Three-Dimensional Imaging of Dynamic Changes After Nd:YAG/Er:YAG Laser Skin Tightening: A Prospective Study

To objectively quantify early and mid-term facial tightening after dual-wavelength Er:YAG/Nd:YAG laser treatment in Chinese women using three-dimensional (3D) imaging.

In this prospective observational study, 13 women with lower facial aging underwent four full-face treatment sessions of dual-wavelength Er:YAG/Nd:YAG (Fotona 4D) at 1-month intervals. Standardized 3D facial images were obtained at baseline and at 1 week, 1, 3, and 6 months after completion of the final treatment session. The primary objective outcomes were vertical displacements (mm) of predefined periocular and midfacial landmarks relative to baseline. Secondary outcomes included Wrinkle Severity Rating Scale (WSRS) scores for nasolabial folds and VISIA pore scores, evaluated at baseline and at 3 and 6 months. Adverse events were recorded.

3D analysis demonstrated significant early and mid-term tightening in the lateral periorbital region. The vertical distance from the lateral canthus to the nasal base decreased by approximately 0.50-0.63 mm at 1 week and by 0.60-0.63 mm at 3 months bilaterally (all p < 0.05), with partial rebound but persistence of mild improvement at 6 months. The highest point of the zygomatic bone showed a delayed, mild elevation that peaked around 1-3 months. WSRS scores for nasolabial folds decreased by about 1 grade at 3 and 6 months on both sides (all p < 0.001). VISIA pore scores improved from 4.97 ± 0.36 at baseline to 3.37 ± 0.43 at 3 months and 3.73 ± 0.54 at 6 months (both p < 0.001). Only transient erythema and edema were observed.

Dual-wavelength Er:YAG/Nd:YAG laser tightening produced early and mid-term improvements in periocular and midfacial laxity, as captured by 3D landmark displacement, with concomitant improvements in wrinkles and pores. 3D imaging provides a sensitive, objective tool to visualize region-specific dynamic responses to energy-based facial rejuvenation.