ENDOLIFT® and multi-wavelength laser photobiomodulation: a randomized controlled trial study on 96 subjects, treating skin laxity of the lower third of the face

Background and aims: Many patients look for procedures that can achieve similar results to surgical lift avoiding the risks and possible complications of surgery. Endolift® and multi-wavelength (MW) laser photobiomodulation (PBM) are considered two of the most effective procedures in the treatment of skin laxity and superficial wrinkles. We aimed to investigate the reduction of skin laxity of the lower third of the face treated with the Endolift® technique alone or in combination with MW Laser PBM. Materials and Methods: From June 2016 to June 2018, 96 subjects (18 M; 78 F) were included in this randomized controlled trial (RCT) conducted in two Italian institutions. The area treated was the lower third of the face. The subjects were classified using the Ptosis Scale (grade I-V) at T0, with a Pinch Test <1.9 mm. We selected only subjects’ grade 4, both males and females, 45-55-years old. Thirty-two subjects (6M; 26F) (group 1) were treated with the Endolift® procedure followed by a session of MW Laser PBM using a simultaneous nonsurgical laser therapy emission of three different wavelengths (532 nm, 808 nm, 1064 nm). The MW Laser PBM was repeated after 7, 14 and 21 days. Thirty-two subjects (6M; 26F) (group 2) underwent only the Endolift® session. 32 subjects (6M; 26F) (group 3) received only MW Laser PBM. Follow up visits were performed at days 60 (T60), 120 (T120) and 540 (T540) after the treatments. The study ended in December 2019 when all the subjects had been followed for 18 months. Results: The results of the three groups were evaluated using the Ptosis Scale at T0, T60, T120 and T540. The combination of the two treatments (group 1) achieved more rapid effects, while MW Laser PBM alone treatment (group 3) achieved the slowest effect. The median test for independent samples showed that all the differences between groups are statistically significant at each follow-up (p=0.000). Conclusions: The Endolift® laser in the last 15 years allows to achieve exceptional results in the treatment of skin laxity reaching the desired ‘soft’ rejuvenation model which is increasingly desired. MW Laser PBM, in combination with Endolift®, obtains better results. Although significant at T540, the effects of MW Laser PBM alone are slower to reach.