At first glance, cleaning the skin with Ultrasonics would seem somewhat of a contradiction.
Certainly, Ultrasonic cleaning is efficient and is widely used in industry, medical, and laboratory situations for cleaning a variety of objects. It is especially useful on intricate shapes or fragile items where scrubbing would damage the surface. But how does it work, and how does it clean the skin?

Some background of Ultrasound as a cleaner
In industry, medical, and laboratory situations, ultrasonic cleaning is undertaken in a cleaning tank with the item to be cleaned suspended in a cleaning solution. This solution varies depending on the item being cleaned. The solution could be caustic, a solvent, or even water.
The frequency of the ultrasound used is typically 25Khz 40Khz, although other frequencies are used for specialised purposes.
The purpose of the Ultrasound as a cleaning process is to enhance the detergency of the cleaning fluid by the process of cavitation.
This is, in effect, "cold boiling" and results from the creation and collapse of countless micro-bubbles in the cleaning liquid, producing shock waves.
After the cleaning process, the item is removed from the tank and rinsed, with the micro-debris and impurities that have been removed left suspended in the cleaning solution. Any heavier impurities fall to the bottom of the tank with the help if gravity.

Scraper on ultrasonic cleaner transmits ultrasonic waves through epidermis

Ultrasonics (Sonophoresis) increases the permeability of the skin, and assists the absorption of active ingredients to the lower levels of the epidermis.

By comparison, the Ultrasonic devices used as cleaners on the skin resemble vibrating scrapers.
How do the scraper and Ultrasound work to clean the skin? Let us review the action of Ultrasound on the epidermis.

Ultrasound and the epidermis
Numerous scientific studies have shown that Ultrasonics (Sonophoresis) increases the permeability of the skin, and assists the absorption of active ingredients to the lower levels of the epidermis.

There are many devices on the market in use daily that are used specifically for this purpose, from medication delivery through to skin treatment therapy.
They all use the cavitation effect to produce micro-bubbles, however in the epidermis these micro-bubbles temporarily reduce the density of lipids in the intercellular domain of the bi-layers.
This disruption occurs due to a combination of micromechanical, thermic and cavitation effects that effectively open up the intracellular pathways, allowing substances with high molecular weights a higher degree of penetration.

With this in mind, the use of Ultrasonics to cleanse the skin becomes difficult to understand, as the Ultrasonics action on the skin is somewhat the opposite effect than that on an inert object being cleaned.
The question must be asked: If an Ultrasonic probe were to be placed on the surface of the skin, surely it would help to push any impurities and micro debris present further in to the epidermis?

Further thought: If the ultrasound opens up the intracellular pathways, and in the process helps release the toxins and debris, how does the debris extract itself to the surface for removal?

Marketing opinions
Following are a variety of discourses taken from the marketing material of organisations marketing ultrasonic devices and services explaining how ultrasonic cleaning of the skin works:

Ultrasonic vibrations penetrates deep into pores to loosen and break up old dead skin cells and oily blockage

Ultrasonic wave motions turn the cleaning liquid in to a vapour, emulsifying and washing away the debris in the pores

Such high frequency vibrations eject and remove just about everything under your skin such as dead skin cells, small black and white heads (difficult to extract by hand) dirt and grease particles, thus, achieving a non-intrusive deep skin cleansing, even to the inner skin layer

An Ultrasonic Spatula is used in conjunction with a specially formulated Cleansing Lotion to create a soft peel and exfoliate the skin, leaving it ultra clean

Employs an ultrasound frequency to exfoliate dead skin cells for a clearer, healthier complexion without the redness and irritation sometimes associated with Microdermabrasion. To also loosen and remove oil, dirt and cellular debris from follicles for cleaner, healthier skin. Pores diminish in size and bacteria levels are reduced

It would seem that there are varying opinions of exactly how Ultrasonics cleans the skin. Some just dont make good sense:

If Ultrasound is said to eject and remove just about everything under your skin then how can it be then used to infuse active ingredients? This is the opposite effect of Sonophoresis.

If Ultrasonic wave motions turn the cleaning liquid in to a vapour, emulsifying and washing away the debris in the pores what is to stop the now increased permeability of the lipid bilayers carrying both the cleaning solution and micro debris further in to the epidermis?

We are heading in to the land of reality with the next statement:

Ultrasonic vibrations penetrates deep into pores to loosen and break up old dead skin cells and oily blockage

The break up old skin cells part is starting to make far more sense and is further supported by the next statement.

