Non-ablative laser treatment improves lip volume, texture, and color

ABSTRACT

Lips undergo several changes with age, decreased volume, elasticity, turgor, and collagen content. Q-switched Nd:YAG laser are known to increase the production of procollagen and elastin and can promote the generation of collagen, which visibly improves facial imperfections. We aimed to determine the efficacy of a 1064 nm Q-switched Nd:YAG fractional laser on improving lip definition, color, and volume. 32 female patients were treated every 2–3 weeks for a total of 3–5 treatments. Improvement was measured in a follow-up visit a month after the final treatment (29.9 ± 1.4 days) by patients’ self-satisfaction questionnaire and physicians blinded evaluations (Likert scale). Patients achieved meaningful aesthetic improvement in in lip color (94% of patients), volume (72%), texture (91%), and overall lip appearance (82%). Furthermore, 91% were satisfied with treatment results and 100% from the overall experience. There were no associated side effects, and the associated pain level (on a 0–10 scale) was rated as 0 in 84% of individuals and 16% as 1. Therefore, laser treatment using a 1064 nm Q-switched Nd:YAG fractional laser on lips is a safe, noninvasive treatment that increases the color and volume of lips, with results that are maintained for at least one month following treatments.

KEYWORDS:

• Lips
• lip aging
• fractional laser

Introduction

Like the rest of the face, lips are subjected to age-related changes. The most prominent of these changes include increased lip length along with decreased lip volume and nasolabial tissue thickness (1–3). Furthermore, several histopathological changes are apparent in the perioral region in aged patients, such as reduced cutis thickness, alongside collagen and elastic fiber fragmentation (2,4). In addition, the upper lip area of the Orbicularis Oris muscle shows signs of atrophy (4), contributing to the appearance of flattened and less defined philtrum columns (3) as well as perioral wrinkles. Furthermore, the redness of the vermilion of the lips decreases significantly with age (3,5), likely due to a reduction in blood flow (3) caused by reduced blood vessel number and total area (6).

Lip rejuvenation is broadly divided into four categories: injections (e.g., hyaluronic acid, collagen), topical treatments (e.g., retinoids, peels, microneedling), surgical lip lift, and laser treatment. Hyaluronic acid injections effectively increase lip fullness (7,8) and decrease perioral wrinkles (8) for up to 6 months but have a significant amount of adverse events (7) and do not target lip color. Topical treatments provide minimal results, while the invasive lip lift significantly improves lip appearance but can leave scars and does not improve lip color (9).

While lasers are used to treat lip hyperpigmentation (10,11), their use for lip rejuvenation has been, thus far, very limited. A pilot study using a non-ablative 2,940 nm Er:YAG laser showed shortening of the philtrum, a decrease in the nasolabial angle, and increased firmness of the skin in the upper lip (12). However, the study failed to note changes in color and volume, as well as the duration of improvement. Q-switched Nd:YAG non-ablative lasers are commonly used for facial rejuvenation due to their efficiency and short down-time (13–18). Clinical and histologic studies have shown that non-ablative lasers induce new collagen formation, thereby improving skin appearance and tightening (16,18–21).

This retrospective study aimed to determine the efficacy of a 1064 nm Q-switched Nd:YAG fractional laser on improving lip definition, color, and volume.

Methods

Patients

This is a retrospective evaluation of 32 female patients aged 22–54 (average = 31.7 ± 1.3 years). Only female patients aged 18 and above wishing to improve lip appearance were included in the study. Exclusion criteria were lip tattoo, the use of photosensitive Medications or Immunosuppressors, Lichen Planus, active herpes in the last 60 days or skin Malignancy in the last 5 years. None of the participants had undergone lip or perioral injections in the 6 months prior to the evaluation. Smoking was not an exclusion criteria. 27 of the 32 patients were treated using the 1064 ND-YAG fractional laser in the facial area as well. Five patients were treated with a 1540 nm laser for acne scars.

Treatment

Treatments were conducted at the “Protocollo Grace Clinic” in Milan, Italy, by a single physician. Patients were treated with a 1064 nm Q-switched Nd:YAG fractional laser (Harmony XL Pro Special Edition, ClearLift, Alma LTD, Israel) every 2–3 weeks for a total of 3–5 treatments. A pixel tip was used with depth control spacers; volume improvement was achieved using the deeper tips (−1, −2) ideally targeting mid dermis, while the 0 spacer was used for color enhancement. The entire lip area was treated by lasing continuously and slowly, in-motion, accumulating energy up to 1 Kilojoule (kJ) for approximately 5–10 passes. Initial treatment was conducted at a fluence of 800–1200 millijoules per pulse (mJ/P) and increased to 1200–1600 mJ/P for the second session, 1600–2000 mJ/P for the third 1800–2200mJ/P for the fourth and fifth session.

