Ablative fractional CO₂ laser is an established tool for dermatologic and aesthetic indications. Non-ablative wavelengths, such as 1540 and 1570 nm, are increasingly being combined with CO₂ laser to optimise the results while reducing the recovery time. A narrative review of the literature was conducted, including ex vivo, in vivo, and in vitro studies, as well as human clinical trials that evaluated the efficacy, safety, and histological impact of dual-laser systems. Preclinical studies have shown that sequential application of fractional CO₂ followed by 1540/1570 nm expands the thermal coagulation zone without increasing the ablation depth. At the histological level, the dual protocol promotes collagen remodelling with greater thermal precision. On a clinical level, a combined treatment has shown efficacy in improving scars, striae distensae, skin laxity, and wrinkles, with reduced recovery times compared to CO₂ monotherapy. Preliminary data also suggest potential benefits in inflammatory conditions such as hidradenitis suppurativa. The sequential CO₂ + 1540/1570 nm combination represents an effective and well-tolerated approach in regenerative dermatology. Current evidence supports its use as a versatile, safe, and reproducible technique for skin rejuvenation and scar modulation; however, further comparative studies are needed to standardise protocols.

Laser-assisted exosome delivery (LAED) combines ablative fractional lasers with immediate topical application of exosomes. Here, we introduce the LAED concept and report two uncontrolled feasibility observations: a 62-year-old man with atrophic acne scars and a 68-year-old woman with diffuse dyschromia underwent fractional CO₂ laser treatment followed by topical exosomes. Both cases showed early, encouraging signals of clinical improvement and shorter downtime, with good tolerability. An exploratory day-7 patient self-evaluation using a 5-point Likert scale for speed/comfort of recovery yielded 5/5 in both cases. Given the two-case, non-comparative design, causality cannot be inferred, and efficacy remains hypothesis-generating. These preliminary findings motivate controlled trials with standardized objective and patient-reported measures and longer follow-up to determine whether LAED truly enhances the cosmetic benefits of fractional laser treatment.

Skin scars represent a complex therapeutic challenge, with significant functional, aesthetic, and psychological implications. Despite advances in laser therapy, monotherapy has significant limitations, particularly for patients with complex scars with atrophic, hypertrophic, vascular, and pigmentary components. The combined use of multiple laser sources, in sequential or simultaneous mode, allows for the selective targeting of specific tissue components and improves clinical efficacy while maintaining a good safety profile. This narrative review critically analyses the available evidence on combination therapies for atrophic, hypertrophic, keloid, and post-surgical and burn scars. Protocols combining ablative lasers (CO₂, Er:YAG), non-ablative lasers (1540–1550 nm), vascular lasers (PDL, Nd:YAG) and intense pulsed light (IPL) are reported. Possible integrations with adjuvant techniques, such as radiofrequency, platelet-rich plasma (PRP), and laser-assisted drug delivery, are also mentioned as areas for future development. The available data suggest a promising role for multimodal strategies, but the literature remains limited by small cohorts, heterogeneous protocols, and short follow-up periods. Although adverse events are generally mild and transient, typically involving erythema, oedema, or temporary dyschromia, an awareness of safety considerations remains essential, particularly in higher phototypes and when using ablative modalities. Further prospective and multicentre studies are needed to define standardised protocols and consolidate the role of combination therapies in the management of scars.

Background: Acne vulgaris is a multifactorial disease with significant clinical and psychosocial impacts. Methods: The purpose of this study was to evaluate the efficacy of a combination therapy including oral isotretinoin and a non-ablative 675 nm red-light laser compared with laser monotherapy. Thirteen young patients with active facial acne of varying severity were enrolled and divided into two groups: Seven subjects received laser monotherapy treatment (RT group), while six underwent combined laser and isotretinoin therapy (RTI group). The laser protocol consisted of six weekly sessions, with a 5-point pain scale used to monitor tolerability. Standardized photographs were obtained at baseline and at a 3-month follow-up after the last treatment. Each patient completed the Acne Radar Questionnaire, and lesion severity was assessed using the Global Evaluation Acne (GEA) scale. Results: All patients completed the study without adverse events. Scores from the Acne Radar Questionnaire improved in both groups, while the GEA scale demonstrated a significant reduction in lesion severity, confirmed by photographic comparison. Pain was reported as mild in most cases, and no discontinuations occurred. Conclusions: These findings indicate that the 675 nm laser is a safe and effective therapeutic option for acne vulgaris, with isotretinoin addition resulting in more rapid and pronounced clinical improvement.

Background: Keloids are fibroproliferative scars with a prominent vascular component, and pulsed dye laser (PDL) is an established treatment, but objective imaging biomarkers of response are lacking. Objective: To evaluate whether dynamic optical coherence tomography (D-OCT) can provide quantitative, depth-resolved monitoring of keloid vascular remodeling under PDL and to explore candidate metrics for hypothesis-generating assessment in future studies. Methods: We conducted a prospective single-case pilot, hypothesis-generating study of a thoracic keloid treated with three sessions of 595 nm PDL, acquiring D-OCT scans at baseline and approximately 30, 60, and 90 days over a standardized 4 × 4 mm region of interest at 0.15, 0.30, and 0.50 mm depths. Primary D-OCT metrics included vascular en-face area, vessel length density, junction density, and mean vessel caliber. Results: The superficial layer (0.15 mm) showed an almost complete collapse of vascular signal (area −88% vs. baseline), the intermediate layer at 0.30 mm exhibited a sustained ~39% reduction in vascular area with parallel decreases in length and caliber at stable branching, and the deep layer at 0.50 mm showed modest area changes with longer but thinner vessels. These depth-resolved changes were consistent with clinical improvement in Vancouver Scar Scale and POSAS scores. Conclusions: D-OCT yielded quantitative, clinically interpretable vascular metrics that align with the expected effects of PDL in this single patient. In this patient, the percentage reduction in vascular area at 0.30 mm by week 8 emerged as a candidate quantitative metric for response monitoring; thresholds in the order of ≥25% could be tested prospectively as hypothesis-generating cut-offs in future controlled and reliability-tested studies, but are not proposed here as validated clinical criteria.

Background and Objectives: Melasma, a hypermelanotic dermatologic condition that mainly affects women, poses challenges due to its complex etiology involving environmental and genetic factors. Its pathophysiology, marked by intricate histological changes, is not fully understood. This study explored the efficacy and safety of a new 785 nm picosecond laser in treating facial melasma. Materials and Methods: An 11-participant cohort, comprising women with Fitzpatrick phototypes II-III, underwent a treatment protocol with a new 785 nm picosecond laser. The clinical evaluation used the Global Aesthetic International Score (GAIS) and the Five-Point Likert Scale Questionnaire. The aim of the study was to understand the capacity of the 785 nm wavelength laser to interact with both the pigmentary and vascular components of melasma. Results: The GAIS outcomes revealed excellent (18.2%), good (54.5%), poor (18.2%), and no results (9.1%). The Likert Scale responses varied from very satisfied (18.2%) to slightly satisfied (9.1%). Clinical images at three months demonstrated resolution of melasma with no adverse events. Conclusions: This non-invasive procedure showed positive outcomes and high patient tolerance, emphasizing its potential in melasma management. However, in order to fully understand the interactions of pigmentary and vascular components with the 785 nm wavelength laser, further research is required. The small cohort represents a limitation for this study, therefore studies that include a larger number of patients are needed to assess the effectiveness of this laser treatment for facial melasma.