Defining Skin Quality and Optimizing Outcomes With Multimodal Aesthetic Strategies

Skin quality remains a central focus in aesthetic dermatology, encompassing texture, tone, and mechanical properties such as firmness and elasticity, according to Brian Hibler, MD, FAAD​, during his session, “Rapid Rise of ‘Skin Quality’ Treatments.”​ The session emphasized that no single modality could address all aspects of skin quality, underscoring the need for combination approaches.

Skin quality was defined by features including “smooth,” “even surface,” and “small pores,” alongside even pigmentation, radiance, and reduced redness. Mechanical characteristics—tightness, elasticity, and lack of sagging—were also highlighted as essential components.

Lasers were identified as a primary tool, with Dr Hibler stating that “lasers are the most important tool in skin quality treatments.” However, limitations were noted, as lasers “cannot provide significant lifting, volume restoration, and relaxation of dynamic lines.” This reinforces the need for adjunctive therapies.

A comprehensive laser approach requires targeting multiple chromophores. Effective photorejuvenation involves hemoglobin, melanin, and water, with the caveat that “no one laser/wavelength meets all of these objectives on its own.” Selection depends on lesion type, depth, and patient skin type.

For vascular lesions, targeting oxyhemoglobin at specific wavelengths allows vessel clearance through intravascular thrombosis. In pigmentary conditions, wavelength selection must align with lesion depth and skin phototype, with shorter wavelengths for superficial pigment and longer wavelengths for deeper or darker skin types.

Non-ablative fractional lasers were highlighted for their role in inducing dermal remodeling through controlled thermal injury. The 1927 nm thulium laser was noted as particularly effective for dermatoheliosis and actinic keratoses, with low downtime and a favorable safety profile.

Beyond lasers, the presentation emphasized synergistic treatments. Microneedling, chemical peels, neuromodulators, hyaluronic acid fillers, and energy-based devices each target different aspects of skin quality. For example, microneedling improves texture and pores, while neuromodulators “soften dynamic lines” and fillers enhance contour and light reflection.

Dr Hibler concluded that skin quality requires a multimodal approach and combining therapies can optimize outcomes. Early intervention with less aggressive treatments may help delay visible aging changes.

Reference
Hibler B. Rapid rise of “skin quality” treatments. Presented at: Music City SCALE Symposium; May 13–17, 2026; Nashville, TN.