Device-Induced Neocollagenesis: Profibrotic Response or True Neocollagenesis?

Background and Objectives: Many light and radiofrequency-based rejuvenation devices have claimed to increase collagen production in the skin dermal tissue. However, there has not been enough scientific evidence to prove whether the result is just a profibrotic response or not. We aimed to find the optimal skin rejuvenation device that shows true neocollagenesis. Study Design/Materials and Methods: We evaluated dermal collagen thickness and gene expression of procollagen type 1, 3, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β) resulting from different energy-based devices in a rat model in vivo. The wound-healing response was evaluated histologically and by real-time polymerase chain reaction (RT-PCR) at immediate, 1st, 2nd, 4th, 8th, and 12th week after the initial procedure. Results: At the 12th week, the most relevant changes of the dermal thickness were found in specimens after treatment with electrosurgical unit, fractional CO₂ and 1064 nm Q-switched Nd:YAG. Procollagen 1 and 3 were also found to be the highest in electrosurgical unit, fractional CO₂, and microneedle radiofrequency. Dramatic changes of MMP-3 and TGF-β were remarkable at the early observation but went back to normal level at 12th week. The ratio of procollagen 1 and 3 was found to be the lowest with Q-Switched Nd:YAG 1064 nm and fractional CO₂. Conclusion: Electrosurgical unit resulted in most significant changes, but due to irreversible thermal damage and extremely high procollagen results it is considered as a profibrotic response. Fractional CO₂ and Q-Switched Nd:YAG 1064 nm are applicable to face skin rejuvenation treatment considering thickening of dermal tissue and lower procollagen 1:3 ratio similar to the neocollagenesis purpose. Lasers Surg. Med.