Fotona 4D для омоложения лица: экспертный консенсус и клиническое применение (2025)

Recently, the 2025 Expert Consensus on the Clinical Applications of Dual-Wavelength 1064 nm Nd:YAG and 2940 nm Er:YAG Lasers for Facial Rejuvenation was officially released. The consensus outlines the indications, treatment parameters, contraindications, and precautions for using 1064 nm Nd:YAG and 2940 nm Er:YAG lasers in facial rejuvenation procedures.

На основе evidence-based medicine and aligned with real-world clinical needs, the expert panel identified five key clinical questions. Using the Delphi method, they achieved a relatively high level of agreement and formulated six recommendation statements, which serve as valuable references for clinical practice.

Technical Features

Clinical Question 1: What new technologies have driven the application of dual-wavelength lasers in facial rejuvenation?

Recommendation 1: The combination of 1064 NM ND: YAG -лазер и 2940 nm Er:YAG laser integrates extended pulse width technology, pulse-stacking technology, and Variable Square Pulse (VSP) technology, creating four distinctive operating modes: SMOOTH mode, SupErficial mode, FRAC3 mode, and PIANO mode. These modes are applied in different facial rejuvenation protocols. (Evidence quality: Level 2–3, Recommendation strength: Strong).

➤ Key Technologies

1. Extended Pulse Width Technology
   This technique extends the natural oscillation laser pulse width from microseconds to milliseconds, enhancing the selective heating ability of pulsed lasers on target tissues. It enables deeper and larger-volume tissue heating, suitable for conditions with longer thermal relaxation times, such as hair removal and vascular lesions.
2. Pulse-Stacking Technology
   By modulating a 2000 μs pulse width through extended pulse width technology and combining it into multiple sequential pulses, this method increases the overall pulse duration. It helps resolve the contradiction between tissue heating and cooling during rejuvenation treatments, allowing more controlled skin temperature elevation.
3. Variable Square Pulse (VSP) Technology
   VSP delivers adjustable-duration square-shaped pulses, ensuring stable energy transmission throughout the pulse. This maintains tissue temperatures above the threshold required to trigger desired biological effects, improving safety and consistency during treatment.

VSP Technology

• Short Pulse Width
  • Micro-short pulse (100 μs)
  • Short pulse (300 μs)
  • Main effect: Ablation / Vaporization
• Long Pulse Width
  • Long pulse (600 μs)
  • Super-long pulse (1000 μs)
  • Extra-long pulse (XLP, 1500 μs)
  • Main effect: Tissue Heating

Operating Modes

1. SMOOTH Mode
   • Treatment Mode: A non-ablative Er:YAG laser setting with a pulse width of 250 ms.
   • Механизм: Composed of a sequence of low-energy, variable square short pulses that accumulate heat gradually without ablating the epidermis. Repeated passes progressively raise the dermal temperature to 60–65 °C, stimulating collagen neogenesis and remodeling.
   • Clinical Advantages: Histological studies show this multi-pulse Er:YAG technique can deliver heat deep into the dermis (200 µm with a single pulse; up to 350 µm with multiple stacked pulses) while partially preserving the epidermis.
2. SupErficial Mode
   • Treatment Mode: An ablative Er:YAG laser setting using variable square pulse technology.
   • Механизм: Operates at a 100 µs short pulse width, achieving maximal ablation with minimal residual thermal damage, thereby sparing surrounding tissue.
   • Clinical Advantages: Produces a “cold ablation” effect—patients experience little discomfort, no significant downtime, and rapid recovery.
3. FRAC3 Mode
   • Treatment Mode: Uses VSP technology to switch between different square pulse widths, combining them into the FRAC3 delivery mode.
   • Механизм: Employs short pulse widths and high peak power with the 1064 nm Nd:YAG laser to create a three-dimensional fractional pattern of micro-lesions in the epidermis and dermis. The controlled damage stimulates collagen regeneration through the natural wound-healing response.
   • Clinical Advantages: Preclinical and clinical studies show that sub-millisecond Nd:YAG pulses (e.g., 0.3 ms) induce localized dermal injury, leading to new collagen formation, increased skin elasticity, and thickened epidermis. Electron microscopy has confirmed reductions in collagen fiber diameter consistent with the morphology of newly synthesized collagen, improving skin firmness and texture.
4. PIANO Mode
   • Treatment Mode: Based on pulse-stacking technology, with a pulse width range of 0.3–60 seconds using 1064 nm Nd:YAG laser.
   • Механизм: Delivers long-duration, high-frequency pulse sequences for bulk tissue heating over a defined area while avoiding sharp temperature spikes in the epidermis.
   • Clinical Advantages: Because the pulse duration exceeds the thermal relaxation time of epidermis, pigment, and vessels, deep dermal and subcutaneous tissue can be heated safely. This induces fibroblast activity, collagen remodeling, and skin tightening. Additionally, the rise in subcutaneous fat temperature can cause mild fat cell damage, promoting lipolysis for a subtle contouring effect.