Outcome

Improvement was measured one month after the final treatment (29 ± 7.1 days) by patient satisfaction questionnaires and physicians blinded evaluations. Using the Likert scale, scoring assessed improvement in lip color, volume, texture, and overall improvement (scale: 1 = no improvement, 2 = slight improvement, 3 = some improvement, 4 = improved, 5 = very much improved). Paired student t-test was used to test the significance of measurement improvement. Patients rated their pain level using a 0–10 VAS numeric pain distress scale and marked the extent they would recommend this procedure to others.

Results

This study included thirty-two female patients, ages 22–54 (mean age 31.7 ± 1.3), which were treated every 2–3 weeks for a total of 3–5 treatments (Table 1). Aesthetic improvement was assessed one month after the final treatment (29.9 ± 1.4 days) using questionnaires for the patients and physicians in which they rated on a Likert scale (1–5) improvement in lip color, volume, texture, and overall appearance (Figure 1).

Figure 1. Patients and physicians consistently rate improvement similarly. Patients and physicians rated several parameters of lip appearance an average of one month after the final treatment using a Likert scale (1–5). Results represent as mean ± SEM, n = 32. T-test comparison. ***p < .001.

Table 1. Demographics and study summary.

Pt. number	Age	Number of treatments	Average time between treatments (days)	Time to follow up (days)
1	28	4	14	28
2	32	4	14	28
3	26	4	10.3	27
4	31	4	14	28
5	47	4	16.3	28
6	36	4	14	28
7	26	4	14	28
8	42	4	14	28
9	24	4	14	28
10	38	4	14	33
11	25	4	14	27
12	24	3	14	25
13	32	4	14.3	28
14	39	4	14	59
15	29	4	12.3	28
16	23	4	14	28
17	31	3	38.5	29
18	27	5	38	28
19	22	3	28.5	28
20	31	4	14	28
21	25	4	14	28
22	37	4	14	28
23	28	4	14	28
24	27	4	14	59
25	54	4	14	28
26	33	4	14	28
27	36	4	14	28
28	33	4	43.7	28
29	23	3	14	28
30	31	4	14	28
31	36	3	14	28
32	37	4	19	28
Avg	31.7	3.9	17	29.9
SEM	1.3	0.1	1.4	1.4

94% of patients reported improvement in lip color (Likert = 4 or 5 out of 5, Table 2), 72% noted an increase in lip volume, 91% improved lip texture, and 84% improved overall lip appearance. Furthermore, 91% were satisfied with treatment results and 100% from the overall experience. Patients and the treating physician consistently scored the parameters similarly, except for improvement in lip volume, where the physicians rated that improvement higher (p < .001, Figure 1). Representative individual responses can be seen in Figure 2.

Figure 2. Representative images of patients taken before the first treatment (right panel) and during the follow-up meeting (left panel).

Table 2. Assessment of aesthetic improvement and satisfaction 4 weeks post treatments represented by the % of patients reporting a Likert scale of 4–5 (n = 32).

Parameter	% Patients with Likert 4–5
Improvement in lip color	94%
Improvement in lip volume	72%
Improvement in lip texture	91%
Overall improvement	84%
Satisfaction from treatment results	91%
Personal experience	100%

Likert scale:

1 = No improvement

2 = Slight improvement

3 = Medium improved

4 = Improved

5 = Very improved

There were no associated adverse events, and the VAS pain level was rated as 0 (on a 0–10 scale) in 84% of individuals, and 16% rated the pain level as 1.

Discussion

According to a 2020 statistics report published by the American Society of Plastic Surgeons, the amount of non-injection lip augmentation procedures has increased by 84% over the past 20 years, and the number of soft tissue filler procedures has risen almost 4 million annually in the United States alone (22). However, none of the current treatments achieve long-lasting results without side effects or scarring.

Laser treatments have become increasingly popular for many skin rejuvenation procedures due to their safety, reliability, minimal downtime, and potency, with an increase of over 480% since 2020 (22). Lasers are used to treat pigmentation, scars, venous lakes, and melasma due to their deep penetration and absorbance by hemoglobin and melanin. However, their use for lip rejuvenation procedures has only been demonstrated in small groups and on specific characteristics. For example, a small study of 15 women showed that laser treatment using a 2940 nm non-ablative Er:YAG laser decreased the distance between the base of the nose and lip’s vermillion but did not address lip color, volume, and lower lip texture (12). Here, we show that a novel 1064 nm Q-switched Nd:YAG fractional laser treatment for lip rejuvenation increases lip color, volume, and texture with little to no pain. Most importantly, patients were very pleased with their results one month after treatment, and the physicians also saw a marked improvement.

The main advantage of laser treatment, compared to topical fillers, is the ability of the laser to improve lip color, known to significantly decrease with age and the results showing a more “natural” enhancement. Furthermore, laser treatment has deep penetration, does not damage the epidermis, and can be used to treat pigmentations (left from cold sores), scars, and melasma. Further studies on the efficacy of this treatment should assess improvement quantitatively and include a more extended follow-up period. This laser procedure has the potential of addressing an untapped market in the aesthetic industry by providing a safe, effective, painless, and natural enhancement treatment with lasting results.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.