Lamina (Laser, Microneedling, Nanofat) Facial Rejuvenation: A Novel Treatment Protocol with Concomitant CO2 Laser, Microneedling, and Nanofat for Aesthetic Facial Rejuvenation
While skin resurfacing with lasers has been a mainstay of facial rejuvenation for decades, advances in regenerative medicine are rapidly changing the norm in facial rejuvenation. Multiple studies have shown promise in utilizing some form of progenitor cells in cosmetic treatment protocols of the face. Result from these studies have shown a decreased inflammatory reaction with reversal of skin aging in the reticular and papillary dermis. The efficacy of laser treatments has been offset by the prolonged healing time and significant discomfort during recovery. We hypothesized that immediately following CO2 laser treatment application of nanofat with microneedling creating opened channels to the reticular dermis through which the nanofat may improve analgesia and wound healing. Here we present a case series evaluating the impact of this combined approach on patient recovery and wound healing.
Methods/Technique
:All patients were treated by the senior author with CO2 laser delivered in two applications. The first treatment was performed in DP setting (25 watts, 1000 microseconds dwell time, 500 micrometers spacing, for 13% coverage). This was performed in the area with the deepest rhytids along the upper and lower lip. The subsequent second treatment, was in HP setting (3.5 watts, 0 spacing, for 78% coverage). Immediately thereafter, the patient underwent microneedling with depth set to 2mm, with an endpoint of pinpoint bleeding. The treated areas then underwent topical application of 3cc of harvested nanofat. This was isolated from a macrofat harvest through sequentially smaller connectors and subsequent separation through a Nanofilter to achieve a maximum 500 micron size. The nanofat was then microneedled into the surface. Patient characteristics, procedural details and outcomes were examined. Follow up visits and/or phone calls were performed at Post-op day 3 and 6. Patients were also asked when they felt they had a “full recovery” from the LaMiNa treatment , meaning they felt comfortable in going in public as they would prior to the procedure.
Results/Complications
:10 patients underwent the described treatment. The mean age was 62.9 years (range 58–75), and mean BMI was 22.8 (range 18.8-30.6). No patients experienced rash/herpetic outbreak; 1 patient with a history of cold sores was given prophylactic antiviral medication. All patients reported a 0 pain score (on a scale of 1–10) immediate after the procedure, as well as on Day 3 and Day 6. A full recovery was reported on average by 5.3 days.
Conclusion
:Addition of topical biologics to the wound bed immediately following combined CO2 laser and microneedling resulted in a relatively painless recovery and accelerated wound healing. Biologic additions to multiple facial rejuvenation techniques have been described in recent literature. None of these, however, have utilized the three phase approach that the LaMiNa treatment protocol does. Attempts to apply biologicals either topically or by intradermal injection have resulted in either poor dermal penetration or non-uniform distribution. The microneedling of the nanofat creates thousands of new pathways into the reticular dermis for all of the regenerative factors from the adipose derived stromal vascular fraction. By decreasing the acute and sub-acute pain of facial rejuvenation this approach provides a comfortable experience and technically optimal outcome for patients undergoing facial rejuvenation.