Introduction

Photobiomodulation (PBM) therapy, previously known as low-level laser therapy, has gained recognition as a non-invasive therapeutic modality for enhancing postoperative recovery. PBM utilizes specific wavelengths of light to induce photochemical and photophysical reactions at the cellular level, promoting tissue repair, reducing inflammation, and modulating pain. Its applications span across various medical fields, including dermatology, oral surgery, and plastic surgery, making it a valuable adjunct to facial procedures that often involve delicate and highly visible areas of the body (1).

The mechanisms underlying PBM therapy are rooted in its interaction with mitochondrial chromophores, particularly cytochrome c oxidase. Upon absorption of light, this interaction stimulates adenosine triphosphate (ATP) production, enhances cellular respiration, and activates signaling pathways involved in cell proliferation and migration. These cellular effects contribute to faster wound healing, reduced inflammatory responses, and increased tissue resilience, which are critical in facial procedures where recovery impacts both function and aesthetics (2). Moreover, PBM has demonstrated a capacity to modulate fibroblast activity, collagen synthesis, and angiogenesis, all of which are integral to optimal postoperative outcomes.

Facial procedures, ranging from minimally invasive interventions such as botulinum toxin injections to complex reconstructive surgeries, present unique challenges in postoperative care. The facial region is not only anatomically intricate but also prone to edema, bruising, and scarring due to its rich vascular and lymphatic networks. PBM therapy offers an innovative approach to mitigating these challenges, as it has shown efficacy in reducing postoperative pain, minimizing swelling, and enhancing wound healing in various clinical studies (3). Additionally, its non-invasive nature and absence of significant side effects make it an attractive option for patients undergoing aesthetic or reconstructive facial procedures.

Clinical studies have highlighted the potential of PBM in specific contexts, such as enhancing recovery following rhinoplasty, reducing scarring after dermal resurfacing, and managing postoperative complications in maxillofacial surgeries. For instance, patients treated with PBM after facial surgeries often report lower pain scores and faster resolution of swelling compared to those receiving standard postoperative care alone (4). Furthermore, the advent of advanced PBM devices with adjustable wavelengths and power densities has enabled precise application tailored to individual patient needs and specific procedural outcomes. Despite the promising outcomes associated with PBM, its adoption in routine clinical practice remains inconsistent. Variability in treatment protocols, such as differences in light wavelengths, power densities, and application durations, has led to heterogeneity in reported outcomes. Additionally, the lack of standardized guidelines for PBM in postoperative facial care highlights the need for further research and consensus among clinicians.

Review

PBM has emerged as a promising therapeutic intervention for optimizing postoperative recovery in facial procedures, particularly in enhancing tissue healing and minimizing common complications such as pain and edema. The interaction of specific light wavelengths with mitochondrial chromophores, primarily cytochrome c oxidase, facilitates ATP production and reactive oxygen species modulation, promoting cellular repair and anti-inflammatory effects. These mechanisms have been validated in clinical studies demonstrating accelerated wound healing and reduced postoperative complications in patients undergoing facial surgeries (1, 5). Additionally, PBM has shown significant promise in reducing pain, a frequent concern in facial procedures, by modulating nociceptive pathways and decreasing pro-inflammatory cytokine activity.

Clinical applications of PBM in facial procedures highlight its potential to address unique anatomical challenges. For instance, its use in rhinoplasty and other maxillofacial surgeries has been associated with reduced swelling and improved scar quality, emphasizing its role in enhancing both functional and aesthetic outcomes (6). However, the heterogeneity in treatment protocols, including variations in wavelength, dose, and duration, poses a challenge to standardizing its use. Future studies should aim to establish evidence-based guidelines to optimize PBM protocols, ensuring consistent and reproducible outcomes across diverse patient populations and surgical interventions.

Mechanisms of Photobiomodulation in Tissue Repair and Healing

PBM operates through intricate cellular and molecular mechanisms that facilitate tissue repair and accelerate healing processes. The primary interaction occurs at the mitochondrial level, where light photons, especially within the red and near-infrared spectrum, are absorbed by cytochrome c oxidase. This enzyme, a crucial component of the electron transport chain, responds by enhancing mitochondrial activity, leading to an increase in ATP production. ATP serves as the primary energy source for cellular functions, enabling processes such as proliferation, migration, and protein synthesis, which are critical for tissue repair (7). Beyond energy production, PBM stimulates mitochondrial biogenesis and improves cellular resilience under oxidative stress, creating a favorable environment for recovery.

