive management for extensive or recurrent lesions while preserving eyelid function. Therapy selection is individualized based on lesion characteristics, patient comorbidities, and risk– benefit considerations to optimize outcomes and reduce recurrence.6, 7 Discussion Xanthelasma palpebrarum is the most common cutaneous xanthoma, typically occurring in middle-aged and older individuals. Although it may be associated with lipid abnormalities, a significant proportion of patients present with normal lipid profiles. Despite its benign and non-malignant nature, the lesion frequently warrants clinical evaluation due to cosmetic concerns and its potential association with underlying systemic conditions.

The differential diagnosis is broad and includes necrobiotic xanthogranuloma (NXG), syringomas, sebaceous hyperplasia, juvenile xanthogranuloma, AAPOX, palpebral sarcoidosis, lipoid proteinosis, nodular basal cell carcinoma, and pseudoxanthogranulomatous lesions such as postvitrectomy silicon oil deposits. NXG, a nonLangerhans cell histiocytosis associated with monoclonal gammopathy, can be differentiated by its systemic involvement and characteristic

histopathologic features.

Likewise, xanthelasma-like lesions in Erdheim–Chester disease may resemble xanthelasma palpebrarum clinically but lack the multiorgan involvement typical of this systemic disorder.1, 8 Xanthelasma palpebrarum is strongly associated with lipid metabolism disorders.

Epidemiological studies indicate that approximately 50% of affected individuals present with either primary or secondary dyslipidemia.

Primary lipid disorders commonly implicated include familial hypercholesterolemia types IIa and IIb, type IV hypertriglyceridemia, and low levels of high-density lipoprotein (HDL). Secondary causes arise from systemic or metabolic conditions, such as diabetes mellitus, hypothyroidism, nephrotic syndrome and primary biliary cholangitis characterized by elevated lipoprotein X. Additionally, pharmacological agents, including retinoids and estrogens, may contribute to lesion formation, while systemic inflammatory conditions such as sarcoidosis can rarely precipitate lipid deposition. The recognition and management of these underlying disorders are essential, as uncontrolled lipid abnormalities not only predispose patients to the formation and recurrence of xanthelasma lesions but also significantly increase the risk of cardiovascular morbidity and mortality.1 The clinical course of xanthelasma palpebrarum is influenced by lesion characteristics and treatment modality, with recurrence

rates generally below 50%, though deeper lesions with dermal involvement exceeding 1 µm exhibit higher recurrence, approaching 60% after retreatment.

Effective management requires a comprehensive approach combining local lesion-directed therapy with cardiometabolic risk reduction.

Lifestyle interventions—including...... regular aerobic and resistance exercise, weight optimization, dietary modification with low saturated fat and high fiber intake, and smoking cessation—are foundational, while pharmacologic therapy with statins, fibrates, or PCSK9 inhibitors should be tailored to individual lipid profiles and cardiovascular risk. Evaluation and management of comorbid metabolic conditions, such as diabetes mellitus, thyroid dysfunction, and hepatic disease, are critical to prevent recurrence and reduce systemic morbidity.1 Various modalities, including surgical excision, laser, chemical cautery, and RFA, are utilized for management. RFA offers precise, tissue-sparing ablation with good cosmetic outcomes.

It effectively treats xanthelasma palpebrarum, minimizing tissue damage and postoperative complications while preserving eyelid function and aesthetics.

Concurrent management of metabolic and cardiovascular risk factors further supports comprehensive patient care.

Conclusion Xanthelasma palpebrarum, though histologically benign, often signals increased systemic and cardiovascular risk, necessitating an integrated January 2026

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Safe and Aesthetic Clearance of Xanthelasma with Radiofrequency Ablation

management strategy.

Radiofrequency ablation (RFA) is a highly effective treatment, offering precise lesion removal with minimal tissue injury, low postoperative complications,

and preservation of eyelid function and aesthetics. Combined with systematic evaluation and management of associated metabolic and cardiovascular factors, RFA achieves durable local control while supporting comprehensive patient-centered care, underscoring its role as a preferred therapeutic modality for xanthelasma palpebrarum.

References 1. Nair PA, Singhal R. Xanthelasma palpebrarum - a brief review. Clin Cosmet Investig Dermatol. 2017; 11:15. Published 2017 Dec 18. doi:10.2147/ CCID.S130116 2. Al Aboud AM, Shah SS, Blair K, Al Aboud DM. Xanthelasma Palpebrarum.

