|Themes: Aesthetic Mesotherapy, Controversies in Aesthetic Medicine, Combination Therapy.
The majority of modalities used for skin rejuvenation incorporate the wound healing process. Conventional wisdom has leaned towards more is best. The biggest challenge is finding the balance between the degrees of injury (acceptable downtime) and effectiveness (best outcome). Darker skin types limit aggressive treatments. Ablative treatments, e.g. laser resurfacing and deep peeling, while aesthetically effective, may cause epidermal thinning, papillary dermis fibrosis and cicatricial healing. Fractional treatments minimize this effect, but there is still up to 20% coagulation of tissue and the ensuing necrosis stimulates cicatricial healing. Medical needling does exactly the opposite, which is ideal.
Preservation of the epidermis maintains environmental protection and minimizes downtime. There are no reported post treatment pigmentation issues, even with sun exposure. The procedure breaks down scar tissue, allowing reorganization. It can be performed on most areas of the body by individuals with minimal skills and requires minimal capital outlay.
Percutaneous collagen induction uses thousands of tiny needle pricks into the upper dermis to trigger the wound healing cascade. The upregulation of TGF-B3 through this process is thought to be the reason for natural collagen regeneration following needling, as opposed to scar collagen secondary to TGF-B1 and B2 associated with thermal injury.
Understanding the predictable phases of wound healing dictates optimum timing for treatment and modalities to obtain greatest success. Prolonging the inflammatory phase (day 1-5) will result in more growth factors. Photomodulation and lymph drainage are valuable from day 2-14 and then cosmetic rolling combined with Sonophoresis and micro-current are beneficial to assist maximum delivery of nutrients to cells. Collagenase peaks at around day 14 to reorganize collagen fibrils, converting collagen 3 to collagen 1 and it therefore makes no sense to reinjure the skin more frequently than every 30 days.
Collagen synthesis requires Vitamin A (e.g. Retinyl Palmitate, Retinyl Acetate, Retinol or Tretinoin), Vitamin C (e.g. Magnesium Ascorbyl Phosphate, L-Ascorbic Acid), key amino acids (proline & glycine), bioflavonoids, growth factors, selenium, silicon allied with magnesium and calcium, copper peptides, zinc and iron (co-factors), hormones and essential fatty acids (for cell function and membranes). Stem cell products and platelet rich therapy hold enormous promise.
Does depth of injury matter?
To gain some insight, a retrospective study on 44 patients was done using data from Visia Skin Analysis to provide objective numbers. While there are many variables (age, lifestyle, compliance, active ingredients and dose applied topically, duration of treatment etc.) the positive findings are encouraging in that they were obtained, for the most part, under least favorable conditions (compliance).
Methods: Measurements for brown spots, pores, wrinkles, evenness and UV spots were used to determine effectiveness of products alone vs. the use of rollers with 0.2 mm, 0.3 mm, 0.5 mm, 1 mm and 2 mm long needles combined with products.
Editors note: This article was originally published back in 2004, and since that time there has been increasing controversy of both the dangers associated with use and the questionable professional ethics of beauty therapists/aestheticians providing sun bed facilities. With the emergence of new sunbed (Or Solarium) standards in many parts of the world, we thought it would be a good idea to review and update the article.
While tanning booths and sunbeds are a popular revenue earner in many beauty salons, little thought is given to the damage they can cause to the cells of the skin through prolonged or unsupervised use.
The negative effects of UVA from the sunbed will often require remedial treatments that will cost far more than the cost of the sunbed tan did.
While it is true that the UVR spectrum of most sun beds does not cause erythema, there is still damage being caused at a cellular level, and for some individuals this can lead to melanomas and skin cancers.
In the US, the FDA warns that some tanning operators may claim that UVA sunlamps and sunbeds are safer than the sun and UVB lamps. This is not true. In fact, exposure to the UV radiation from sunlamps adds to the total amount of UV radiation you get from the sun during your lifetime, further increasing your risk of cancer.
Such was the concern; the American Medical Association (AMA) passed a resolution in 1994 calling for a ban of the use of suntan parlour equipment for non-medical purposes. U.S Dermatologists have also urged the FDA to take action to discourage use of suntan parlours and suntan beds.
In many sun tanning clinics, there is a degree of consultation with the client regarding the suitability of a particular skin type for specific frequency/duration of treatments, however in some clinics it is just a "pay and self-serve use" approach.
