Background and aims: Many patients look for procedures that can achieve similar results to surgical lift avoiding the risks and possible complications of surgery. Endolift® and multi-wavelength (MW) Laser photobiomodulation (PBM) are considered two of the most effective procedures in the treatment of skin laxity and superficial wrinkles. We aimed to investigate the reduction of skin laxity of the lower third of the face treated with the Endolift® technique alone or in combination with MW Laser PBM. Materials and Methods: From June 2016 to June 2018, 96 subjects (18 M; 78 F) were included in this randomized controlled trial (RCT) conducted in two Italian institutions. The area treated was the lower third of the face. The subjects were classified using the Ptosis Scale (grade I-V) at T0, with a Pinch Test <1.9 mm. We selected only subjects’ grade 4, both males and females, 45-55-years old. Thirty-two subjects (6M; 26F) (group 1) were treated with the Endolift® procedure followed by a session of MW Laser PBM using a simultaneous nonsurgical laser therapy emission of three different wavelengths (532 nm, 808 nm, 1064 nm). The MW Laser PBM was repeated after 7, 14 and 21 days. Thirty-two subjects (6M; 26F) (group 2) underwent only the Endolift® session. 32 subjects (6M; 26F) (group 3) received only MW Laser PBM. Follow up visits were performed at days 60 (T60), 120 (T120) and 540 (T540) after the treatments. The study ended in December 2019 when all the subjects had been followed for 18 months. Results: The results of the three groups were evaluated using the Ptosis Scale at T0, T60, T120 and T540. The combination of the two treatments (group 1) achieved more rapid effects, while MW Laser PBM alone treatment (group 3) achieved the slowest effect. The median test for independent samples showed that all the differences between groups are statistically significant at each follow-up (p=0.000). Conclusions: The Endolift® laser in the last 15 years allows to achieve exceptional results in the treatment of skin laxity reaching the desired ‘soft’ rejuvenation model which is increasingly desired. MW Laser PBM, in combination with Endolift®, obtains better results. Although significant at T540, the effects of MW Laser PBM alone are slower to reach.

Lasers and others energy-based devices have reached very high levels of results. Although the area of the lower eyelids is one of the most difficult to treat without surgery, Endolift® represents one of the safest and effective techniques that we can offer. Endolift® procedure was performed with a 200 microns second-generation bare fiber connected to an Italian 1470nm semiconductor laser to treat the lower eyelids of a 43-year-old patient with wrinkles and skin laxity. No anesthesia was required. The fiber was easily inserted through the skin, without any incisions, directly between the orbicularis oculi muscle and the septum. The total laser energy delivered was 80 J for each side. Post-procedure the patient immediately resumed her daily activities. Snap Back test was performed before (T0) and 6 months (T1) after the procedure; Fitzpatrick “wrinkle score” and “degree of elastosis” were assessed at T0 and T1; investigator Global Aesthetic Improvement scale (iGAIS), external investigator Global Aesthetic Improvement scale (eiGAIS) and participant Global Aesthetic Improvement scale (pGAIS) were also recorded at T1. The treatment has been completed with a session of a vascular 532nm diode laser for treating the fine telangiectasias, immediately before the Endolift® procedure. The lower eyelids have benefited from the possibility that the Endolift® has to remodel and retract the tissues, activate the collagen production, and stimulate the neo-angiogenesis. Results are evaluated at T1, when the skin laxity is reduced and superficial wrinkles are smoothed, resulting in an overall compacting of the skin which is visible and continues to progress over the following months. The only adverse events recorded were redness for 3 hours and a light swelling for 2 days. Snap Back test at T0 was severe and negative at T1; at T0 wrinkle score” was II and Fitzpatrick “degree of elastosis” was 7-9 but at T1 Fitzpatrick “wrinkle score” was I and Fitzpatrick “degree of elastosis” was 1-3; iGAIS, eiGAIS and pGAIS at T1 were all +3. Endolift® can currently be considered one of the leading non-surgical treatments for the laxity of lower eyelids.

Background: Skin biorevitalization involves multiple intradermal injections to enhance skin quality, but precise dermal targeting can be challenging due to variations in skin thickness smaller, less painful needles with fewer skin reactions are attractive options.Aims: This study evaluates a new Micro‐Needle device's performance and safety in comparison with the classic needle used in skin biorevitalization.Patients/Methods: Subjects with facial and neck skin aging were enrolled. Safety outcomes, including immediate and local tolerability, were assessed. Performance outcomes measured skin radiance, wrinkles and photoaging grade, hydration, subepidermal low echogenic band, dermis thickness, and skin elasticity. Both subjects and investigators recorded Global Aesthetic Improvement Scale scores.Results: Micro‐Needle injections demonstrated superior performance compared to the classic needle, influenced by the specific skin zones and thickness. Micro‐Needle was superior for skin wrinkles at D49 for periorbital zone and nasolabial folds by −14.5% (p = 0.01) and −15% (p = 0.004), respectively, and for neck by 9.6% (p = 0.0008). The Nanosoft device showed a faster improvement for skin hydration at D42 for the cheek zone (p = 0.04) and at D75 for the neck area (p = 0.01); and for skin radiance at D75 (p = 0.03) and at D120 (p = 0.0098). Ex vivo studies confirmed the Micro‐Needle's accuracy in product placement in the dermis. Adverse events were milder with Micro‐Needle and no serious adverse events occurred.Conclusions: Both needles significantly improved skin quality, but Micro‐Needle enhanced the outcomes of skin biorevitalization procedures, particularly in terms of skin wrinkle reduction, elasticity, and overall skin hydration.