In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 1, 2024.

3. Krajewska-Węglewicz L, Dźwigała M, Sobolewski P, Wasążnik-Jędras A, Walecka I. Reflectance Confocal Microscopy Can Help Differentiate Adult Xanthogranulomatous Disease from Xanthelasma-A Case Report. J Clin Med.

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2025; 14(4):1359. Published 2025 Feb 18.

Doi: 10.3390/jcm14041359 4. Chaudhary S, Umar S. Comparative Study to Evaluate the Efficacy of Radiofrequency Ablation Versus Electrocautery in the treatment of Xanthelasma Palpebrum. Ann. Int. Med. Den. Res. 2017; 3(6):DT01-DT04.

5. Akdag M. The Effects of Radiofrequency in Xanthelasma of Eyelid: Case Report.

Journal of International Dental and Medical Research. September 2013; 6(3):128-131.

6. Laftah Z, Al-Niaimi F. Xanthelasma: An Update on Treatment Modalities. J Cutan Aesthet Surg. 2018; 11(1):1-6. doi:10.4103/

JCAS.JCAS_56_17 7. Pathania V, Chatterjee M. Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: a case series.

J Cutan Aesthet Surg. 2015; 8(1):46-49. doi:10.4103/0974-2077.155084.

8. Malekzadeh H, Ormseth B, Janis JE. A Practical Review of the Management of Xanthelasma palpebrarum. Plast Reconstr Surg Glob Open. 2023; 11(5):e4982. Published 2023 May 24. doi:10.1097/GOX.0000000000004982.

NEWS

Tailored Abrocitinib Treatment for Atopic Dermatitis Current developments in Dermatology emphasize individualized approaches, including flexible dosing of abrocitinib, an oral JAK1 inhibitor for moderate-to-severe atopic dermatitis, allowing dose escalation during flares and reduction to the lowest effective level once stable, supporting shared decision-making while maintaining efficacy and safety. Safety data show that treatmentemergent adverse events correspond to the current dose, with no carryover risk after stepping down from higher doses, reinforcing long-term dose adjustment feasibility. In parallel, theoretical and early clinical analyses of large-spot picosecond lasers suggest improved strategies for treating pigmented lesions in Asian skin. Using a melanosome disruption threshold energy model across 532–1,064 nm, investigators found that smaller spots favoured epidermal targets while larger spots optimized dermal melanosomes, reducing required energy by 39–65% and perilesional exposure. Clinical feasibility was supported by a small case series with a 1,064 nm largespot laser, where an ectopic Mongolian spot and a nevus of Ota cleared effectively without adverse events. Together, these findings highlight a precision-based dermatology approach, integrating tailored systemic therapy and targeted procedural interventions to maximize efficacy while minimizing risk.

Copper Peptides Gain Attention as Next-Generation Skincare Innovation Copper peptides, particularly the naturally occurring tripeptide GHK-Cu, are emerging as a major focus in professional skincare for advanced skin rejuvenation. Designed to mimic the molecule’s native biological environment, next-generation formulations enhance delivery into the skin and support natural repair mechanisms against oxidative stress and age-related decline. GHK-Cu, which naturally complexes with copper in human plasma, helps maintain firmness, radiance, and overall vitality, but its levels decrease with age. Topical reintroduction addresses common aging concerns such as reduced density, loss of firmness, dullness, and fine lines, while remaining suitable for diverse skin types. Innovative delivery systems stabilize the peptide and facilitate deeper penetration, overcoming limitations of conventional formulations that remain superficial, with dermatological, nonirritation, and non-sensitization testing confirming safety and efficacy. Clinical studies report measurable improvements in skin firmness and density within one week, maintained at four weeks, along with visible reduction of fine lines and wrinkles. Consumer-reported outcomes closely mirror these findings, including enhanced smoothness, brightness, hydration, and overall skin vitality. By aligning with the skin’s natural repair pathways, copper peptides deliver rapid, biologically familiar responses, and advances in delivery technology now allow deeper penetration to support structural integrity, firmness, and visible rejuvenation. These developments position copper peptides as a cornerstone of nextgeneration, evidence-based biomimetic skincare, offering solutions that complement the skin’s intrinsic renewal processes.