Treatment Plan

Clinical Question 2: Which facial skin aging issues can dual-wavelength lasers improve?

Recommendation 2:

1. Mild to moderate facial skin laxity: including mild-to-moderate periorbital laxity, mild brow or eye drooping, downturned mouth corners, deepened nasolabial folds, jawline sagging, and unclear facial contours.
2. Mild to moderate photoaging: including uneven skin tone, enlarged pores, fine lines, and textural irregularities.
   Evidence quality: Level 2–4
   Recommendation strength: Strong

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2940 nm Er:YAG Laser for Mild-to-Moderate Facial Laxity and Photoaging

1. Periorbital Rejuvenation:
The extremely shallow optical penetration of the 2940 nm Er:YAG laser makes it ideal for delicate periorbital rejuvenation. When applied with appropriate energy density, the laser penetrates only a few microns optically while achieving tissue heating depths of several hundred microns—well below the eyelid skin thickness.

• Clinical Study: In a prospective study, 30 patients received SMOOTH-mode (250 ms) 2940 nm Er:YAG treatment around the eyes at an energy density of 3.75 J/cm² and 1.7–2.0 Hz, once per month for three sessions. Wrinkle assessment using the Fitzpatrick periorbital wrinkle scale showed significant improvement both clinically and statistically, with effects maintained up to 12 months post-treatment.
• Pulse Width Study: Manuskiatti et al. investigated short- vs. ultra-long pulse low-energy Er:YAG lasers for Asian periorbital wrinkles. Short-pulse treatment used 0.5 J/cm² with 50% overlap; ultra-long pulse delivered the same energy over 6 evenly spaced pulses in 250 ms at 1 Hz. Both approaches effectively improved periorbital wrinkles with minimal downtime and low risk of transient adverse effects.

Clinical Application: SMOOTH-mode Er:YAG gently heats the dermis without significant epidermal ablation, making it suitable for sensitive periorbital skin.

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2. Nasolabial Fold Rejuvenation:
SMOOTH-mode Er:YAG laser has also shown efficacy for intrabuccal treatment of nasolabial folds.

• Prospective Study: A half-face randomized controlled study evaluated intrabuccal vs. external SMOOTH-mode Er:YAG application (4.0 J/cm², 4-week intervals, 5 sessions). Optical coherence tomography revealed significant dermal thickening on the intraoral side (+29% vs. +2% on the external side).
• Clinical Study: 20 patients received 2940 nm Er:YAG intrabuccal treatment (250 ms, 12 J/cm², 1.8 Hz, every 2 weeks for 6 sessions). Evaluations using the modified Fitzpatrick wrinkle scale and blinded photographic assessment showed significant nasolabial wrinkle improvement at 6 months. Patient-reported satisfaction confirmed favorable aesthetic outcomes.

Clinical Application: SMOOTH-mode Er:YAG promotes deep dermal collagen remodeling and neocollagenesis with minimal epidermal injury, making it effective not only for periorbital and nasolabial folds but also for other facial laxity areas.

• Comparative Study: Serdar and Tatlıparmak compared non-ablative SMOOTH-mode Er:YAG to fractional radiofrequency for facial and neck laxity. Satisfaction rates were similar (89–93% vs. 86–92%), demonstrating comparable efficacy.

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1064 nm Nd:YAG Laser for Mild-to-Moderate Facial Laxity and Photoaging

1. Facial Wrinkle Improvement:
Long-pulse 1064 nm Nd:YAG promotes dermal collagen synthesis, improving wrinkles without epidermal damage.

• Periorbital and Perioral Study: 10 patients received 5 mm spot diameter, 13 J/cm², 300 μs pulse width, 7 Hz, every 2 weeks for 3 sessions. Patient satisfaction and clinician/computer-based indices showed peak improvements 2 months post-final treatment, with sustained results at 6 months.
• Neck Laxity Study: Marini and Alexiou treated 16 patients with the ultra-long pulse PIANO mode (energy 24 J/cm², 20 mm spot, 1.5 s pulse, 5-minute interval, 1 session/week for 6 weeks). Skin elasticity improved 7% with single-pass treatment and up to 21% with 2–3 passes.

