Paper Title
Fractional Carbon Dioxide In Combination With Topical Astaxanthin Vs. Fractional Carbon Dioxide: A Pilot Study Split Lower Face Comparison Of Fine Wrinkle Improvement

Abstract
Background: Wrinkles are a natural consequence and sign of aging, and to date a number of techniques have been developed to control their appearance. These include laser treatment, chemical peels, botulinum toxin injections, or the application of topical treatments. Astaxanthin is a source of active antioxidant enzymes and is generally accepted to provide cosmetic improvements, such as enhancing skin elasticity, minimizing crow’s feet, reducing pigmentation, boosting moisture levels, blocing the production of melanin, inhibiting the appearance of aging due to light, and helping skin damage to heal more quickly. However, no studies have yet been carried out to make comparisons between fractional carbon dioxide laser treatment performed with and without combination with topical astaxanthin to treat the fine wrinkes which appear on the lower portion of the face. Objectives: To assess the effects of applying topical astaxanthin (78.9μm solution) combned with fractional carbon dioxide laser and compare these with the solo use of the fractional carbon dioxide laser for the treatment of fine wrinkles on the lower portion of the face. Materials and methods: The study investigated 20 participants, with each receiving treatment on the left or right side of the face, decided randomly. Half of the face was treated with the fractional carbon dioxide laser and topical astaxanthin, while half was treated using only the fractional carbon dioxide laser. The evaluation was carried out using digital photography (AnteraÒ 3D photography) and a patient satisfaction score recorded at the baseline (day 0), and then at day 3 and week 4 following the treatment. Results: A measurement was taken of the mean difference in the wrinkle index based on the photographic evidence (Antera3DÒ camera), comparing between the baseline and the intervals after treatment. The resuts for the fractional carbon dioxide laser treatment alone showed a statistically significant fall from 9.81 to 8.68 (p=0.004), while for the combination treatment there was a statistically significant fall from 9.74 to 8.77 (p=0.006). No statistically significant difference was found between the two groups (p =0.568). Furthermore, the use of topical astaxanthin produced no observable side effects. Conclusions: The application of topical astaxanthin combined with fractional carbon dioxide laser treatment works effectively in reducing fine wrinkles, but the difference when compared to the fractional carbon dioxide laser treatment alone is not statistically significant. This may be a consequence of the low concentration levels of topical astaxanthin used, and the fact that only a single treatment was performed. Furthermore, the short duration before the follow-up check as awell as the small sample size may also play a part in these findings. Topical astaxanthin did not show any negative side effects. Keywords - Astaxanthin, wrinkles, fractional carbon dioxide laser