Another fundamental aspect of PBM's mechanism lies in its ability to modulate ROS. While excessive ROS levels can lead to cellular damage and inflammation, PBM induces a controlled production of ROS that triggers secondary signaling cascades. These cascades activate transcription factors such as nuclear factor erythroid 2-related factor 2 (Nrf2), which upregulates the expression of antioxidant enzymes. This fine balance between ROS production and antioxidant activity contributes to reduced oxidative stress, a key factor in mitigating inflammation and promoting tissue repair after facial procedures (8). PBM also plays a pivotal role in modulating inflammatory responses. It reduces the expression of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), while enhancing the release of anti-inflammatory mediators such as interleukin-10 (IL-10). This shift in cytokine profile alleviates inflammation, minimizes edema, and supports faster recovery. Studies indicate that PBM's effects on inflammation are dose-dependent, with optimal therapeutic windows ensuring enhanced healing without overstimulation or suppression of the immune response (9).

Angiogenesis, the formation of new blood vessels, is another critical mechanism influenced by PBM. The increased availability of ATP and reduced oxidative stress collectively create conditions conducive to endothelial cell proliferation and migration. This process is further supported by the upregulation of vascular endothelial growth factor (VEGF), a key signaling protein in angiogenesis. Enhanced vascularization improves oxygenation and nutrient delivery to the affected tissues, accelerating wound healing and improving the cosmetic and functional outcomes of facial procedures (10). The stimulation of lymphangiogenesis, alongside angiogenesis, is particularly relevant in reducing postoperative edema, a common complication in facial surgeries.

Collagen synthesis and extracellular matrix remodeling represent additional facets of PBM's reparative mechanisms. Fibroblasts, the primary cells responsible for collagen production, exhibit increased activity under PBM exposure. This stimulation not only enhances the production of type I and III collagen but also regulates matrix metalloproteinases (MMPs), enzymes involved in collagen degradation. Balanced collagen turnover ensures improved tensile strength of healing tissues while preventing hypertrophic scarring, which is of particular concern in aesthetically sensitive regions such as the face (11). Moreover, PBM has been shown to influence stem cell activation and differentiation, providing a regenerative boost to damaged tissues. Stem cells residing in the skin, bone marrow, and other niches respond to PBM by proliferating and migrating toward injury sites. These cells contribute to tissue regeneration by differentiating into specialized cells such as keratinocytes, fibroblasts, or endothelial cells, depending on the requirements of the damaged tissue. The recruitment and activation of these cells underline PBM's potential to promote recovery even in complex or chronic wounds.

Applications of Photobiomodulation in Minimizing Postoperative Pain and Swelling

The application of PBM therapy in reducing postoperative pain and swelling has been widely explored across various medical disciplines, including facial and maxillofacial procedures. Pain and swelling are common consequences of surgical interventions, often resulting from localized inflammation, tissue trauma, and vascular disturbances. PBM offers a non-invasive and adjunctive strategy to address these complications by modulating inflammatory pathways, enhancing lymphatic drainage, and influencing neural signaling (12).

One of the primary mechanisms by which PBM alleviates pain is through the modulation of peripheral nerve activity. It reduces nerve excitability and slows the transmission of nociceptive signals to the central nervous system. Studies have shown that PBM decreases the release of pain-mediating neurotransmitters, such as substance P, while upregulating endogenous opioid peptides. This dual effect minimizes the perception of pain and enhances patient comfort during the postoperative period (11). Moreover, PBM promotes the repair of damaged nerve fibers by stimulating Schwann cells, which facilitate nerve regeneration, further contributing to long-term pain reduction. PBM has also demonstrated efficacy in mitigating postoperative swelling. The lymphatic system plays a pivotal role in clearing excess interstitial fluid and inflammatory mediators that accumulate after surgical trauma. PBM enhances lymphatic vessel contraction and improves lymph flow, expediting the resolution of edema. In facial procedures, where swelling can significantly impact recovery and aesthetic outcomes, this effect is particularly advantageous (13). Enhanced lymphatic drainage also reduces localized pressure in inflamed tissues, indirectly alleviating pain caused by mechanical compression of nerve endings.

The anti-inflammatory effects of PBM further underscore its role in minimizing postoperative swelling and pain. PBM reduces the activity of pro-inflammatory cytokines such as interleukin-1 beta (IL-1β) and TNF-α, while promoting anti-inflammatory cytokines like IL-10. This shift in the inflammatory profile dampens the cascade of events that lead to excessive swelling and discomfort. Additionally, PBM has been shown to stabilize cell membranes and mitigate mast cell degranulation, thereby reducing histamine release, which contributes to vascular permeability and subsequent edema (14).