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Black Peel: A Modern Therapeutic Approach for Inflammatory Acne

Black Peel: A Modern Therapeutic Approach for Inflammatory Acne Dr. Kanika Popli

MD (Dermatology) Founder and Consultant Dermatologist Kanayaa Skin Clinic Gorakhpur, Uttar Pradesh Introduction

A

cne vulgaris is a chronic, inflammatory disorder of the pilosebaceous unit that affects individuals globally, with significant dermatological and psychosocial implications.

It is estimated to impact approximately 9.4% of the world’s population, ranking as the eighth most prevalent skin disease. Although acne predominantly arises during adolescence—affecting more than 85% of teenagers—it is not confined to this age group and often persists into adulthood, particularly among women.

Notably, adult female acne constitutes nearly two-thirds of all acne-related consultations, emphasizing its chronicity and considerable healthcare burden.

Clinically, acne lesions are categorized as non-inflammatory or inflammatory, each exhibiting distinct morphological features and severity. Non-inflammatory lesions include open comedones (blackheads), marked by dilated follicles filled with oxidized keratin, and closed comedones (whiteheads), where the follicular opening is blocked by sebum and keratin. Inflammatory lesions encompass erythematous

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papules, pustules with purulent material, and deeper nodules or cysts exceeding 5 mm in diameter. These can cause dermal injury, post-inflammatory hyperpigmentation, and scarring. Acne typically affects sebaceous gland-rich areas such as the face, neck, chest and upper back. The clinical spectrum includes variants like neonatal and infantile acne, acne conglobata, acne fulminans, acne mechanica, occupational acne, chloracne, acne excoriée, and drug-induced acne—the latter often linked to corticosteroids, androgens, lithium, isoniazid, and phenytoin.

While these entities share histopathological features with acne vulgaris, they differ in etiology, severity, distribution, and systemic associations.1,2 The pathogenesis of acne is multifactorial, involving intricate interactions among genetic susceptibility, hormonal influences—particularly........ androgens—environmental..... factors such as humidity, ultraviolet exposure, and pollution, as well as dietary habits, stress, and comedogenic agents including certain cosmetics

Black Peel: A Modern Therapeutic Approach for Inflammatory Acne

and medications. Four primary mechanisms underlie acne development: seborrhea, follicular hyperkeratinization, Cutibacterium acnes proliferation, and inflammation.

Epigenetic modifications, including DNA methylation, may influence gene expression in inflammatory pathways, offering emerging therapeutic insights.

Seborrhea, driven by elevated androgens and insulin-like growth factor-1 (IGF-1), enhances sebum secretion correlating with acne severity. Concurrently, abnormal keratinocyte desquamation within the follicular infundibulum leads to comedone formation. C. acnes, an anaerobic, lipophilic gram-positive bacterium, thrives in the lipid-rich follicle and secretes lipases that hydrolyze triglycerides into proinflammatory free fatty acids.

These microbial by-products, along with innate immune activation, recruit neutrophils, macrophages, and lymphocytes, perpetuating inflammation.

Neutrophil-derived reactive oxygen species contribute to follicular rupture, driving the evolution of papules, pustules, nodules, and cysts.1,2 Severe nodulocystic acne often necessitates systemic therapy, guided by disease severity and response. Topical retinoids such as tretinoin, adapalene, and tazarotene normalize follicular keratinization, while topical antibiotics like clindamycin and erythromycin, when combined with benzoyl peroxide, minimize bacterial resistance.

Combination regimens yield superior outcomes compared to monotherapy. Adjunctive agents including salicylic acid, azelaic acid, niacinamide, and dapsone

provide additional anti-inflammatory and keratolytic benefits.

Hormonal therapies—oral contraceptives and spironolactone—are effective in androgen-driven acne. When conventional treatments produce suboptimal improvement or aesthetic enhancement is desired, chemical peels offer a non-invasive adjunct, promoting epidermal exfoliation, dermal remodeling, and improved overall skin clarity.1,2 Case Report A 22-year-old male presented with moderate to severe inflammatory acne predominantly involving the cheeks. Clinical assessment revealed multiple erythematous papules, pustules and nodules, along with post-inflammatory hyperpigmentation and early atrophic scarring. The patient reported recurrent breakouts resistant to conventional topical therapies. A treatment plan was initiated using a black peel formulation containing organic acids with keratolytic, antimicrobial, and anti-inflammatory properties. The peel was applied in a controlled manner under clinical supervision. Over subsequent sessions, the patient exhibited significant improvement, characterized by reduction in inflammatory lesions, fading of pigmentation, and enhanced skin texture. This case demonstrates the efficacy and safety of black peel as a valuable adjunct in the management of persistent inflammatory acne, offering visible rejuvenation and improved skin clarity with minimal downtime.

