Subdermal 1064-nm Nd:YAG Laser for the Aesthetic Management of Brachial Ptosis: Blinded Clinical Evaluation in 24 Upper Limbs.

Background and objective: Subdermal application of Nd:YAG lasers at wavelengths of 1064, 1320, and 1444 nm has shown promise as a minimally invasive treatment for mild to moderate brachial ptosis. This study explores the efficacy and safety of our procedure, using the 1064 nm wavelength as a standalone modality.

Study design/materials and methods: This was a single-arm, evaluator-blinded clinical trial. A standardized surgical protocol was implemented using subcutaneous delivery of a pure 1064 nm Nd:YAG laser (SP Dynamis, Fotona, Slovenia). The study included 24 upper limbs from 12 female patients diagnosed with stage 2a or 2b brachial ptosis (El Khatib classification). Standardized anthropometric measurements and photographic documentation were obtained at 35 days, 3 months, and 9 months postprocedure. Safety and efficacy were assessed through clinical evaluations and validated patient-reported outcome measures.

Results: Significant esthetic improvements were observed in all treated limbs (p < 0.0001), including reductions in maximum arm circumference (p = 0.0005) and ptosis grade (p = 0.0016) in both arms. The most pronounced changes occurred by Day 35, with additional minor improvements at 3 months that remained stable through the 9-month follow-up. Patient satisfaction was high, and no significant intraoperative or postoperative complications were reported.

Conclusions: Subdermal 1064 nm Nd:YAG laser shows a favorable efficacy and safety profile and, if validated in larger studies, could become a first-line option for mild to moderate brachial ptosis.