(This is more prevalent in Hairdressing salons than Aesthetics and beauty clinics)
While sunbed clinic operators who do provide a consultation and believe they may be providing a safe service for their clients, there is an important factor to consider:
With the mixed ethnicity of many people, it is difficult to gauge the risk of using the sunbeds by simply observing the colour of their skin. Mixed genetic pools will often disguise or alter the REAL Fitzpatrick rating for the particular skin colour and therefore the risk. Without some way to measure the melanin content to calculate the risk, how can we be sure we will not have a time bomb on our hands? (My own skin is a perfect example of this) Although melanin measuring devices have been around for over ten years, a majority of operators choose not to use them. (Or don't think they need to)
In many countries, health authorities provide guidelines for the use of artificial sun tanning devices, (Such as this example from the UK) however with the emergence of more and more artificial UV related issues, (Including death) there are likely to be more stringent regulations on the horizon.
UVA is the silent killer of cells
Skin is a potential target of oxidative injury because it is continuously exposed to visible light, ultra violet irradiation and oxygen, all critical for the maintenance of cellular life.
Skin is the bodys first line of barrier defence, and as part of the skin structure there are numerous other types of barrier defence system designed to protect those structures themselves.
It is well accepted that alterations in skin lipids due to exposure to UVR result in membrane damage. The major reactive species that can initiate lipid peroxidation is the hydroxyl radical OH. Damages of the membrane function are associated with a variety of harmful skin alterations.
UVR leads to erythema, chronic exposure leads to acceleration of the skin aging process and increased risk of skin cancer development over time.
Sun light components responsible for photo aging are wavelength region arbitrarily defined as UVB, which is in the range of 290 to 320 nm. UVB light normally penetrates the epidermis.
UVA is in the range 320 to 400nm (also called long and short UVA respectively, or UVA 1 & UVA 2) and is considered less damaging at a given dose or irradiation, however it penetrates much more deeply into the skin and has a greater effect on dermal tissue.
UVA is the primary wavelength used in sun beds because it causes the tanning reaction both the immediate tanning and immediate pigment darkening reaction. (IPD) and the delayed tanning reaction, or new melanogenisis.
UVA can also evoke the sunburn reaction, but the erythema or sunburn producing capacity of UVA is very weak, but the long term deleterious effects on the skin and accelerating skin aging are high.
Although UVA radiation causes less erythema than UVB, it is becoming increasingly clear that this spectrum of sunlight is insidious and cannot be disregarded.
UVA Skin Cell Damage
- Damage to melanocytes caused by DNA damage
- Vit C oxidization
- Impair Vitamin A receptors within cell membranes
- Excess keratinisation
- DNA damage and inhibition of DNA synthesis
- Depletion of epidermal Langerhans cells reducing skin barrier defence
- Increase in matrix metalloproteinases (MMPs) cause damage to collagen and elastin fibres
- Damage to cell membranes through lipid peroxidation
- Increase in free radicals
UVA induced photosensitivity
What is not well know is that UVA is the portion of the UV spectrum most often associated with photosensitivity resulting from drugs and disease.
Sunbed clients taking certain prescription drugs can unknowingly increase their reaction to ultraviolet radiation. These drugs may not make them noticeably sensitive to sunlight, but they may make them very sensitive to the intense ultraviolet radiation in a tanning booth.
In the US, the FDA has published a list of medications that increased sensitivity to light (HHS Publication FDA 91-8280).
These drugs include, but are not limited to:
- Some antibiotics
- Some high blood pressure medications
- Some tranquilizers
- Some birth control pills
- Some oral diabetes medications
A final word...
If you have a sun bed in your clinic & believe you are a Professional skin treatment therapist, think again!
A TAN IS A SCAR! This statement should be enough to stop skin treatment therapists offering the service of sunbeds in clinics.
It is well known that treatments for the ageing skin are a large part of the services offered by a beauty salon. Treatments for skin lightening, wrinkles, resurfacing, muscle atrophy and more, so why offer a service that is going accelerate all of these conditions?
In the eyes of consumer protection agencies it could be considered professional negligence.
The legal implications abound.
Note: In March 2008, Australian authorities introduced new regulations for operators of sunbed and solarium clinics. The regulations raised the minimum age for users from 15 to 18-years-old.
The regulations will also prohibit solarium use for people with fair skin. Under the new laws the frequency and duration of solarium sessions will also be limited.
|Florence Barrett-Hill is Australasias leading independent beauty therapy technical educator, therapist, researcher and author who has vast experience covering all aspects of professional beauty therapy and paramedical skin care.
Florence has over 30 years of experience and holds over a dozen diplomas and international qualifications covering every aspect of modern skin treatment therapy. Her ground-breaking book "Advanced Skin Analysis" has received critical acclaim worldwide and is a standard text in many beauty therapy schools and colleges.
Florence is the director of Pastiche Resources, an international post graduate education service provider. Pastiche offer training programs covering a myriad of technical subjects internationally.
2004 Virtual Beauty Corp