Before Treatment

After Treatment

Figure 1: Moderate to severe inflammatory acne on the cheeks showing significant post-treatment improvement with black peel therapy Diagnosis The diagnosis of acne vulgaris is primarily clinical, based on the type, distribution, and severity of lesions. Severity is categorized as mild, moderate, or severe according to lesion count and anatomical extent. A detailed patient history—including age of onset, triggering factors, medications, and family history—helps identify underlying contributors. Lesion counting provides an objective grading method, while multimodal digital imaging enhances clinical assessment by visualizing erythema, pigmentation, comedones, papules, pustules, and nodules with improved accuracy.3,4 The Sebumeter quantitatively measures sebum output, reflecting sebaceous gland activity associated with acne severity and helping monitor therapeutic outcomes. Hormonal evaluation assesses January 2026

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Black Peel: A Modern Therapeutic Approach for Inflammatory Acne

serum androgens such as total and free testosterone, DHEA-S, and androstenedione, alongside LH, FSH, and prolactin levels to detect endocrine abnormalities like PCOS that exacerbate acne.

Standardized scoring systems ensure consistent evaluation— Global Acne Grading System (GAGS) quantifies severity across six regions; Investigator’s Global Assessment (IGA) offers a qualitative overview based on predominant lesion type; and the Comprehensive Acne Severity Scale (CASS) distinguishes between inflammatory and non-inflammatory lesions for precise disease profiling.5,6,7 Accurate diagnosis and grading are fundamental to selecting appropriate therapy, tracking response, and optimizing patient outcomes through personalized acne management.

Treatment Patient Assessment A comprehensive patient evaluation is essential prior to initiating treatment. This begins with obtaining a detailed medical history, including the patient primary dermatologic concerns, current pharmacologic therapies, and any history of post-inflammatory hyperpigmentation, active acne, atrophic scarring, or hypersensitivity reactions. A thorough physical examination should follow, with emphasis on determining the Fitzpatrick skin type, identifying active lesions, assessing skin barrier integrity, and evaluating for signs of inflammation or dermatoses.

These clinical findings guide the suitability for chemical peeling and help tailor the procedure for optimal therapeutic outcomes while minimizing risk.8,9,10 34

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Pre-Procedural Skin Preparation Adequate skin priming is imperative for the safety and efficacy of chemical peel procedures.

Pre-treatment involves once-daily application of topical tretinoin 0.025% for two weeks to enhance epidermal turnover, discontinued three days prior to the procedure to mitigate irritant dermatitis risk.

Strict photoprotection with broad-spectrum sunscreen and sun avoidance is advised, particularly in patients with higher Fitzpatrick skin types, to reduce post-inflammatory hyperpigmentation. A test peel is recommended during the initial consultation by applying the peel to a one square centimeter area in the postauricular region and observing the site for 15 to 20 minutes to assess immediate hypersensitivity. The area should then be re-evaluated after one week for any signs of erythema, desquamation, or crusting.

Only in the absence of adverse reactions should the patient proceed to full-face application.

On the day of the procedure, the skin should be gently cleansed and thoroughly degreased using alcohol or acetone to remove surface oils and ensure even distribution of the peeling agent.8,9,10 Mechanism of action Black Peel is a combination chemical peeling agent whose therapeutic effects arise from the synergistic pharmacologic activities of its ingredients: black acetic acid, salicylic acid (0.5%), tetrahydrojasmonic acid (6%), biosulfur (10%), and potassium iodide (0.1%). Black acetic acid, rich in organic minerals and amino acids, provides

potent antioxidant activity and modulates cutaneous microcirculation. Salicylic acid, a beta-hydroxy acid, exerts comedolytic, keratolytic, and anti-inflammatory effects by normalizing follicular keratinization and promoting epidermal exfoliation.

