INTRODUCTION
Non-invasive rejuvenation with technology devices, or energy based devices (EBDs), has become standard in many offices. We need to examine the evidence-based medicine behind this increasing technology, to make sure that we are dealing with fact over fiction, with reproducibility over one great case, and making the technology legitimate while demanding to learn the safety of these devices along with their efficacies. We need to be assured that our patients are taken care of, and that utilizing this technology will improve their well-being. This article will review some of the exciting new technological advances with EBDs. We have been using intense pulsed light (IPL) sources for many years. Originally designed to treat vascular lesions, we soon learned that they are effective for other indications as well, including hair removal and pigmentary concerns. Soon we learned that collagen and elastin changes occurred with their use and this led to the term photorejuvenation being coined, which has become common term among laser surgeons. In 2000, Biter1 reported on the use of IPL over a period of time to affect textural changes in the skin along with improving the reds and browns and even pores in the skin. In 2015, Ping et al2 published their ndings in a retrospective analysis of the long-term effects of using an IPL over time in a group of Chinese patients. Their group in Foshan, China has treated over 5300 patients with the IPL and studied the rst 2354 patients who received treatment to examine the clinical facial features that occurred over time. Each patient was required to have received at least three IPL treatments to be included in the analysis and most of the patients who were studied had yearly IPL treatments as well. Clinical photographs were taken yearly during the 12 years of follow-up in this group of patients, and an independent panel studied the effects seen. The results showed that there was an effective rate between 88.24% and 96.45% in the study participants for improving signs of photodamage and for the rejuvenation of the skin. It is the single largest clinical evaluation in IPL history and as shown in Figure 1, has had and will have profound effects on our patients. Fractional skin resurfacing has also gained popularity all over the world. Whether we are using ablative fractional lasers or non-ablative fractional lasers, we have seen great effects from these devices in our patients. With the ablative fractional CO2 lasers, one thing we have learned from our colleagues is that long-term results with them are achievable. The work by Clementoni showed one- and two-year results following fractional CO2 lasers.3 In 2014, evaluations byTan et al4 took this work further and looked at 56 patients and followed them for one month post laser resurfacing and then 30 patients at five years. Photo-damage scores in those 30 patients were significantly changed
