A Systematic Review of Unintended Pigmentary Changes Following Popular, Minimally Invasive Skin-Tightening Procedures
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Background: Minimally invasive energy-based aesthetic procedures are increasingly used for skin tightening and tissue remodeling. However, unintended pigmentary complications remain a clinical concern, particularly among individuals with darker Fitzpatrick skin phototypes. Objective: To systematically review the reported pigmentary complications, associated risk factors, clinical characteristics, and preventive or corrective strategies following minimally invasive energy-based skin-tightening procedures. Methods: A systematic review informed by PRISMA 2020 was conducted using PubMed/MEDLINE, Embase, Scopus, and Web of Science. The search was performed in January 2026 and covered publications from January 2022 to January 2026. Eligible evidence was evaluated through independent screening, data extraction, and design-specific methodological appraisal using the Newcastle–Ottawa Scale, AMSTAR 2, and Joanna Briggs Institute checklists. Findings were synthesized narratively because of methodological and clinical heterogeneity. Results: Six publications were synthesized, comprising a retrospective cohort, an experimental and clinical investigation, two case reports, and two reviews. The largest explicitly reported primary cohort included 186 patients. Post-inflammatory hyperpigmentation was the principal cutaneous complication described. Potential contributing factors included thermal energy delivery, treatment intensity, procedural technique, and skin phototype. Evidence concerning insulated radiofrequency delivery, adjunctive photobiomodulation, and topical management suggested possible preventive or corrective benefits. However, inconsistent outcome reporting and limited comparative data prevented reliable estimation of complication incidence or comparative treatment effects. Conclusion: Pigmentary complications are clinically relevant following energy-based aesthetic procedures, particularly in patients susceptible to post-inflammatory pigmentation. Standardized prospective investigations are needed to quantify risks and evaluate prevention strategies
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