INTRODUCTION
According to the American Society of Plastic Surgeons, nonsurgical cosmetic procedures accounted for over 15 million cosmetic procedures performed in the United States in 2018.1 In addition, Google searches for awareness of anti-aging and skin resurfacing procedures have seen a rise.2 These procedures aim to combat the inevitable problem of skin aging and help to promote skin rejuvenation.
Skin aging is a natural process that results from a build-up of oxidative stress and cumulative DNA damage, which result in increased skin laxity, wrinkling, xerosis, abnormal pigmentation, and dullness.3 Skin aging occurs due to both intrinsic and extrinsic factors. Intrinsic aging is a product of chronological age and genetic and hormonal factors.3 On the other hand, extrinsic aging is primarily a product of ultraviolet (UV) radiation, environmental chemicals, toxins, pollutants, diet, and comorbid illnesses.3 In addition, with age, there is a natural decline in skin lipids such as fatty acids and ceramides, putting older individuals at risk of dry skin and xerosis.3
Skin Rejuvenation Using Energy-Based Devices (Lasers and Microneedling with Radiofrequency (MRF))
Since the invention of selective photo-thermolysis in the early 1980s, lasers and other energy-based technologies have transformed the field of cosmetic dermatology and anti-aging medicine.4 There are a variety of energy-based devices (EBD) that exist for skin rejuvenation, scar revision, collagen tightening, and correction of dyspigmentation.4 Laser resurfacing produces controlled skin injury to stimulate wound healing and collagen remodeling, which results in skin rejuvenation. EBD treatment falls into 2 categories: ablative and non-ablative laser skin resurfacing.4
Ablative laser skin resurfacing can be achieved using high-energy CO2 or erbium lasers that target water in tissue, causing vaporization of the entire epidermis and partial dermis.4 These lasers are used to treat facial rhytids, atrophic scars, and various epidermal/dermal lesions by thermally ablating and vaporizing the epidermis and heating the dermis to tighten the skin bed.4 While ablative lasers provide the best clinical outcomes in a