Clinical applications of PBM in facial surgeries provide robust evidence supporting its benefits in postoperative care. For instance, in patients undergoing rhinoplasty or other facial cosmetic surgeries, PBM has been shown to significantly reduce swelling within the first week postoperatively. Similarly, studies in maxillofacial surgery, such as after third molar extractions, have reported substantial pain relief and faster resolution of swelling in patients treated with PBM compared to those receiving conventional care alone (15). These clinical findings not only highlight the therapeutic efficacy of PBM but also underline its potential to enhance patient satisfaction by reducing recovery times and associated discomfort. PBM’s versatility is further demonstrated by its ability to adapt to diverse surgical scenarios. Different wavelengths and dosages can be tailored to address specific postoperative needs, such as controlling pain in areas with high nerve density or managing edema in regions prone to fluid retention. This adaptability, coupled with its non-invasive nature, positions PBM as an appealing option for clinicians seeking to optimize postoperative recovery while minimizing the risk of side effects or complications.

Enhancement of Wound Healing and Scar Reduction with Photobiomodulation

PBM therapy has shown significant potential in enhancing wound healing and minimizing scar formation, particularly in the context of facial surgeries where aesthetic outcomes are paramount. The light wavelengths utilized in PBM penetrate the skin and interact with cellular components to accelerate the repair process while modulating the factors that contribute to scar formation. The therapy is particularly effective in promoting epithelialization, collagen remodeling, and angiogenesis, all of which are critical to the wound healing cascade.

PBM’s ability to enhance wound healing begins with its effect on keratinocytes and fibroblasts, the primary cells involved in skin regeneration. Light absorption stimulates these cells, leading to increased proliferation and migration to the wound site. This is complemented by the upregulation of growth factors such as transforming growth factor-beta (TGF-β) and epidermal growth factor (EGF), which are essential for epithelial repair and the formation of a functional dermal layer (16). Additionally, PBM accelerates the synthesis of extracellular matrix proteins, including collagen and elastin, resulting in stronger and more elastic tissue that better resembles the original skin structure.

Scar formation, often a concern following facial procedures, is closely linked to the balance of collagen types produced during wound healing. Type I collagen, predominant in healthy skin, contributes to tensile strength, while type III collagen, common in early wound healing, is associated with less organized scar tissue. PBM has been found to increase the production of type I collagen while facilitating the transition from type III collagen, thereby improving scar quality and reducing hypertrophic or keloid scars (17). This effect is further supported by the regulation of matrix metalloproteinases (MMPs), enzymes that remodel the extracellular matrix and prevent excessive collagen accumulation.

Another key mechanism by which PBM enhances scar reduction is its impact on angiogenesis. The formation of new blood vessels is vital for delivering oxygen and nutrients to the wound bed, thereby supporting tissue regeneration and reducing ischemic stress. PBM stimulates VEGF expression and endothelial cell proliferation, leading to the development of well-organized capillary networks in the healing tissue (18). Improved angiogenesis not only accelerates wound closure but also ensures that the scar tissue is well-vascularized and less prone to hypoxic-induced fibrosis. The anti-inflammatory properties of PBM further contribute to improved wound healing and scar outcomes. By modulating inflammatory cytokines, PBM reduces the risk of chronic inflammation, which is a known driver of excessive scarring. It also limits oxidative stress in the wound environment by enhancing antioxidant defenses. This dual action creates an optimal environment for healing, where the inflammatory phase resolves efficiently, allowing the proliferative and remodeling phases to proceed unimpeded (18). Such modulation ensures a balance between tissue repair and scar formation, critical in facial surgeries where even minor imperfections can be aesthetically significant.

Clinical evidence supports the role of PBM in wound management and scar reduction. For instance, studies involving patients undergoing facial reconstructive surgeries have demonstrated faster epithelialization and better cosmetic outcomes in those treated with PBM. These findings highlight PBM’s ability to influence both the speed and quality of wound healing, making it an invaluable tool in postoperative care. The non-invasive nature of the therapy, coupled with its minimal risk of adverse effects, further underscores its suitability for managing wounds in highly visible areas such as the face.

Comparative Effectiveness of Photobiomodulation Across Facial Procedures

PBM therapy has found applications across a wide array of facial procedures, demonstrating its versatility and effectiveness in optimizing postoperative outcomes. The varying demands of different surgical and non-surgical interventions provide a unique lens through which the comparative efficacy of PBM can be analyzed. From enhancing recovery in aesthetic surgeries like facelifts to improving healing in maxillofacial reconstructions, PBM exhibits adaptability and consistency in delivering therapeutic benefits.

