1470 nm Diode laser for enhancement of the Lower Face: a prospective evaluation with patients’ and physicians’ reported outcomes

1470 nm Diode laser for enhancement of the Lower Face: a prospective evaluation with patients’ and physicians’ reported outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 1470 nm Diode laser for enhancement of the Lower Face: a prospective evaluation with patients’ and physicians’ reported outcomes Reem Karami, Ahmad Kassas, Ghassan Abu Sittah, George Christopoulos, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9050373/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Lower facial aging and loss of jawline definition are common concerns among many patients. While surgical procedures offer definitive correction, many individuals seek minimally invasive options with shorter recovery times. The 1470-nm diode laser aims to address this by promoting skin tightening and restoration of the mandibular contour. Aims Evaluate the efficacy and safety of this laser in the treatment of mild to moderate lower facial laxity using validated patient-reported outcomes and independent clinician assessments. Methods We identified patients with mild to moderate lower facial laxity who underwent a single treatment; those with severe laxity, previous procedures in the treatment area, or used combined modalities were excluded. Assessments included the FACE-Q® Satisfaction with Facial Appearance scale and standardized 2D/3D photography at baseline, 3 months, and 6 months. Three independent plastic surgeons, blinded to timing, evaluated pre- and post-treatment images using the Global Aesthetic Improvement Scale (GAIS). Results Twenty-six patients were included. FACE-Q® scores improved from a baseline mean of 47 to 54 at 3 months and 62 at 6 months. GAIS evaluations showed aesthetic improvement in 61–74% of patients, with no cases of worsening. Two patients developed temporary marginal mandibular neuropraxia, resolving by 6–10 weeks. Conclusion the 1470 nm diode laser demonstrated measurable improvement in lower facial laxity with minimal downtime and acceptable safety. It represents a promising minimally invasive alternative for selected patients, although longer-term and controlled studies are needed to validate durability and refine indications. Diode lase Subdermal Laser Jowl Jawline Lower face laxity Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The lower face and neck, particularly the mandibular border, are central to facial aesthetic harmony. A youthful jawline is defined by a sharp inferior mandibular contour without cutaneous redundancy or jowl formation 1 . Age-related loss of definition reflects a multifactorial, three-dimensional process involving skeletal resorption, soft tissue descent, and cutaneous degeneration 2 . Intrinsic and extrinsic aging mechanisms contribute to dermal thinning, reduced elasticity, and progressive laxity. Simultaneously, volumetric redistribution of fat compartments, attenuation of retaining ligaments, weakening of the mandibular septum, and mandibular recession collectively promote lower facial ptosis 3 , 4 , 5 . Collectively, these factors play a significant role in aging of the lower face 6 . The mandibular ligament is a key structural determinant in jowl development. As described by Furnas 7 , it consists of deep and superficial components. The deep layer provides firm fixation of the platysma and depressor musculature to the mandible and is central to deep-plane rhytidectomy techniques. The superficial component comprises retinacular cutis fibers tethering the dermis to the platysma, influencing lower facial contour dynamics 8 . The face, being our most prominent feature, holds a significant cosmetic and psychosocial importance for individuals 9 . Current approaches to rejuvenating the lower face and neck include non-surgical treatments, minimally invasive options, and surgical interventions. While facelifts and neck lifts can effectively address age-related changes and enhance youthful appearance, some patients may find them undesirable due to the increased downtime, higher costs and elevated risk of complications 10 , 11 . There is a growing demand for non-surgical aesthetic solutions that is evidenced by the substantial expansion of this field over the past decade 12 . The subdermal use of the 1470 nm diode laser for is a minimally invasive outpatient treatment designed to address skin aging. This technique employs the use of micro-optical fibers inserted beneath the skin to deliver energy at a 1470 nm wavelength. This targeted energy promotes collagen remodeling and skin tightening, resulting in a rejuvenated, more youthful appearance 13 . This study aims to retrospectively evaluate the efficacy of this procedure in addressing lower facial skin laxity, with the aim of establishing an evidence base for this technology. Material and methods This study conducted at our clinic in London, United Kingdom, with the aim of evaluating the efficacy and safety of the 1470 nm diode laser in the management of lower facial laxity. We identified patients who had previously voluntarily presented to our plastic surgery clinic with concerns about sagging or laxity in the lower face. Inclusion criteria included both male and female patients with mild to moderate laxity who underwent skin tightening with the 1470 nm diode laser. Patients with severe laxity, those who had undergone previous facial procedures in the targeted area, or individuals who received combination treatments involving other aesthetic modalities in the lower face or neck were excluded from the study to ensure a homogeneous sample and to better isolate the effects of the laser alone. The primary objective was to assess the degree of aesthetic improvement following treatment, utilizing patient-reported outcomes, clinician evaluations, and objective measurements. Prior to treatment all patients completed the FACE-Q® questionnaire, specifically the satisfaction with facial appearance scale. This is a validated patient-reported outcome measure used to evaluate satisfaction with overall facial appearance. It consists of 10 questions which generated a converted numerical score, with a scale of 0 to 100, that served as the baseline measurement. Standardized two- and three - dimensional (2D and 3D) photographs were also captured at presentation. Follow-up FACE-Q® assessments and photographs were obtained at 3 and 6 months post-treatment. Additionally, three independent plastic surgeons evaluated the pre- and 6 months post-treatment photographs using the Global Aesthetic Improvement Scale (GAIS), a five point scale ranging from worse to very much improved. The procedure was performed using the Eufoton® LASEmaR® 1500 system under