Non-ablative Erbium-YAG 2940-nm Fractional Laser Treats Periorbital Static Wrinkles Safely in Fitzpatrick Skin Types III-IV.

BACKGROUND: Treating periorbital static wrinkles in patients with pigmented skin is challenging due to the risk of post-inflammatory hyperpigmentation. This study aimed to evaluate a safe and effective laser modality for this underrepresented demographic. METHODS: A prospective, single-center, split-controlled, evaluator-blinded trial was conducted, enrolling 27 Asian patients with Fitzpatrick skin types (FSTs) III-IV. Patients were treated with a non-ablative erbium-YAG 2940-nm fractional laser, undergoing three sessions at eight-week intervals. Treatment efficacy was assessed at six months using objective VISIA imaging, in vivo confocal microscopy, and standardized clinical scales (the Fitzpatrick wrinkle scale assessed by blinded evaluators, and the Global Aesthetic Improvement Scale assessed by patients). RESULTS: The results demonstrated significant wrinkle reduction (mean improvement: 0.9 points on the Fitzpatrick wrinkle scale), robust dermal collagen remodeling (confirmed via confocal microscopy), and high patient satisfaction (88.9% at six months). Notably, no post-inflammatory hyperpigmentation or serious adverse events occurred, and discomfort was tolerable (visual analog scale 3-5). CONCLUSIONS: The optimized non-ablative erbium-YAG protocol successfully addressed the critical risk of pigmentary complications in pigmented skin, providing actionable clinical guidelines. This study fills an important gap in the literature by delivering evidence-based, safe, and effective laser parameters for periorbital static wrinkles in FSTs III-IV. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .