Palabras clave
arrugas
laxitud
láser CO₂ fraccionado
exosomas
rejuvenecimiento
SLEB
Cómo citar
Resumen
El cuello desempeña un papel clave en la percepción estética del envejecimiento, lo que ha incrementado la demanda de intervenciones no invasivas para su rejuvenecimiento. Este estudio evaluó la eficacia del láser CO₂ fraccionado, aplicado como monoterapia y en combinación con exosomas sintéticos derivados de células madre vegetales, en pacientes con laxitud cutánea y arrugas cervicales. Se incluyeron 14 mujeres (28 hemicuellos), con edades entre 35 y 58 años, predominantemente fototipo III (78,6%). La mayoría presentaba laxitud moderada (85,7%) y arrugas de severidad media (71,4%), según las escalas IBSA y Fitzpatrick Wrinkle Classification Scale (FWCS), respectivamente. Se aplicaron tres sesiones de láser CO₂ fraccionado en todo el cuello. Posteriormente, se administraron exosomas en el hemicuello izquierdo y solución salina como placebo en el derecho. Ambos protocolos mostraron mejoras significativas (p < 0,05) en la reducción de laxitud y arrugas, siendo más pronunciadas en la terapia combinada. La ecografía evidenció aumento del grosor dérmico y reducción del SLEB, con significancia estadística en el hemicuello tratado con láser y exosomas. La satisfacción del paciente fue mayor en el tratamiento combinado. En conclusión, la combinación de láser CO₂ fraccionado con exosomas representa una alternativa segura, eficaz y bien tolerada para el rejuvenecimiento cutáneo del cuello
Citas
1. Yaar M, Gilchrest BA. Aging of skin. In: Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008.
2. Khavkin J, Ellis DAF. Aging skin: histology, physiology, and pathology. Facial Plast Surg Clin North Am. 2011;19(2):229–34.
3. Tan SL, Brandt MG, Yeung JC, Doyle PC, Moore CC. The aesthetic unit principle of facial aging. JAMA Facial Plast Surg. 2015;17(1):33–8.
4. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthetic Surg J. 2006;26(1 Suppl):S4–9.
5. Fisher GJ, Varani J, Voorhees JJ. Looking older: fibroblast collapse and implications. Arch Dermatol. 2008;144(5):666–72.
6. Tchkonia T, Morbeck DE, Von Zglinicki T, Van Deursen J, Lustgarten J, Scrable H, et al. Fat tissue, aging, and cellular senescence. Aging Cell. 2010;9(5):667–84.
7. Rivera Z, Rivera I, Ollarves V, Lugo DA, Hagel I. Aspectos moleculares del envejecimiento cutáneo. Dermatol Venez. 2021;59(2):16–26. Available from: https://revista.svderma.org/index.php/ojs/article/view/1494
8. Duncan DI. The future of skin tightening: mechanical or biological? Dermatol Rev. 2020;1(4):128–37.
9. Gold MH. Noninvasive skin tightening treatment. J Clin Aesthet Dermatol. 2015;8(6):14–8.
10. Ziai K, Wright HV. Carbon dioxide laser rejuvenation of the facial skin. Clin Plast Surg. 2023;50(3):421–36.
11. Oran A, Akkaya AD. Evaluation of fractional CO₂ laser treatment for neck rejuvenation: clinical and ultrasound-based assessment. J Cosmet Laser Ther. 2020;22(3–4):157–63.
12. Tierney EP, Hanke CW. Ablative fractionated CO₂ laser treatment in the aging neck: evaluation of clinical efficacy and safety. Dermatol Surg. 2011;37(4):489–500.
13. Orringer JS, Kang S, Johnson TM, Karimipour DJ, Lee J, Chung JH, et al. Connective tissue remodeling induced by carbon dioxide laser resurfacing in photodamaged human skin. Arch Dermatol. 2004;140(11):1326–32.
14. Park JH, Lee JH, Lee Y, Kim JY, Lee JH. Clinical efficacy of exosomes derived from human adipose stem cells in skin rejuvenation using microneedling. Dermatol Ther. 2021;34(1):e14687.
15. Proffer TJ, Saini R, McDaniel DH. Topical exosome therapy for skin rejuvenation: a pilot study. J Drugs Dermatol. 2022;21(5):510–6.
16. Jo YJ, Kim JH, Lee J, Park JH. Effects of topical exosomes derived from Lactobacillus plantarum on skin aging: a randomized controlled trial. Int J Mol Sci. 2022;23(9):4567.
17. Lee J, Kim H, Park J, Choi Y. Ultrasonographic markers of skin aging: SLEB and dermal thickness correlation with age. Skin Res Technol. 2020;26(6):870–7.
18. Zhang Y, Wang Y, Li X, Zhang J. Dermal remodeling and SLEB reduction after fractional laser therapy: a prospective study. Lasers Med Sci. 2021;36(4):789–96.
19. Chen Y, Zhao Y, Li X, Wang Y. Exosome-mediated rejuvenation of aged skin: mechanisms and clinical applications. Stem Cell Res Ther. 2022;13(1):45.
20. Zhao Y, Li X, Zhang Y, Wang Y. Exosomes in skin aging and rejuvenation: therapeutic potential and mechanisms. J Cell Mol Med. 2023;27(2):e12345.