local anesthesia. A total of 10 ml of local anesthetic was administered, consisting of 8 ml of normal saline solution combined with 2 ml of 1% Lidocaine without adrenaline. The lower face was divided into five anatomical treatment zones: two mandibular zones, two submandibular zones, and one submental zone (Fig. 1 ). Device settings per anatomical area followed the inbuilt manufacturer’s device settings for these areas at level 3. This included a power of 4–7 Watts and pulse duration of 100–300 milliseconds. The energy delivered per treatment area ranged between 300–400 Joules, with the total delivered energy to be 1500 Joules. The fiber used was the standard 300 microns in diameter. These fibers are sterile and designed for single use. Laser energy is delivered through the tip of the optical fiber, which is moved in a fan-shaped motion to evenly disperse the energy and ensure all targeted areas are treated effectively. Each patient received one treatment session. Results A total of 26 patients were included in this study, consisting of 24 women and 2 men, with ages ranging from 32 to 64 years. All participants were in good general health, with no underlying co-morbidities. The procedure was performed as an outpatient treatment, allowing patients to return home shortly after completion. Figures 2 and 3 display pre- and post-procedure images of two of our patients. Figure 4 provides a volumetric assessment using 3D imaging with Vectra H2 (Canfield Scientific, Parsippany, N.J), revealing a 4.2 cc reduction in the jowl area volume following the Endolift procedure. FACE-Q® Patient Assessment Regarding patient-reported outcomes assessed using the validated FACE-Q® questionnaire for overall satisfaction with facial appearance, the pre-treatment scores averaged 47, reflecting the baseline level of satisfaction with facial appearance prior to undergoing the Endolift® procedure. This initial score indicates a moderate level of concern or dissatisfaction, which motivated the patients to seek treatment. At the 3-month postoperative mark, the average FACE-Q® score increased to 54, suggesting that patients perceived a noticeable and meaningful improvement in their facial aesthetics. By the 6-month follow-up, the scores continued to rise further, reaching an average of 62 (Fig. 5 ). This sustained and progressive increase in scores over time suggests a continued enhancement in patient satisfaction beyond the immediate recovery period. Physician Assessment Three independent plastic surgeons evaluated the 2D and 3D photographs of the patients, all of whom were blinded to the timing of the intervention to minimize assessment bias and ensure objectivity. The detailed results of their evaluations are summarized in Table 1 . Notably, none of the physicians observed any deterioration in facial aesthetics following the treatment. Furthermore, no patients were rated as “very much improved,” which aligns with the typical expected outcomes of energy-based devices that aim to enhance skin quality and contour rather than achieve dramatic, full correction of laxity. Table 1 Physician assessment of paitents pre treatment and 6 months post treatment photographs, blinded to treatment time. Global Aesthetic improvement scale Percentage of patients Physician 1 Physician 2 Physician 3 Worsened 0% 0% 0% Unchanged 25.8% 22.6% 19.4% Improved 61.3% 64.5% 74.2% Much improved 12.9% 12.9% 6.4% Very much improved 0% 0% 0% The most common finding across all evaluations was an improvement in facial aesthetics after the procedure. Specifically, Physician 1 noted improvement in 61.4% of patients, Physician 2 observed similar gains in 64.5%, and Physician 3 reported improvements in 74.2%. These rates highlight that a significant proportion of patients experienced noticeable benefits in facial appearance. Meanwhile, a subset of patients—25.8%, 22.6%, and 19.4% respectively—were rated as unchanged, indicating minimal or no visible change in their photographs. The remaining patients, representing 12.9%, 12.9%, and 6.4%, were classified as “much improved,” suggesting some patients achieved appreciable aesthetic enhancement, although not to a full or dramatic extent. Complications During the follow-up period, patients reported mild post-procedure pain, swelling, bruising and discomfort that persisted for a few days. All symptoms resolved within 5–7 days after the procedure. We had two patients who had experienced temporary unilateral neuropraxia of the marginal mandibular nerve, necessisating botulinum toxin injection to the contralateral side for symmetrization. Full recovery and symmetry of the mouth movement was reported after 6 weeks in one patient and 10 weeks in the other. Discussion The lower face continues to pose a significant treatment challenge for plastic surgeons, owing to its complex anatomy and wide range of available treatment modalities. Surgical interventions, such as deep plane facelifts with soft tissue repositioning, skin tightening, and volume restoration through fat grafting, remain the gold standard for significant rejuvenation, delivering the most dramatic and durable results. However, the inherent invasiveness, longer recovery times, and higher costs associated with surgery often deter many patients, especially those seeking minimal downtime or concerned about surgical risks. Consequently, non-surgical and minimally invasive options have gained popularity, including botulinum toxin, dermal fillers, radiofrequency devices, ultrasound, and laser technologies 14 . Energy-based devices offer a promising middle ground, targeting skin laxity with minimal recovery. The 1470 nm diode laser exemplifies this trend and offers a dependable alternative for patients with mild to moderate skin laxity of the lower face. The mechanism of action of the laser is multifacated and can be summarized into three primary effects. First, the high absorption coefficient of the 1470 nm wavelength by water molecules which generates controlled thermal energy, inducing collagen fiber contraction. Second, the delivery of laser energy creates micro-injuries within the deep dermal layers, initiating a wound-healing cascade that stimulates neocollagenesis. Third, the procedure induces lipolysis, facilitating the emulsification and subsequent resorption of small localized fat deposits 15 , 16 . The subdermal laser operates on the fibroseptal network described by Minelli et al. 8 , primarily functioning through a stimulatory mechanism. It activates and enhances the existing fibroseptal structures without inducing significant fibrosis or scarring. This targeted stimulation promotes tissue tightening and rejuvenation while avoiding the formation of dense, fixed scar tissue that could impair future