2. Photoaging Improvement:
Features such as epidermal thinning, rough texture, wrinkles, pigmentation, and telangiectasia can be improved.

• Koh et al.: 12 Korean women received 5 full-face non-ablative treatments (13–14 J/cm², 0.3 ms, 5 mm, 7 Hz, 3–6 week intervals). Elasticity, pigmentation, texture, pores, wrinkles, and fine lines improved significantly.
• Groot and Smith: In a randomized controlled study of Fotona 4D modes, half-face treatments with either 1064 nm (FRAC3 + PIANO) or 2940 nm (SMOOTH + SupErficial) showed that each wavelength improved specific parameters (1064 nm: texture, pores, pigmentation, elasticity; 2940 nm: wrinkles, texture, elasticity). Full-mode combination treatments demonstrated superior overall improvement, including spots, pore size, and lifting.

Recommendation 3:
1064 nm Nd:YAG laser (PIANO mode) is recommended for facial rejuvenation in the cheeks or jawline, particularly for localized fat accumulation, where it can be used in lipolytic mode to improve contour.
Evidence quality: Level 2–4
Recommendation strength: Strong

1. Mechanism of Laser Lipolysis

High-temperature laser lipolysis is a technique that uses laser-induced heat to damage adipocytes, thereby achieving fat reduction. Studies indicate that adipocytes are highly sensitive to brief exposure to elevated temperatures. For example:

• Exposure to 50 °C for 1 minute dramatically decreases adipocyte viability.
• Exposure to 45 °C for 3 minutes reduces adipocyte survival to about 40%.

Preclinical studies using 1064 NM ND: YAG -лазер on porcine adipose tissue, combined with surface cooling, demonstrated that subcutaneous temperatures at 5–7 mm depth could reach levels sufficient to induce adipocyte thermal damage, while maintaining the skin surface at a safe 38 °C.

In a human-based numerical model study, 10 volunteers received 1064 nm Nd:YAG laser irradiation on the abdomen. Surface temperature changes were recorded and compared with model predictions, simulating temperature distribution at different tissue depths and resulting adipocyte thermal injury. Optimal treatment parameters were identified to maximize adipocyte apoptosis while protecting the epidermis.

• Using a radiant energy of 1.2 W/cm² и forced-air heat transfer of 60–130 W/cm², with 4–5 treatment cycles, surface temperatures remained within the safe 31–38 °C range, while subcutaneous tissue reached 43–47 °C, sufficient to induce programmed adipocyte death.

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2. Clinical Application

The Nd:YAG PIANO mode is a novel, non-invasive fat-reduction technology. It heats deep dermal layers to selectively damage adipose tissue, while sequential 2940 nm Er:YAG SMOOTH-mode laser treatment stimulates dermal collagen remodeling, providing simultaneous fat reduction and skin tightening.

Clinical Study Examples:

Abdominal and Submental Fat Treatment:

• Patients: 12 abdominal, 20 submental fat cases
• Уход: 3–6 sessions, 2–4 weeks apart
• Шаг 1: 1064 nm Nd:YAG PIANO mode, energy density 1.2 W/cm²
  • Abdomen: maximum surface temperature 40 °C
  • Submental: max 39 °C, min 38 °C
  • Zimmer cooling system level 1, duration 15–20 min
• Шаг 2: 2940 nm Er:YAG SMOOTH-mode, energy density 2.0 J/cm², frequency 3.3 Hz, 7 mm spot diameter, 3 min per area immediately after step 1

Результаты:

• Skin fold thickness decreased significantly: abdominal −4.5 mm, submental −4.3 mm
• Abdominal patients: weight reduction −0.9 kg, waist circumference −3.9 cm

Sequential Treatment Study (Vas et al.):

• Patients: 10 female subjects (lateral waist/lower abdomen)
• 1064 nm Nd:YAG: 1.2 W/cm², 42 °C, 8 min, PIANO mode
• 2940 nm Er:YAG: 7 mm spot, 2.0 J/cm², 2.0 Hz, SMOOTH mode
• Частота: every 2 weeks, 4 sessions
• Assessment: photographic documentation, waist circumference, 2D ultrasound, low-dose CT, bioelectrical impedance for fat mass, and shear-wave elastography for tissue tightening

Исход:
Sequential dual-wavelength laser treatment significantly reduced waist circumference and total fat while improving tissue firmness.