21. Manzini JL. Declaración de Helsinki: principios éticos para la investigación médica. Acta Bioeth. 2000;6(2):321–34. Available from: https://doi.org/10.4067/s1726-569x2000000200010
22. Tateo A, Siquier-Dameto G, Artzi O, Humzah D, Molina B, Jain R, et al. IBSA photographic scale for neck laxity. Clin Cosmet Investig Dermatol. 2021;14:349–54.
23. Fitzpatrick R, Geronemus R, Goldberg D, Kaminer M, Kilmer S, Ruiz-Esparza J. Noninvasive radiofrequency for periorbital tightening. Lasers Surg Med. 2003;33(4):232–42.
24. Kim E, Cho G, Won NG, Cho J. Age-related changes in skin biomechanics: neck vs cheek and forearm. Skin Res Technol. 2013;19(3):236–41.
25. Roberts WE, Cheng T. Neck aging and rejuvenation: a balanced approach. Dermatol Rev. 2024;5(3).
26. Haykal D, Cartier H, Goldberg D, Gold M. Advancements in laser technologies for skin rejuvenation. J Cosmet Dermatol. 2024.
27. Kwon HH, Yang SH, Lee J, Park BC, Park KY, Jung JY, et al. Combination treatment with exosomes and fractional CO₂ laser for acne scars. Acta Derm Venereol. 2020;100(18):1–8.
28. Bai G, Truong TM, Pathak GN, Benoit L, Rao B. Clinical applications of exosomes in cosmetic dermatology. Skin Health Dis. 2024.
29. Surg GCJ. The utilization of human placental mesenchymal stem cell derived exosomes in aging skin. J Surg. 2021. Available from: https://exosomes.com/wp-content/uploads/2021/04/JSUR-1388-2.pdf
30. Wang WM, Wu C, Jin HZ. Exosomes in chronic inflammatory skin diseases and skin tumors. Exp Dermatol. 2019;28(3):213–8.
31. Kim YJ, Yoo SM, Park HH, Lim HJ, Kim YL, Lee S, et al. Exosomes from umbilical cord blood mesenchymal stem cells stimulate skin rejuvenation. Biochem Biophys Res Commun. 2017;493(2):1102–8.
32. Zhou Y, Seo J, Tu S, Nanmo A, Kageyama T, Fukuda J. Exosomes for hair growth and regeneration. J Biosci Bioeng. 2024;137(1):1–8.
33. Shin KO, Ha DH, Kim JO, Crumrine DA, Meyer JM, Wakefield JS, et al. Exosomes from human adipose tissue-derived mesenchymal stem cells promote epidermal barrier repair. Cells. 2020;9(3):680.
34. Zhang KL, Wang YJ, Sun J, Zhou J, Xing C, Huang G, et al. Artificial chimeric exosomes for anti-phagocytosis and targeted cancer therapy. Chem Sci. 2019;10(5):1555–61.
35. Olumesi KR, Goldberg DJ. A review of exosomes and their application in cutaneous medical aesthetics. J Cosmet Dermatol. 2023;22(10):2628–34.
36. Alcolea López M, Hernández Torres M, Trelles MA. Láseres ablativos fraccionales en patología dermoestética. Rev Cient SEME. 2022;71:3–14. Available from: https://www.seme.org/revista/palabras-clave/laser-co2
37. Criado A, Ortiz Quevedo A. Láser fraccionado de CO₂, exosomas y la combinación de ambos en el tratamiento de cicatrices atróficas de acné. Rev Iberoam Láser Médico. 2024;4(1). Available from: https://rilmed.ailmed.org/index.php/rilmed/article/view/34
38. Nguyen ST. Exosomes derived from mesenchymal stem cells: A novel agent for skin aging treatment. Biomed Res Ther [Internet]. 2024 [cited 2025 Mar 24];11(12):7003–14. Available from: http://bmrat.com/index.php/BMRAT/article/view/946
39. Ma D, Wu Z, Zhao X, Zhu X, An Q, Wang Y, et al. Immunomodulatory effects of umbilical mesenchymal stem cell-derived exosomes on CD4+ T cells in patients with primary Sjögren’s syndrome. Inflammopharmacology [Internet]. 2023 [cited 2025 Mar 24];31(4):1823–38. Available from: https://link.springer.com/article/10.1007/s10787-023-01189-x
40. 4Zhang L, Ouyang P, He G, Wang X, Song D, Yang Y, et al. Exosomes from microRNA-126 overexpressing mesenchymal stem cells promote angiogenesis by targeting the PIK3R2-mediated PI3K/Akt signalling pathway. J Cell Mol Med [Internet]. 2021 [cited 2025 Mar 24];25(4):2148–62. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.16192
41. Hunzeker CM, Weiss ET, Geronemus RG. Fractionated CO2 Laser Resurfacing: Our Experience With More Than 2000 Treatments. Aesthetic Surg J [Internet]. 2009 [cited 2025 Mar 24];29(4):317–22. Available from: https://academic.oup.com/asj/article-abstract/29/4/317/191937
42. 4Avram MM, Tope WD, Yu T, Szachowicz E, Nelson JS. Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing. Lasers Surg Med [Internet]. 2009 [cited 2025 Mar 24];41(3):185–8. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/lsm.20755
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Derechos de autor 2025 Revista Iberoaméricana de Láser Médico