surgical procedures. Nilforoushzadeh et al. 17 , similar to our study, explored the use of the laser to address jowling. In their study, patients’ biometric characteristics were assessed using the VisioFace 1000 D, the multi-probe adapter Cutometer (Courage & Khazaka Electronics, Cologne, Germany), and a skin ultrasound imaging system (TPM, Lüneburg, Germany) to measure skin layer thickness and elasticity. Results demonstrated increased density in both the dermis and epidermis. The study also reported a 90% patient satisfaction rate; however, it was unclear how this figure was derived or whether a validated questionnaire was used to assess satisfaction. Additionally, the findings are limited by the small sample size of only nine participants, which restricts the generalizability of the results to a broader population. The versatility offered by the diode laser is particularly valuable for aesthetic practitioners, as it broadens the range of treatments achievable with a single device. Numerous case series have been published to evaluate its efficacy across different areas of the face. For example, Nilforoushzadeh et al. 18 conducted a study assessing its the effectiveness in treating nasolabial folds and marionette lines. The results were promising, demonstrating improvements in skin thickness and high patient satisfaction. However, similar to earlier studies, this research was limited by a small sample size and lacked objective measures for grading patient satisfaction. Conversely, Lotfi et al. 19 evaluated the improvement of the upper face, providing more objective data by measuring eyebrow position—specifically, eyebrow height from the center of the pupil in medial, central, and lateral regions. They reported a 71.5% improvement in these measurements, indicating effective results in this area. We believe our study offers more comprehensive and reliable results compared to existing literature, particularly due to its larger sample size of 26 patients and the implementation of standardized assessment tools, such as the FACE-Q® questionnaire and GAIS scores. These tools provide validated measures of patient satisfaction and aesthetic improvement, enhancing the objectivity of our findings. Limitations of this study include its relatively short follow-up period which restricts our capacity to determine the long-term durability of outcomes. Moreover, there is a potential for observer bias of the plastic surgeons assessing the pictures, despite efforts to employ validated subjective tools. There is a scarcity in data about the diode laser, with most studies being case series of small sizes. A recent systematic review evaluating the current evidence surrounding it highlighted a significant gap in high-quality, randomized controlled trials. The review emphasized that the existing literature is primarily composed of small case series and observational studies, which limits the strength and generalizability of the conclusions regarding the procedure’s safety and efficacy. This paucity of rigorous scientific data accenuates the need for larger, prospective, and controlled studies to better understand the long-term outcomes and to firmly establish the role of the laser in minimally invasive facial rejuvenation 20 . This review also noted that none of the included studies reported any adverse outcomes. This finding aligns with previous reviews that concluded adverse events associated with laser treatments are generally mild and self-limiting 21 . However, it is important to acknowledge the potential for both reporting and publication bias, as thermal energy from laser procedures can, in certain cases, lead to adverse effects such as skin burns, seromas, hematomas, neuropraxia, and local infection 22 . In our series, we had two serious complications of injury to the marginal mandibular nerve that recovered within 10 weeks. Although the literature does not address nerve injury as something common, there have been many cases of neuropathy related to the marginal mandibular nerve, causing paresthesia, paresis and even muscle paralysis 23 . It is important to emphasize this to help raise awareness among practitioners using the device, thereby promoting safer application and better patient outcomes. Conclusion The 1470 nm diode laser is a minimally invasive technique that has demonstrated encouraging results in improving signs of lower face aging. The procedure offers several advantages, including minimal downtime and a low complication rate, making it an attractive alternative to more invasive surgical options. Many patients prefer it due to its safety profile, quick recovery, and the ability to achieve visible improvements without the need for extensive surgical intervention, as we have shown with our patient cohort. As the technique continues to develop, it is increasingly being integrated into the comprehensive management of facial aging. However, further research and longitudinal studies are necessary to fully establish its long-term efficacy and optimal patient selection criteria. Declarations Ethics approval The Ethics Committee has confirmed that ethical approval is waived. Consent to participate Informed consent was obtained from all individual participants included in the study. Consent to publish The authors affirm that subject provided informed consent for publication of the images in Figs. 2, 3 and 4. Clinical trial number Not applicable Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution R.K. Manuscript writing and study designA.K. Data collection and performing the researchG.C. Patient recruitment and performing the researchG.A.S Patient rectruitment and performing the researchM.E. 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World J Biol Pharm Heal Sci. ;16(3):23-41.10.30574/wjbphs.2023.16.3.0496 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Mar, 2026 Reviews received at journal 27 Mar, 2026 Reviewers agreed at journal 19 Mar, 2026 Reviewers invited by journal 17 Mar, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9050373","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":609057713,"identity":"6a7ad571-fa42-4ec9-854e-cdaa67b56e9d","order_by":0,"name":"Reem Karami","email":"","orcid":"","institution":"The Ghanem Clinic","correspondingAuthor":false,"prefix":"","firstName":"Reem","middleName":"","lastName":"Karami","suffix":""},{"id":609057715,"identity":"4cbb035e-4cf9-438c-87c8-6b9900314a2d","order_by":1,"name":"Ahmad Kassas","email":"","orcid":"","institution":"The Ghanem Clinic","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Kassas","suffix":""},{"id":609057717,"identity":"c21cc5eb-0586-4d23-bab7-90411323c730","order_by":2,"name":"Ghassan Abu Sittah","email":"","orcid":"","institution":"American University