Tetrahydrojasmonic acid enhances epidermal turnover, attenuates inflammation, and contributes to pigmentary regulation.

Biosulfur offers keratolytic and antibacterial properties, facilitating desquamation and preventing bacterial colonization. Potassium iodide exhibits broad-spectrum antimicrobial activity and supports tissue repair and wound healing. Additionally, this combination inhibits tyrosinase activity, reducing melanogenesis and hyperpigmentation.

Its antioxidant properties confer photoprotection by neutralizing reactive oxygen species and mitigating oxidative cellular damage.8,9,10 Procedure After informed consent and proper skin priming, the face is cleansed and degreased to ensure uniform peel penetration.

Sensitive areas such as the inner canthi, nasolabial folds, and lips are protected with a barrier ointment. Black Peel is applied in a single uniform pass using gauze or a brush. The number of layers depends on the desired depth of keratocoagulation, with additional layers used cautiously in thicker or less responsive areas. As the peel is self-limiting, no neutralization is required.

It remains on the skin for 15 minutes before being rinsed off with water. Mild exfoliation

Black Peel: A Modern Therapeutic Approach for Inflammatory Acne

follows, improving pigmentation, texture, and overall skin 8,9,10 appearance.

Post-Procedure Care Post-procedure care includes immediate application of cold compresses to alleviate discomfort, followed by regular use of bland emollients and physical sunscreen. Gentle cleansing and moisturizing should be resumed after the first 24 hours and continued until complete reepithelialization.

Patients must be advised to avoid exfoliants, retinoids, and direct sun exposure until full skin recovery.8,9,10 Advantages of Black Peel include its multifaceted therapeutic effects and selflimiting nature, which simplifies the procedure. It is effective in treating mild to moderate acne, post-inflammatory hyperpigmentation, acne scars, and enlarged pores. The peel is well-tolerated with minimal side effects and requires minimal downtime, making it a convenient and efficient treatment option for patients.8,9,10 Discussion Acne vulgaris is a prevalent dermatologic condition affecting up to 100% of adolescents and an increasing number of adults, especially women.

High-glycemic diets exacerbate acne via insulin and IGF-1 pathways. Though chronic and psychologically distressing, acne is highly manageable with appropriate, evidencebased therapeutic interventions targeting its multifactorial 1 pathogenesis.

Chemical peeling is a versatile therapeutic modality widely utilized in dermatologic

practice for skin rejuvenation and treatment of various dermatoses, including acne vulgaris. The mechanism of chemical peeling is founded on the controlled induction of cutaneous injury analogous to chemical burns, which stimulates epidermal regeneration and dermal remodeling. Peels are categorized based on the depth of injury induced: superficial peels affect the epidermis exclusively; mediumdepth peels extend to the papillary dermis; and deep peels penetrate the mid-reticular dermis, occasionally reaching the subcutis if misapplied.

The depth of peeling is influenced by multiple factors, including the chemical agent used, its concentration, volume applied, mode and number of applications, patient skin type, integrity of the stratum corneum, and the dermatologic indication. Depth is cumulative and dose-dependent, with single applications producing superficial keratocoagulation, whereas multiple passes increase penetration depth.

Additionally, exposure time is inversely related to agent concentration; higher concentrations achieve target depth in shorter durations.10 Clinically, superficial chemical peels effectively reduce corneocyte cohesion, promote epidermal desquamation, and stimulate dermal collagen synthesis, resulting in improved skin texture and tone with minimal downtime and epidermal regeneration typically occurring within 3 to 5 days.

These peels are suitable for all Fitzpatrick skin types and are frequently utilized in the

management of mild acne and skin rejuvenation. Mediumdepth peels, which extend injury from the epidermis into the papillary dermis, are indicated for treatment of dyschromias, solar lentigines, actinic keratoses, superficial scars, and pigmentary disorders.