An Ultrasonic Spatula is used in conjunction with a specially formulated Cleansing Lotion to create a soft peel and exfoliate the skin, leaving it ultra clean

We are now getting to the truth of the matter:

Employs an ultrasound frequency to exfoliate dead skin cells for a clearer, healthier complexion without the redness and irritation sometimes associated with Microdermabrasion.

So there you have it. But are we really cleaning the skin surface? Would preparing or exfoliating the skin surface be a better description of what is happening?
The Ultrasound and scraper are preparing the skin by removing the very top layer of loose skin and debris. This is happening at a superficial level.

In todays climate of marketing hype and misinformation regarding many consumer products and services, the skin treatment professional must make every effort to distance themselves from terminology and statements that may challenge their credibility.

More to consider:
The presence of ultrasound in the cleaning or scraping of the skin surface raises some issues. As previously discussed, Ultrasound increases the permeability of the skin, and assists the absorption of ingredients to the lower levels of the epidermis.
The quality of the formulations used in conjunction with ultrasound are usually of the highest purity so superfluous ingredients (preservatives, colourings, odour masking agents, etc, are not carried to these lower levels.
Clearly using some cleansing agents on the skin surface with Ultrasound could produce some unwanted reactions, and potentially render the planned following treatment less effective due to dilution of the active ingredients.

Summary
Using Ultrasound as a skin preparation procedure has merits when used with other skin cleaning procedures. However, awareness that Ultrasound enhances skin permeability and the importance of care to be taken with the formulations applied during the cleaning process is critical to the success of the overall treatment program it is part of.

There are other procedures available to prepare the skin before the use of Sonophoresis and other infusion treatments other than ultrasound for those who are uncomfortable with the validity of the science of Ultrasonic skin cleaning.

2005 Virtual Beauty Corp

In the ever-increasing modalities of skin treatment therapies comes LED Photomodulation, the latest form of Phototherapy.

This relatively new process has the unique ability to stimulate and/or inhibit cell-signalling pathways for skin rejuvenation and potentially represents the next frontier in anti-aging medicine.
Photomodulation is a process that manipulates or regulates cell activity using light sources without thermal effect. This is achieved using portions of the visible light spectrum that does not contain any Ultra Violet or Infra Red, thus achieving a non-thermal, non-invasive, and non-ablative method of skin rejuvenation.

The primary goal of non-ablative rejuvenation is the stimulation of new collagen and dermal extra-cellular matrix substance, which visibly improves the appearance of wrinkles without disturbance or damage to the overlying epidermis.
Until recently, our thinking about how to accomplish this has involved primarily thermal methods, whether it is heating of the dermis to stimulate fibroblast proliferation or heating blood vessels for photocoagulation. Intense Pulsed Light and Laser treatments are the most common modalites used that employ thermal methods. Although highly effective, there are the thermal discomfort considerations that some clients will not be prepared to accept. This is where LED Photomodulation has its place in the market.

How does it work?
LED Photomodulation uses low intensity light emitting diodes to create a process similar to plant photosynthesis whereby plants use chlorophyll to convert sunlight into cellular building blocks.
The light emitted by the LEDs is absorbed by epidermal cells and produces a remarkable cascade of events.

ATP, (Adenosine Triphosphate) the form of energy that cells utilise, is produced in this process and used to power the metabolic processes that synthesize DNA, RNA, needed proteins, enzymes, and other biological materials needed to repair or regenerate cell and tissue components; foster mitosis or cell proliferation; and/or restore homeostasis.
Studies of LED Photomodulation have shown skin textural improvement accompanied by increased collagen deposition with reduced MMP-1 (collagenase) activity in the papillary dermis. Using Photomodulation, scientists theorise that we are both slowing down collagen breakdown and building up new collagen.
One of the benefits of LED Photomodulation is that a wide range of Fitzpatrick skin types can be treated safely. Because of the low-intensity and specific bandwidth control of the light source, (Absorbed energy typically less than a 25 watt light bulb) there is no thermal damage to the epidermis.

With this in mind, LED Photomodulation offers novel, safe, non-ablative approach to photoaging when used in conjunction with specific skin care products. 

The specifics
Light doses ranging from 1.0 to 6.0 Jcm-2 in the frequency range of 560nm 780nm (Orange-Red) have been proven to be most effective for skin rejuvenation treatments that relate to rehabilitation of the microcirculation and encouragement of fibroblast activity. Techniques that pulse the light at specific cycles or codes (on-time and off-time) have reportadly proved most effective and this technique has been patented as the term LED Photomodulation by one US based company.