of Beirut Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ghassan","middleName":"Abu","lastName":"Sittah","suffix":""},{"id":609057720,"identity":"9bbf348b-f2bc-46ed-bb17-eb008625e50e","order_by":3,"name":"George Christopoulos","email":"","orcid":"","institution":"The Ghanem Clinic","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Christopoulos","suffix":""},{"id":609057740,"identity":"faa7eeb8-eabe-4d87-a620-d7db9fdb46cf","order_by":4,"name":"Mahmoud Elkouly","email":"","orcid":"","institution":"The Ghanem Clinic","correspondingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Elkouly","suffix":""},{"id":609057752,"identity":"9d4d1ca5-3d64-4e37-ab7e-b6d4840220b3","order_by":5,"name":"Zara Nusser","email":"","orcid":"","institution":"The Ghanem Clinic","correspondingAuthor":false,"prefix":"","firstName":"Zara","middleName":"","lastName":"Nusser","suffix":""},{"id":609057755,"identity":"8bc9e5b3-925f-4a74-bf3e-7fcae28744b3","order_by":6,"name":"Ali Ghanem","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYHACxgeMDQwMBhCOBQ8DM2EtzAYHEVokiNLCJoGshbB6/mnHr1V/3GFjt5397MFHN2okZMzZmR8w/KjYhlOLxO2cshsHz6Ql7+zJSzbOOSbBY9nMZsDYc+Y2bmtu56TdONh2ONngQI6ZdG6DBI/BYaB3GNtwa5EHaik42PY/2eD8G/PfRGkxuJ1+jOFg2wE7gxs5ZsxEaTG8ncMscbYtOcHgxhtjaZBfDA6zGRzE5xe52+kPP1S22dkbnM8x/JxTYwNkHH744EcFHu8z8IBjJLEBWewAHvVAwP4ARNrjVzQKRsEoGAUjGgAAqmhZ6Qb8ezAAAAAASUVORK5CYII=","orcid":"","institution":"The Ghanem Clinic","correspondingAuthor":true,"prefix":"","firstName":"Ali","middleName":"","lastName":"Ghanem","suffix":""}],"badges":[],"createdAt":"2026-03-06 12:08:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9050373/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9050373/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106401572,"identity":"7f4b68f1-8fb4-4854-adc3-9694cc3b80c0","added_by":"auto","created_at":"2026-04-08 09:07:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17055,"visible":true,"origin":"","legend":"\u003cp\u003eThe anatominal treatment zones of the lower face of patients undergoing Endolift procedure. Two mandibular zones (zone 1), two submandibular zones (zone 2) and one submental zone (zone 3).\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9050373/v1/8457294c5d16093aaf2c8b60.jpg"},{"id":105763871,"identity":"05e0392f-f9de-423f-a970-bd91027efd34","added_by":"auto","created_at":"2026-03-30 19:21:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":180105,"visible":true,"origin":"","legend":"\u003cp\u003eA. Pre-procedure photograph of a 37-year-old female presenting with a request for improved jawline definition. B. Six-month postoperative result following Endolift treatment.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9050373/v1/8e259dbe1a9c6d0559980ac9.jpg"},{"id":105904193,"identity":"abe6726d-5d38-4f19-a962-0953e4745847","added_by":"auto","created_at":"2026-04-01 10:06:04","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":174933,"visible":true,"origin":"","legend":"\u003cp\u003eA. Pre-procedure photograph of a 33-year-old female presenting with double chin and laxity of the jowls. B. Six-month postoperative result following Endolift treatment showing enhanced jawline definition.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9050373/v1/36c98193b6a73504a11edc51.jpg"},{"id":105763873,"identity":"dcfb83d1-1422-4057-be30-fb5be543d3fd","added_by":"auto","created_at":"2026-03-30 19:21:09","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":70792,"visible":true,"origin":"","legend":"\u003cp\u003eVolumetric assessment using 3D imaging with Vectra H2 (Canfield Scientific, Parsippany, N.J) comparing the pre and post procedure volme of the jowl area. Analysis revealed a 4.2 cc reduction in the jowl area volume following the Endolift procedure.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9050373/v1/65ae2f21bbaf3321a0b827a3.jpg"},{"id":105763874,"identity":"2d6ad785-ec84-495d-8e6c-e654a2545ceb","added_by":"auto","created_at":"2026-03-30 19:21:09","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":96494,"visible":true,"origin":"","legend":"\u003cp\u003eThe average FACE-Q® scores for facial appearance demonstrated a progressive improvement at pre-treatment, 3 months post-treatment, and 6 months post-treatment\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9050373/v1/2db549660022530cdb265e51.jpg"},{"id":106405336,"identity":"ef0f57ed-8718-4453-8c60-1c7af338d552","added_by":"auto","created_at":"2026-04-08 09:25:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1047359,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9050373/v1/81321675-b184-4a2e-9aa0-6c615d78fa59.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"1470 nm Diode laser for enhancement of the Lower Face: a prospective evaluation with patients’ and physicians’ reported outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe lower face and neck, particularly the mandibular border, are central to facial aesthetic harmony. A youthful jawline is defined by a sharp inferior mandibular contour without cutaneous redundancy or jowl formation\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Age-related loss of definition reflects a multifactorial, three-dimensional process involving skeletal resorption, soft tissue descent, and cutaneous degeneration\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Intrinsic and extrinsic aging mechanisms contribute to dermal thinning, reduced elasticity, and progressive laxity. Simultaneously, volumetric redistribution of fat compartments, attenuation of retaining ligaments, weakening of the mandibular septum, and mandibular recession collectively promote lower facial ptosis \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Collectively, these factors play a significant role in aging of the lower face \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The mandibular ligament is a key structural determinant in jowl development. As described by Furnas \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, it consists of deep and superficial components. The deep layer provides firm fixation of the platysma and depressor musculature to the mandible and is central to deep-plane rhytidectomy techniques. The superficial component comprises retinacular cutis fibers tethering the dermis to the platysma, influencing lower facial contour dynamics \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe face, being our most prominent feature, holds a significant cosmetic and psychosocial importance for individuals \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Current approaches to rejuvenating the lower face and neck include non-surgical treatments, minimally invasive options, and surgical interventions. While facelifts and neck lifts can effectively address age-related