2.2. Procedure

AMSC-MP was obtained from the Tissue Bank and Regenerative Medicine Department, Dr. Soetomo Teaching Hospital, Surabaya. This study used α-tocopherol as the vitamin E. The AMSC-MP was obtained legally pursuant to the standard for the tissue donor and stem cell culture. The combination was gel with a mixture of 9.2 ml AMSC metabolite products, 0.1 ml vitamin E, and 0.8 mg sodium alginate. The mixture was made at the Tissue Bank and Regenerative Medicine Department, Dr. Soetomo Teaching Hospital, Surabaya. The mixture was dosed 2 ml per application measured using a 3 ml sterile syringe.

All the participants had understood the research procedure before the treatment began. The participants were examined using a Janus 3D Facial Analysis System before having treatment to obtain objective baseline data (observation 1). We measured wrinkle, polarized spot, UV spot, and pore category. Thereafter, all participants had facial skincare (priming) with tretinoin 0.025% cream and SPF 30 sunscreen cream for two weeks before treatment.

The combination of AMSC-MP and vitamin E or the AMSC-MP alone was applied after the laser fractional CO₂ laser by Fraxis® as LADD. The laser parameter was 6.6–10 mJ with 1 stack, 1 pass, and 1 mm distance. Both groups were treated 3 times with an interval of 4 weeks. All participants were instructed to use sunscreen every day and tretinoin 0.025% every day and start from the first week after treatment. The progression of wrinkle, polarized spot, UV spot, and pores was assessed on 4th week after first treatment (observation 2) and 4th week after the third treatment (observation 3).