Clinical Question 3: How to Select Parameters for Dual-Wavelength Laser Facial Rejuvenation?

Recommendation 4:

1. Comprehensive Facial Rejuvenation:
   • For full-face anti-aging treatment, it is recommended to use a dual-wavelength full-mode protocol (specific parameters detailed in Table 2).
   • The suggested treatment sequence is: SMOOTH → FRAC3 → PIANO → SupErficial.
   • When selecting parameters, factors such as pulse width, spot size, frequency, and energy should be carefully considered to ensure optimal efficacy and safety.
2. Targeted Treatment for Specific Skin Aging Issues:
   • For isolated concerns, one or more modes from the full-mode protocol can be selectively applied for targeted treatment.

Evidence Quality: Level 2–4
Recommendation Strength: Strong

Table 2: Recommended Parameters for Dual-Wavelength 1064 nm Nd:YAG and 2940 nm Er:YAG Lasers in Full-Mode Facial Rejuvenation:

Режим	Indication	Ширина импульса	Размер пятна	Energy Density / Power	Частота	Сессии лечения	Operational Notes	Treatment Course	Recommendation Strength
SMOOTH (intraoral)	Downturned mouth corners, deepened nasolabial folds	250 ms	7 mm	7–9 J/cm²	1.6–3.3 Hz	400–800 pulses per side, total ~1,000 pulses	Use medical cotton swabs for cleaning, treat mucosa in sequence, disinfect thoroughly to avoid cross-infection	1×/month, 3–5 sessions	Strong
SMOOTH (periorbital)	Mild-to-moderate periorbital laxity	250 ms	7 mm	1–3 J/cm²	1.6–3.3 Hz	150–300 pulses per eyebrow, 1–2 cm above brow, 1.6 Hz sliding treatment	For periorbital treatment, patient cannot wear contact lenses; recommend eye shields	1×/month, 3–5 sessions	Strong
FRAC3	Отбеливание кожи	1.6 ms	9–10 mm	10–20 J/cm²	4–5 Hz	2–4 passes per area (forehead, upper/lower cheek, jawline), slight redness expected	Use cold air cooling, low energy first, minimize passes in yellow areas	1×/month, 3–5 sessions	Strong
PIANO	Дряблость кожи	>5 s	10 mm	Lower jaw: 180–260 J/cm²; Submental/jowl: 100–120 J/cm²	Fixed, non-adjustable	Repeat per area as FRAC3, raise skin temp to 40 °C, maintain 5 min for jawline, 3–5 min for periorbital	For lax areas, can increase passes for cumulative effect; high-energy session may also induce fat reduction	1×/month, 3–5 sessions	Strong
PIANO (deep fat, R33T applicator with cooling)	Localized subcutaneous fat	5–6 s	9–10 mm	300–500 J/cm²	Fixed, non-adjustable	Treat cheeks or submental fat, maintain temp 38–40 °C for 10–15 min, cooling level 2–4	Use R33T applicator for precise fat reduction; vertical overlapping passes	1×/month, 3–5 sessions	Strong
PIANO (deep fat, S11-L Runner with cooling)	Localized subcutaneous fat	5–6 s	9 mm	1.2 W/cm²	Fixed, non-adjustable	Treat cheeks or submental fat, maintain temp 38–40 °C for 10–15 min, cooling 2–4	Use L-Runner applicator, scan area evenly with overlapping passes	1×/month, 3–5 sessions	Strong
SupErficial	Epidermal resurfacing	100 µs	5–7 mm	0.5–2.0 J/cm²	2 Hz	1–2 passes over full face

Безопасность

Clinical Question 4: What are the adverse reactions and management strategies associated with dual-wavelength laser treatments?

Recommendation 5: Both 1064 nm Nd:YAG and 2940 nm Er:YAG lasers are widely used in clinical practice. Post-treatment care should follow standard laser aftercare protocols, with emphasis on proper moisturizing and sun protection. Prior to treatment, strict adherence to contraindications is essential to prevent serious adverse events. If severe adverse reactions occur, prompt symptomatic management is required (Evidence Level: 2–4; Recommendation Strength: Strong).