changes and enhance youthful appearance, some patients may find them undesirable due to the increased downtime, higher costs and elevated risk of complications \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. There is a growing demand for non-surgical aesthetic solutions that is evidenced by the substantial expansion of this field over the past decade \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe subdermal use of the 1470 nm diode laser for is a minimally invasive outpatient treatment designed to address skin aging. This technique employs the use of micro-optical fibers inserted beneath the skin to deliver energy at a 1470 nm wavelength. This targeted energy promotes collagen remodeling and skin tightening, resulting in a rejuvenated, more youthful appearance \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. This study aims to retrospectively evaluate the efficacy of this procedure in addressing lower facial skin laxity, with the aim of establishing an evidence base for this technology.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis study conducted at our clinic in London, United Kingdom, with the aim of evaluating the efficacy and safety of the 1470 nm diode laser in the management of lower facial laxity. We identified patients who had previously voluntarily presented to our plastic surgery clinic with concerns about sagging or laxity in the lower face. Inclusion criteria included both male and female patients with mild to moderate laxity who underwent skin tightening with the 1470 nm diode laser. Patients with severe laxity, those who had undergone previous facial procedures in the targeted area, or individuals who received combination treatments involving other aesthetic modalities in the lower face or neck were excluded from the study to ensure a homogeneous sample and to better isolate the effects of the laser alone.\u003c/p\u003e \u003cp\u003eThe primary objective was to assess the degree of aesthetic improvement following treatment, utilizing patient-reported outcomes, clinician evaluations, and objective measurements. Prior to treatment all patients completed the FACE-Q\u0026reg; questionnaire, specifically the satisfaction with facial appearance scale. This is a validated patient-reported outcome measure used to evaluate satisfaction with overall facial appearance. It consists of 10 questions which generated a converted numerical score, with a scale of 0 to 100, that served as the baseline measurement. Standardized two- and three - dimensional (2D and 3D) photographs were also captured at presentation. Follow-up FACE-Q\u0026reg; assessments and photographs were obtained at 3 and 6 months post-treatment. Additionally, three independent plastic surgeons evaluated the pre- and 6 months post-treatment photographs using the Global Aesthetic Improvement Scale (GAIS), a five point scale ranging from worse to very much improved.\u003c/p\u003e \u003cp\u003eThe procedure was performed using the Eufoton\u0026reg; LASEmaR\u0026reg; 1500 system under local anesthesia. A total of 10 ml of local anesthetic was administered, consisting of 8 ml of normal saline solution combined with 2 ml of 1% Lidocaine without adrenaline. The lower face was divided into five anatomical treatment zones: two mandibular zones, two submandibular zones, and one submental zone (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDevice settings per anatomical area followed the inbuilt manufacturer\u0026rsquo;s device settings for these areas at level 3. This included a power of 4\u0026ndash;7 Watts and pulse duration of 100\u0026ndash;300 milliseconds. The energy delivered per treatment area ranged between 300\u0026ndash;400 Joules, with the total delivered energy to be 1500 Joules. The fiber used was the standard 300 microns in diameter. These fibers are sterile and designed for single use. Laser energy is delivered through the tip of the optical fiber, which is moved in a fan-shaped motion to evenly disperse the energy and ensure all targeted areas are treated effectively. Each patient received one treatment session.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 26 patients were included in this study, consisting of 24 women and 2 men, with ages ranging from 32 to 64 years. All participants were in good general health, with no underlying co-morbidities. The procedure was performed as an outpatient treatment, allowing patients to return home shortly after completion. Figures\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e display pre- and post-procedure images of two of our patients. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e provides a volumetric assessment using 3D imaging with Vectra H2 (Canfield Scientific, Parsippany, N.J), revealing a 4.2 cc reduction in the jowl area volume following the Endolift procedure.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eFACE-Q® Patient Assessment\u003c/h3\u003e\n\u003cp\u003eRegarding patient-reported outcomes assessed using the validated FACE-Q\u0026reg; questionnaire for overall satisfaction with facial appearance, the pre-treatment scores averaged 47, reflecting the baseline level of satisfaction with facial appearance prior to undergoing the Endolift\u0026reg; procedure. This initial score indicates a moderate level of concern or dissatisfaction, which motivated the patients to seek treatment. At the 3-month postoperative mark, the average FACE-Q\u0026reg; score increased to 54, suggesting that patients perceived a noticeable and meaningful improvement in their facial aesthetics. By the 6-month follow-up, the scores continued to rise further, reaching an average of 62 (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This sustained and progressive increase in scores over time suggests a continued enhancement in patient satisfaction beyond the immediate recovery period.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePhysician Assessment\u003c/h3\u003e\n\u003cp\u003eThree independent plastic surgeons evaluated the 2D and 3D photographs of the patients, all of whom were blinded to the timing of the intervention to minimize assessment bias and ensure objectivity. The detailed results of their evaluations are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Notably, none of the physicians observed any deterioration in facial aesthetics following the treatment. Furthermore, no patients were rated as \u0026ldquo;very much improved,\u0026rdquo; which aligns with the typical expected outcomes of energy-based devices that aim to enhance skin quality and contour rather than achieve dramatic, full correction of laxity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePhysician assessment of paitents pre treatment and 6 months post treatment photographs, blinded to treatment time.