In facial cosmetic surgeries, such as facelifts and blepharoplasties, PBM has been shown to significantly reduce edema and bruising, two common postoperative concerns. These benefits are attributed to PBM’s capacity to modulate inflammatory pathways and enhance lymphatic drainage. Studies have highlighted that patients treated with PBM following cosmetic facial procedures report shorter recovery times and fewer complications compared to standard postoperative care (19). This improvement is particularly relevant for aesthetic procedures, where minimizing visible signs of surgery is critical for patient satisfaction.

Maxillofacial surgeries, including orthognathic procedures and mandibular reconstructions, present additional challenges such as extensive tissue trauma and the risk of infection. PBM’s ability to stimulate cellular repair mechanisms, reduce bacterial loads, and improve vascularization makes it a valuable adjunct in these contexts. Clinical trials have documented reduced pain and enhanced healing in patients undergoing third molar extractions when treated with PBM, demonstrating its effectiveness even in procedures with significant tissue disruption (20). Furthermore, PBM’s role in minimizing postoperative complications like trismus and alveolar osteitis underscores its utility in maxillofacial care.

Table 1: Summary of Photobiomodulation Applications in Facial Procedures
Aspect	Mechanisms	Applications	Clinical Outcome
Pain Management	Modulation of nociceptive pathways, reduction in substance P, and increase in endogenous opioids.	Postoperative pain relief in surgeries and fillers	Decreased pain scores, faster resolution of discomfort
Swelling Reduction	Enhanced lymphatic flow, reduced inflammatory cytokines, and mast cell stabilization	Management of edema post-surgery	Faster reduction in swelling and improved recovery times
Wound Healing	Increased ATP production, collagen remodeling, and fibroblast stimulation	Healing after reconstructive and cosmetic procedures	Accelerated epithelialization and tissue regeneration
Scar Quality	Promotion of type I collagen synthesis, regulation of MMPs, and reduced oxidative stress	Prevention of hypertrophic or keloid scarring	Improved scar aesthetics, reduced fibrotic tissue
Comparative Effectiveness	Dose-dependent effects tailored to specific procedures	Rhinoplasty, laser resurfacing, orthognathic surgeries	Enhanced outcomes in both surgical and non-surgical contexts

The application of PBM in minimally invasive facial procedures, such as dermal fillers and laser resurfacing, further expands its clinical utility. In laser-based skin resurfacing, for instance, PBM has been employed to reduce erythema and promote faster epithelialization. The therapy’s anti-inflammatory properties play a pivotal role in reducing the severity and duration of redness and discomfort that typically follow these treatments. Patients undergoing PBM after resurfacing report improved skin texture and quicker recovery times, illustrating its adjunctive value in aesthetic dermatology (21).

Comparisons across these procedures highlight the dose-dependent nature of PBM’s effectiveness. Surgical interventions that involve deeper tissue trauma, such as orthognathic surgeries, often require higher energy densities and longer exposure times to achieve optimal results. Conversely, superficial procedures like laser resurfacing benefit from lower dosages tailored to the thinner layers of affected tissue. This flexibility in dosing not only ensures safety but also enhances the precision of PBM application across diverse clinical scenarios. The economic and logistical aspects of integrating PBM into facial procedures also warrant consideration. While PBM devices represent an upfront investment, their ability to reduce recovery times and minimize postoperative complications can translate into cost savings for healthcare providers and patients alike. Moreover, the non-invasive nature of PBM and its compatibility with existing surgical workflows make it an accessible option for clinics and hospitals. Studies have reported high patient compliance and satisfaction rates with PBM, further supporting its adoption in diverse procedural contexts (22).

PBM’s comparative effectiveness is also shaped by patient-specific factors, including age, skin type, and the extent of surgical intervention. Older patients or those with comorbidities may exhibit slower healing rates, making PBM particularly beneficial in accelerating their recovery. Similarly, individuals with sensitive skin prone to hyperpigmentation or scarring may experience better cosmetic outcomes with PBM-supported healing. These personalized advantages highlight the therapy’s broad applicability and its ability to cater to individual patient needs across various facial procedures (Table 1).

Conclusion

Photobiomodulation therapy has emerged as a versatile and effective adjunct in optimizing postoperative recovery for facial procedures. Its multifaceted mechanisms, including pain modulation, inflammation control, and tissue repair enhancement, make it invaluable in both surgical and non-surgical contexts. Clinical evidence supports its efficacy in improving wound healing, minimizing scarring, and reducing recovery times. Future research and standardized protocols will further solidify its role in advancing postoperative care in facial interventions.

Disclosure

Conflict of interest

There is no conflict of interest

Funding

No funding

Ethical consideration

Non applicable

Data availability

Data that support the findings of this study are embedded within the manuscript.

Author contribution

All authors contributed to conceptualizing, data drafting, collection and final writing of the manuscript.