These peels necessitate longer healing times, generally around one week, and require stringent post-procedure photoprotection due to an elevated risk of transient post-inflammatory hyperpigmentation, especially in patients with higher Fitzpatrick skin phototypes. Deep chemical peels, commonly employing phenol in combination with croton oil, penetrate into the reticular dermis, inducing substantial collagen remodeling and providing marked clinical improvement in severe photoaging, deep rhytides, and atrophic scarring. However, deep peels are associated with increased risks, including prolonged epithelialization of up to two months, potential for scarring, pigmentary alterations, and systemic toxicity, thereby necessitating specialized patient monitoring.10 Emerging combination peels such as black peel have demonstrated increasing clinical interest. Unlike many conventional peels, black peel does not require neutralization, enhancing its safety and tolerability while reducing procedural time and associated expenses. It induces a gentle, invisible exfoliation process with minimal adverse effects and suitability across diverse skin types. Preliminary clinical data support its efficacy: Kim et al. reported significant January 2026

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Black Peel: A Modern Therapeutic Approach for Inflammatory Acne

reductions in acne severity following three sessions over six weeks, with 69% of patients achieving complete clearance and substantial improvement in inflammatory lesions. Similarly, Raj Kumar et al. demonstrated marked improvement in nodulocystic acne with repeated black peel applications, with over half of patients exhibiting excellent responses.8 Comparative evaluations suggest that black peel is similarly effective to 25% TCA peels in reducing acne lesion counts, with trends favouring black peel for inflammatory

lesions and TCA peel for non-inflammatory lesions. Furthermore, black peel is associated with fewer adverse effects such as burning, stinging, erythema, and post-peel dryness, enhancing patient comfort and compliance. Black peel represents a promising, multifaceted, safe, and cost-effective chemical peeling agent.8 Conclusion Black peel represents an effective adjunctive modality in acne therapy, demonstrating significant improvements in lesion clearance, pigmentary modulation, and skin surface quality. Its formulation allows for a controlled therapeutic effect that is welltolerated across varied skin types, minimizing adverse reactions and recovery time. These characteristics underscore its adaptability and broad applicability within dermatologic practice. However, further rigorous investigations are necessary to refine treatment protocols and confirm sustained clinical benefits relative to conventional acne treatments.

References 1. Vasam M, Korutla S, Bohara RA. Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochem Biophys Rep. 2023; 36:101578. Published 2023 Nov 23. doi:10.1016/j.bbrep.2023.101578

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Comparison of Two Assessment Methods.

Clin Cosmet Investig Dermatol. 2020; 13:711-716. Published 2020 Sep 28. doi:10.2147/CCID.S266320

2. Sutaria AH, Masood S, Saleh HM, Schlessinger J. Acne Vulgaris. In: StatPearls.

Treasure Island (FL): StatPearls Publishing; August 17, 2023.

5. Choi CW, Choi JW, Park KC, Youn SW. Facial sebum affects the development of acne, especially the distribution of inflammatory acne. J Eur Acad Dermatol Venereol.

2013; 27(3):301-306. doi:10.1111/j.1468-3083.2011.04384.x

3. Gold MH, Bhatia A, Kaur A, Doucette M, Kothare A. Picture-based acne lesion counts: A validation study to assess accuracy and reliability of acne lesion counts via photography. J Cosmet Dermatol.

2022; 21(12):6965-6975. doi:10.1111/jocd.15413

6. Borzyszkowska D, Niedzielska M, Kozłowski M, et al. Evaluation of Hormonal Factors in Acne Vulgaris and the Course of Acne Vulgaris Treatment with ContraceptiveBased Therapies in Young Adult Women.

Cells. 2022; 11(24):4078. Published 2022 Dec 16. Doi: 10.3390/cells11244078.

4. Alsulaimani H, Kokandi A, Khawandanh S, Hamad R. Severity of Acne Vulgaris:

7. Bae IH, Kwak JH, Na CH, Kim MS, Shin BS, Choi H. A Comprehensive Review

January 2026

of the Acne Grading Scale in 2023.

Ann Dermatol. 2024; 36(2):65-73. doi:10.5021/ad.23.094.

8. Puri N, Kumar S, Kaur S, Brar BK. Comparative evaluation of therapeutic efficacy and safety of black peel versus 25% trichloroacetic acid peel in mild to moderate acne vulgaris: a split face study.

J Cutan Aesthet Surg. 2024; 17(1):11-18. doi:10.4103/JCAS.JCAS_69_23.

9. Elghblawi E. Black peel in facial dermatoses. J Cosmet Dermatol. 2018; 17(3):398-402. doi:10.1111/jocd.12388.

10. Soleymani T, Lanoue J, Rahman Z. A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. J Clin Aesthet Dermatol. 2018; 11(8):21-28.

January 2026

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January 2026

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