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGlobal Aesthetic improvement scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePercentage of patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysician 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysician 3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorsened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnchanged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuch improved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery much improved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common finding across all evaluations was an improvement in facial aesthetics after the procedure. Specifically, Physician 1 noted improvement in 61.4% of patients, Physician 2 observed similar gains in 64.5%, and Physician 3 reported improvements in 74.2%. These rates highlight that a significant proportion of patients experienced noticeable benefits in facial appearance. Meanwhile, a subset of patients\u0026mdash;25.8%, 22.6%, and 19.4% respectively\u0026mdash;were rated as unchanged, indicating minimal or no visible change in their photographs. The remaining patients, representing 12.9%, 12.9%, and 6.4%, were classified as \u0026ldquo;much improved,\u0026rdquo; suggesting some patients achieved appreciable aesthetic enhancement, although not to a full or dramatic extent.\u003c/p\u003e\n\u003ch3\u003eComplications\u003c/h3\u003e\n\u003cp\u003eDuring the follow-up period, patients reported mild post-procedure pain, swelling, bruising and discomfort that persisted for a few days. All symptoms resolved within 5\u0026ndash;7 days after the procedure. We had two patients who had experienced temporary unilateral neuropraxia of the marginal mandibular nerve, necessisating botulinum toxin injection to the contralateral side for symmetrization. Full recovery and symmetry of the mouth movement was reported after 6 weeks in one patient and 10 weeks in the other.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe lower face continues to pose a significant treatment challenge for plastic surgeons, owing to its complex anatomy and wide range of available treatment modalities. Surgical interventions, such as deep plane facelifts with soft tissue repositioning, skin tightening, and volume restoration through fat grafting, remain the gold standard for significant rejuvenation, delivering the most dramatic and durable results. However, the inherent invasiveness, longer recovery times, and higher costs associated with surgery often deter many patients, especially those seeking minimal downtime or concerned about surgical risks. Consequently, non-surgical and minimally invasive options have gained popularity, including botulinum toxin, dermal fillers, radiofrequency devices, ultrasound, and laser technologies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Energy-based devices offer a promising middle ground, targeting skin laxity with minimal recovery.\u003c/p\u003e \u003cp\u003eThe 1470 nm diode laser exemplifies this trend and offers a dependable alternative for patients with mild to moderate skin laxity of the lower face. The mechanism of action of the laser is multifacated and can be summarized into three primary effects. First, the high absorption coefficient of the 1470 nm wavelength by water molecules which generates controlled thermal energy, inducing collagen fiber contraction. Second, the delivery of laser energy creates micro-injuries within the deep dermal layers, initiating a wound-healing cascade that stimulates neocollagenesis. Third, the procedure induces lipolysis, facilitating the emulsification and subsequent resorption of small localized fat deposits \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The subdermal laser operates on the fibroseptal network described by Minelli et al. \u003csup\u003e8\u003c/sup\u003e, primarily functioning through a stimulatory mechanism. It activates and enhances the existing fibroseptal structures without inducing significant fibrosis or scarring. This targeted stimulation promotes tissue tightening and rejuvenation while avoiding the formation of dense, fixed scar tissue that could impair future surgical procedures.\u003c/p\u003e \u003cp\u003eNilforoushzadeh et al.\u003csup\u003e17\u003c/sup\u003e, similar to our study, explored the use of the laser to address jowling. In their study, patients\u0026rsquo; biometric characteristics were assessed using the VisioFace 1000 D, the multi-probe adapter Cutometer (Courage \u0026amp; Khazaka Electronics, Cologne, Germany), and a skin ultrasound imaging system (TPM, L\u0026uuml;neburg, Germany) to measure skin layer thickness and elasticity. Results demonstrated increased density in both the dermis and epidermis. The study also reported a 90% patient satisfaction rate; however, it was unclear how this figure was derived or whether a validated questionnaire was used to assess satisfaction. Additionally, the findings are limited by the small sample size of only nine participants, which restricts the generalizability of the results to a broader population.\u003c/p\u003e \u003cp\u003eThe versatility offered by the diode laser is particularly valuable for aesthetic practitioners, as it broadens the range of treatments achievable with a single device. Numerous case series have been published to evaluate its efficacy across different areas of the face. For example, Nilforoushzadeh et al. \u003csup\u003e18\u003c/sup\u003e conducted a study assessing its the effectiveness in treating nasolabial folds and marionette lines. The results were promising, demonstrating improvements in skin thickness and high patient satisfaction. However, similar to earlier studies, this research was limited by a small sample size and lacked objective measures for grading patient satisfaction. Conversely, Lotfi et al. \u003csup\u003e19\u003c/sup\u003e evaluated the improvement of the upper face, providing more objective data by measuring eyebrow position\u0026mdash;specifically, eyebrow height from the center of the pupil in medial, central, and lateral regions. They reported a 71.5% improvement in these measurements, indicating effective results in this area.\u003c/p\u003e \u003cp\u003eWe believe our study offers more comprehensive and reliable results compared to existing literature, particularly due to its larger sample size of 26 patients and the implementation of standardized assessment tools, such as the FACE-Q\u0026reg; questionnaire and GAIS scores. These tools provide validated measures of patient satisfaction and aesthetic improvement, enhancing the objectivity of our findings. Limitations of this study include its relatively short follow-up period which restricts our capacity to determine the long-term durability of outcomes. Moreover, there is a potential for observer bias of the plastic surgeons assessing the pictures, despite efforts to employ validated subjective tools.