Background. An inflammatory foreign-body reaction and the neosynthesis of collagen and the extracellular matrix through injectable collagen stimulators have coexisted since the introduction of the first sterile water-reconstituted poly-L-lactic acid (PLLA) formulation around the turn of the century. The PLLA-LASYNPRO™ microspheres for subdermal implants are a groundbreaking technological advancement that challenges the foreign-body reaction paradigm. The concept of non-inflammatory collagen and extracellular matrix regeneration, along with the initial insights into the rationale and role of the new-technology subdermal implants in aesthetic and regenerative medicine, was central to the discussions among thirteen distinguished experts in micro-invasive aesthetic medicine, aesthetic plastic surgery, and dermatology. This document summarizes their conclusions regarding the PLLA-LASYNPRO™ concept—subdermal microsphere implants designed to facilitate collagen and extracellular matrix regeneration while negligibly triggering persistent inflammation. Additionally, it offers preliminary yet authoritative suggestions from the board for the safe and effective use of the novel JULÄINE™ medical device based on the new-technology microspheres. Methods. An online survey of the experts, preceded by a board discussion in Milan, Italy, focused on skin regeneration and the rationale for the new PLLA technology, drawing on the board experts’ direct experience. The topics surveyed included the anticipated benefits of the new JULÄINE™ medical device and some initial suggestions for its safe and effective use. Results and Conclusions. This document outlines the board’s considerations regarding the shift, driven by the innovative PLLA-LASYNPRO™ ingredient and the CE-approved JULÄINE™ medical device, from the historically dominant FBR paradigm to a new strategy focusing on non-inflammatory collagen and extracellular matrix regeneration. Additionally, it presents practical, albeit preliminary, suggestions based on current clinical research for utilizing the new JULÄINE™ medical device and reaping its anticipated benefits.

Background: Treatment of the lower face with botulinum toxin type A (BoNT-A) is particularly challenging because of the important functional roles of the involved muscles, which increases the risk of adverse events and complications. Methods: To address this issue, a panel of 14 experts conducted a three-round consensus study, including digital surveys and a formal meeting, on the aesthetic treatment of the mentalis (MT), depressor anguli oris (DAO), and platysma (PL) muscles using BoNT-A. The study was complemented by a literature review of 16 international consensus papers published between 2004 and 2024. Results: The primary indications for MT treatment that achieved strong consensus were “peau d’orange” (“golf ball”) chin appearance and hyperactivity. The Italian panel recommended a mean total dose of 8 U (distributed bilaterally), which was higher than the international mean dose of 6.5 U. The preferred injection technique consisted of a combination of intramuscular and intradermal injections. For the DAO, the strongest indication was correction of downturned oral commissures. Both the Italian panel and the international consensus reported a mean total dose of 5.6 U. Most experts (92.8%) preferred intramuscular injections, typically administered at a single injection point lateral to the marionette line in order to remain within a safe treatment zone and avoid diffusion to the depressor labii inferioris muscle. Indications for PL treatment included platysmal bands, jawline recontouring, and improvement of skin texture. The techniques discussed included treatment of both platysmal bands and the jawline. The consensus panel recommended a significantly higher mean total dose (48.4 U) than the international average (38.2 U). The paper also highlights the growing importance of ultrasound imaging as a tool for identifying individual anatomical variations in the lower facial musculature. Conclusions: As the demand for lower face rejuvenation continues to increase, standardized injection techniques and the integration of ultrasound imaging are essential for minimizing functional complications and optimizing aesthetic outcomes.

Background: Hyaluronic acid (HA) hydrogels are the most widely used injectable fillers for facial rejuvenation. A new generation of HA fillers crosslinked with poly(ethylene glycol) diglycidyl ether (PEGDE) has been developed to enhance cohesiveness, tissue integration, stability, and longevity while minimizing swelling and immunogenicity. Owing to their distinct viscoelastic properties, PEGDE-crosslinked HA fillers may require product-specific selection and adapted injection techniques. Objective: The objective of this study is to provide practical, expert-based recommendations for the safe and effective use of PEGDE-crosslinked HA hydrogels in facial aesthetic treatments. Methods: A multidisciplinary panel of nine Italian experts in aesthetic medicine, each with more than 15 years of experience using HA fillers, developed consensus recommendations based on clinical practice and available evidence. A pre-meeting questionnaire informed structured discussions during a face-to-face meeting held in Paris in January 2024. The nominal group technique was applied, with consensus defined as agreement by at least 80% of panel members. Results: Consensus was reached on product selection, injection planes, delivery devices, techniques, and typical treatment volumes for PEGDE-HA hydrogels across multiple facial regions, including the forehead, temples, midface, nasolabial folds, chin, jawline, and lips. Recommended injection techniques included microbolus, macrobolus, and retrograde linear threading, with placement ranging from superficial subcutaneous to supraperiosteal planes depending on the anatomical area and clinical indication. Typical injection volumes generally ranged from 0.1 to 0.5 mL per side. Optional ultrasound mapping was considered beneficial in selected high-risk or superficial procedures to improve anatomical safety. Conclusions: These expert consensus recommendations provide practical guidance for clinicians using PEGDE-crosslinked HA hydrogels in facial rejuvenation. Tailoring product characteristics to injection depth, technique, and regional anatomy may help optimize clinical outcomes and procedural safety. Future research priorities include prospective comparative studies with other crosslinking technologies, standardized reporting of adverse events, long-term outcome registries, and further evaluation of ultrasound-guided injection strategies.