➤ Contraindications

• History of keloid formation
• Excessive sun exposure in the treatment area
• Use of iron supplements or anticoagulant therapy
• Photosensitivity or use of photosensitizing medications
• Беременность
• Active infections in the treatment area, including herpes simplex or other viral infections
• Malignant tumors in the treatment area
• Severe oral diseases (for Er:YAG laser treatments in the oral cavity)

➤ Adverse Reactions and Management

1. Erythema, pain, and burning sensation: Common.
   Usually mild and tolerable, often resolving spontaneously. Cold compresses can be applied, and treatment parameters may need adjustment or the affected area temporarily skipped.
2. Burns, blisters, and scarring: Rare.
   Post-treatment may present with persistent redness or grayish discoloration, followed by crusting or small blisters. Scarring may occur after healing. These reactions are usually associated with excessive energy settings or overlapping pulses. Management includes extending post-treatment cold compresses to reduce discomfort. For severe symptoms, systemic or topical corticosteroids may be indicated. Blisters should be drained if necessary, followed by application of topical antibiotics to prevent infection. Oral antibiotics may be used for systemic treatment. Moist wound-healing ointments can aid tissue repair and minimize scarring. For patients with established scars, early anti-scar therapy is recommended.
3. Гиперпигментация: Rare.
   Can be treated with topical depigmenting agents such as hydroquinone or arbutin cream.
4. Hypopigmentation: Rare.
   Usually resolves spontaneously over months or years. Persistent depigmentation should be evaluated for potential vitiligo.
5. Инфекция: Rare.
   Treatment depends on the type of infection and may include topical or systemic antibiotics or antiviral medications.

Clinical Question 5: What special considerations should be observed during dual-wavelength laser facial rejuvenation treatments?

Recommendation 6: In facial rejuvenation, the combination of 1064 nm Nd:YAG and 2940 nm Er:YAG lasers utilizes four specialized treatment modes—SMOOTH, SupErficial, FRAC3, and PIANO—to achieve both internal and external layered rejuvenation effects. When using these modes, operations should follow the characteristics of each mode, with particular attention to: careful evaluation of oral mucosa during SMOOTH intraoral treatment, and strict monitoring of temperature changes during PIANO mode (Evidence Level: 4–5; Recommendation Strength: Strong).

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1. Full-Mode Treatment Considerations

The full-mode dual-wavelength laser treatment enables multi-layered synergistic anti-aging effects, covering areas from the oral mucosa to dermal connective tissue, deep fat, and the epidermis.

• Recommended treatment sequence: SMOOTH → FRAC3 → PIANO → SupErficial, though the order may be adjusted based on individual patient needs.
• Avoid repeated overlapping irradiation in the same area to prevent excessive energy accumulation and adverse reactions.
• Mode combinations can be personalized according to the patient’s skin condition, using any single mode or a combination of the four modes for optimal results.

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2. SMOOTH Intraoral Mode Considerations

• Apply erythromycin ointment or petroleum jelly to the lips before treatment to prevent tearing.
• Use sterile cotton balls to clean and dry the oral mucosa surface.
• If needed, place small cotton balls in the deeper buccal mucosa to absorb saliva.

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3. FRAC3 and PIANO Mode Considerations

• Treat in segmented areas, gently lifting the skin against the direction of gravity.
• Continuously monitor the temperature device, maintaining 40–42 °C to avoid burns.
• Slightly intensify treatment over ligamentous areas while avoiding hair-bearing regions.

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4. PIANO Mode Considerations

• PIANO mode at high energy has a lipolytic effect and can be applied to nasolabial fat pockets or submandibular fat accumulations.
• For patients with minimal facial fat or pronounced cheek depressions, avoid fat reduction to prevent worsening of the contour.
• Adjust energy or treatment position based on skin temperature indicated by the device to prevent burns or excessive fat removal.

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5. SupErficial Mode Considerations

• Mild erythema or a thin white frost may appear post-treatment.
• Can be intensified in areas with fine lines, enlarged pores, or periorbital regions.
• Caution is advised for patients with melasma or sensitive skin.

Краткое содержание

The dual-wavelength, multi-mode laser platform combining 1064 nm Nd:YAG and 2940 nm Er:YAG represents a next-generation aesthetic medical laser system. While retaining the traditional indications of each wavelength, this system further expands the applications for facial skin rejuvenation. It can effectively improve a variety of signs of skin aging, including mild to moderate skin laxity, uneven skin tone, enlarged pores, and fine lines.

However, due to the current lack of high-quality prospective studies and long-term follow-up data, caution is still warranted when using dual-wavelength lasers for facial rejuvenation. Careful patient selection and precise determination of treatment parameters are essential to ensure both efficacy and safety.