\u003c/p\u003e \u003cp\u003eThere is a scarcity in data about the diode laser, with most studies being case series of small sizes. A recent systematic review evaluating the current evidence surrounding it highlighted a significant gap in high-quality, randomized controlled trials. The review emphasized that the existing literature is primarily composed of small case series and observational studies, which limits the strength and generalizability of the conclusions regarding the procedure\u0026rsquo;s safety and efficacy. This paucity of rigorous scientific data accenuates the need for larger, prospective, and controlled studies to better understand the long-term outcomes and to firmly establish the role of the laser in minimally invasive facial rejuvenation \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis review also noted that none of the included studies reported any adverse outcomes. This finding aligns with previous reviews that concluded adverse events associated with laser treatments are generally mild and self-limiting \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. However, it is important to acknowledge the potential for both reporting and publication bias, as thermal energy from laser procedures can, in certain cases, lead to adverse effects such as skin burns, seromas, hematomas, neuropraxia, and local infection \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. In our series, we had two serious complications of injury to the marginal mandibular nerve that recovered within 10 weeks. Although the literature does not address nerve injury as something common, there have been many cases of neuropathy related to the marginal mandibular nerve, causing paresthesia, paresis and even muscle paralysis \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. It is important to emphasize this to help raise awareness among practitioners using the device, thereby promoting safer application and better patient outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe 1470 nm diode laser is a minimally invasive technique that has demonstrated encouraging results in improving signs of lower face aging. The procedure offers several advantages, including minimal downtime and a low complication rate, making it an attractive alternative to more invasive surgical options. Many patients prefer it due to its safety profile, quick recovery, and the ability to achieve visible improvements without the need for extensive surgical intervention, as we have shown with our patient cohort. As the technique continues to develop, it is increasingly being integrated into the comprehensive management of facial aging. However, further research and longitudinal studies are necessary to fully establish its long-term efficacy and optimal patient selection criteria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval\u003c/h2\u003e \u003cp\u003eThe Ethics Committee has confirmed that ethical approval is waived.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish\u003c/strong\u003e \u003cp\u003e The authors affirm that subject provided informed consent for publication of the images in Figs.\u0026nbsp;2, 3 and 4.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eR.K. Manuscript writing and study designA.K. Data collection and performing the researchG.C. Patient recruitment and performing the researchG.A.S Patient rectruitment and performing the researchM.E. Data collectionZ.N. Data collection and analysisA.G.Patient recruitment and study design\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEllenbogen R, Karlin JV (1980) Visual criteria for success in restoring the youthful neck. \u003cem\u003ePlastic and reconstructive surgery.\u003c/em\u003e ;66(6):826-837.10.1097/00006534-198012000-00003\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSwift A, Liew S, Weinkle S, Garcia JK, Silberberg MB (2021) The facial aging process from the inside out. \u003cem\u003eAesthetic surgery journal.\u003c/em\u003e ;41(10):1107-1119.10.1093/asj/sjaa339\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-Varela-G\u0026oacute;mez F, Sandoval-Garc\u0026iacute;a A, Cabrera-Rios KV (2024) Signs of skin aging: a review. Int J Res Med Sci 12(7):2674\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHussein RS, Bin Dayel S, Abahussein O, El-Sherbiny AA (2025) Influences on skin and intrinsic aging: biologicnvironmental, and therapeutic insights. \u003cem\u003eJournal of Cosmetic Dermatology.\u003c/em\u003e ;24(2):e16688.10.1111/jocd.16688\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman SR, Grover R (2006) The anatomy of the aging face: volume loss and changes in 3-dimensional topography. \u003cem\u003eAesthetic surgery journal.\u003c/em\u003e ;26(1_Supplement):S4-S9.10.1016/j.asj.2005.09.012\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomo T, Yalamanchili H, Sclafani AP (2005) Chin and prejowl augmentation in the management of the aging jawline. \u003cem\u003eFacial plastic surgery.\u003c/em\u003e ;21(01):38-46.10.1055/s-2005-871762\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFurnas DW (1989) The retaining ligaments of the cheek. \u003cem\u003ePlastic and reconstructive surgery.\u003c/em\u003e ;83(1):11-16.10.1097/00006534-198901000-00003\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinelli L, Yang H-M, van der Lei B, Mendelson B (2023) The surgical anatomy of the jowl and the mandibular ligament reassessed. \u003cem\u003eAesthetic plastic surgery.\u003c/em\u003e ;47(1):170-180.10.1007/s00266-022-02996-3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZargaran D, Zoller F, Zargaran A, Weyrich T, Mosahebi A (2022) Facial skin ageing: Key concepts and overview of processes. \u003cem\u003eInternational journal of cosmetic science.\u003c/em\u003e ;44(4):414-420.10.1111/ics.12779\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacono AA, Malone MH, Lavin TJ (2017) Nonsurgical facial rejuvenation procedures in patients under 50 prior to undergoing facelift: habits, costs, and results. \u003cem\u003eAesthetic Surgery Journal.\u003c/em\u003e ;37(4):448-453.10.1093/asj/sjw217\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorduff N (2023) Surgical or nonsurgical facial rejuvenation: the patients\u0026rsquo; choice. \u003cem\u003ePlastic and Reconstructive Surgery\u0026ndash;Global Open.\u003c/em\u003e ;11(10):e5318.10.1097/GOX.0000000000005318\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFitzgerald R, Graivier MH, Kane M et al (2010) Surgical versus nonsurgical rejuvenation. \u003cem\u003eAesthetic Surgery Journal.\u003c/em\u003e ;30(1_Supplement):28S-30S.10.1177/1090820X10373365\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarkabayeva A, Kaliterna D, Karimov S, Abdelmaksoud A, Kamalska M, Binić I (2023) Topical treatment of cutaneous ptosis: Endolift\u0026reg; treatment with 1470-nm wavelength Eufoton\u0026reg; LASEmaR\u0026reg; 1500. \u003cem\u003eJournal of Applied Cosmetology.\u003c/em\u003e ;41(1):45/48\u0026thinsp;\u0026ndash;\u0026thinsp;45/48.10.56609/jac.v41i1.69\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagacho-Vieira FN, Bezerra LJR, Boro D, Santos FA (2024) Revitalizing the lower face: Therapeutic insights and an innovative treatment guideline for jowl rejuvenation. \u003cem\u003eJournal of Cosmetic Dermatology.\u003c/em\u003e ;23(6):1969-1972.10.1111/jocd.16263\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenar H, Benar EB (2024) A new nonsurgical combination approach for skin tightening and remodeling; Endoskin\u0026mdash;A comparative study. \u003cem\u003eJournal of Cosmetic Dermatology.\u003c/em\u003e ;23(8):2574-2580.10.1111/jocd.16306\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKubik P, Gruszczyński W, Łukasik B Assessment of Safety and Mechanisms of Action of the 1470 nm LaserMe Device. Clin Case Rep Int (2024) ; \u003cem\u003e8.\u003c/em\u003e 2024;1683.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNilforoushzadeh MA, Heidari-Kharaji M, Fakhim T, Hanifnia A, Nouri M, Roohaninasab M (2022) Endolift laser for jowl fat reduction: clinical evaluation and biometric measurement. \u003cem\u003eLasers in Medical Science.\u003c/em\u003e ;37(5):2397-2401.10.1007/s10103-021-03494-9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNilforoushzadeh MA, Heidari-Kharaji M, Fakhim T et al (2023) Efficacy evaluation of endolift laser for treatment of nasolabial folds and marionette lines. \u003cem\u003eSkin Research and Technology.\u003c/em\u003e ;29(10):e13480.10.1111/srt.13480\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLotfi E, DellAvanzato R, Ahramiyanpour N, Shadmanyazdi F, Khosravi S (2023) Evaluation of eyebrow position and upper eyelid laxity after endolift laser treatment. \u003cem\u003eSkin Research and Technology.\u003c/em\u003e ;29(10):e13498.10.1111/srt.13498\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eModena DAO, de Melo Yamamoto AP, da Silva TBF (2025) Endolift\u0026reg; is a non-surgical treatment for skin tissue conditions. Is there evidence for its application? \u003cem\u003eLasers in Medical Science.\u003c/em\u003e ;40(1):22.10.1007/s10103-025-04288-z\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNilforoushzadeh MA, Heidari A, Ghane Y et al (2024) The endo-lift laser (intralesional 1470 nm diode laser) for dermatological aesthetic conditions: a systematic review. \u003cem\u003eAesthetic Plastic Surgery.\u003c/em\u003e ;48(23):5097-5114.10.1007/s00266-024-04082-2\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProhaska J, Hohman MH (2018) Laser complications. \u003cem\u003eStat Pearls.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003edos Santos Borges F, Jahara RS, Meyer PF, de Almeida ACT, Almeida M, Mendon\u0026ccedil;a AC (2023) Complications from laser Endolift use: Case series and literature review. \u003cem\u003eWorld J Biol Pharm Heal Sci.\u003c/em\u003e ;16(3):23-41.10.30574/wjbphs.2023.16.3.0496\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Diode lase, Subdermal Laser, Jowl, Jawline, Lower face laxity","lastPublishedDoi":"10.21203/rs.3.rs-9050373/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9050373/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLower facial aging and loss of jawline definition are common concerns among many patients. While surgical procedures offer definitive correction, many individuals seek minimally invasive options with shorter recovery times. The 1470-nm diode laser aims to address this by promoting skin tightening and restoration of the mandibular contour.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eEvaluate the efficacy and safety of this laser in the treatment of mild to moderate lower facial laxity using validated patient-reported outcomes and independent clinician assessments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe identified patients with mild to moderate lower facial laxity who underwent a single treatment; those with severe laxity, previous procedures in the treatment area, or used combined modalities were excluded. Assessments included the FACE-Q\u0026reg; Satisfaction with Facial Appearance scale and standardized 2D/3D photography at baseline, 3 months, and 6 months. Three independent plastic surgeons, blinded to timing, evaluated pre- and post-treatment images using the Global Aesthetic Improvement Scale (GAIS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwenty-six patients were included. FACE-Q\u0026reg; scores improved from a baseline mean of 47 to 54 at 3 months and 62 at 6 months. GAIS evaluations showed aesthetic improvement in 61\u0026ndash;74% of patients, with no cases of worsening. Two patients developed temporary marginal mandibular neuropraxia, resolving by 6\u0026ndash;10 weeks.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ethe 1470 nm diode laser demonstrated measurable improvement in lower facial laxity with minimal downtime and acceptable safety. It represents a promising minimally invasive alternative for selected patients, although longer-term and controlled studies are needed to validate durability and refine indications.\u003c/p\u003e","manuscriptTitle":"1470 nm Diode laser for enhancement of the Lower Face: a prospective evaluation with patients’ and physicians’ reported outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-30 19:21:01","doi":"10.21203/rs.3.rs-9050373/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-28T14:45:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-27T16:53:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194985127933959921673532697429843322338","date":"2026-03-19T17:38:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T17:33:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T05:48:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T05:47:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Plastic Surgery","date":"2026-03-06T11:59:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ece2fabe-cafe-431f-9461-5ac4190da27b","owner":[],"postedDate":"March 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T01:24:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-30 19:21:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9050373","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9050373","identity":"rs-9050373","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}