Wide bandwidth devices have the ability to provide a number of therapeutic treatments in addition to cellular rejuvenation. The chart below shows the various properties of the light spectrum.

Frequency of use
To achieve optimum results, an average of eight treatments over a four week period are recommended in conjunction with tailored skin care and home care regimen, followed up by maintenance treatments at three to six month intervals. Because the technology is still relatively new, it is unclear how often maintenance treatments will be required, but clinical experience to date suggests once a month.   
Improvement has been noted to occur even three to four months after finishing the last treatment, indicating that the collagen deposition is an ongoing process, which continues months afterwards.

There are two stipulations for treatment: Firstly, (and quite obviously) the clients skin must be meticulously cleaned prior to exposure to LED light source, with heavy make-up completely removed. 

As with IPL and microdermabrasion, the strict post treatment use of sunscreen with SPF 30 or higher must be employed.
Although Phototherapy is relatively safe if used properly, it is not without risks.   
As with all treatment modalities and technologies, some essential basic knowledge in Phototherapy is important before one proceeds to use this modality. 

Phototherapy History
Phototherapy has been used in medicine for three decades, with Hungarian physician and researcher, Dr Endre Mester first demonstrating the beneficial effects of monochromatic light in the late 1960s.   
Substantial research has been conducted since for the wound healing properties of various bandwidths of light, with NASA funding research for burn rehabilitation and cell activity studies, with the concept of using low energy, narrow band or coherent light with specific pulse sequences and durations consequently termed photomodulation. 

LED Photomodulation terminology
A LED (light-emitting diode) is a semiconductor device that emits incoherent narrow-spectrum light when an electrical current is applied to it. Because LEDs are low intensity, they are used in arrays or banks of up to 2000 individual units to deliver therapeutic levels of light.   

There are two types of LEDS used for light delivery:
Using individual monochromatic LED banks for each specific colour band. Colours are used individually or in combination to deliver bandwidth required.

Microprocessor controlled polychromatic LEDs using RGB technology. This state-of-the-art digital technology produces up to seven different colours similar to the method used in LCD and Plasma TV and computer screens. Light in the visible spectrum is often termed Monochromatic or Polychromatic. The two terms are explained simply as the following:

Monochromatic:  A single bandwidth of light. i.e. red.
Laser light is a good example of a Monochromatic light source.

Polychromatic: A light source consisting of multiple bands of light (ie violet, blue, green, red, yellow) in the visible spectrum. (Approximately 380nm – 770nm) 
Intense Pulsed Light (or daylight) is an example of polychromatic light.

© 2005 Virtual Beauty Corporation

The skin treatment therapist will be offered many different technologies to treat their clients during their career, and unfortunately some of these technologies ultimately turn out to be more about good marketing than effective treatments. Case in point: tweezer electrolysis hair removal.

Oxygen facials is another modality that is increasing in popularity but also raising a number of questions about effectiveness and credibility due to both the lack of scientific evidence and the growing awareness of the link between oxygen and free radical damage.

Consequently, it is perhaps a prudent time to discuss the operation and merits of this technology.

What are Oxygen facials?
Oxygen therapies for the beauty industry revolve around the use of medical grade oxygen as a delivery mechanism for active ingredients in to the skin. It is also used as a wash over the face of a client post traditional facial therapies in an attempt to stimulate or feed the skin so new collagen growth can occur. Common promotional statements used usually include a reference to the rejuvenating power of oxygen, and this is where the perception of beneficial results is fostered.
In some cases, the oxygen facial is incorrectly termed "hyperbaric oxygen therapy", as this is something completely different.

As a delivery mechanism, the oxygen is compressed and sprayed at high pressure directly on to the skin surface. A serum of active ingredients such as nutrients or vitamins etc, are introduced to the oxygen stream just before the skin, and the combined oxygen and

ingredients in the form of a high pressure jet forces its way past the skins barrier defence systems and in to the lower levels of the epidermis.
The key function of the oxygen here is theorised to be an increased absorption of the active ingredients; much like would be experienced with Iontophoresis or Sonophoresis; the ingredients accompanying the oxygen jet are purported to have beneficial effects due to their specific properties.
In addition to therapeutic compounds, moisturising and other water binding ingredients such as hyaluronic acid can be introduced to the oxygen jet, and this type of use is where the most amount of publicity is being generated and subsequent increased use.

This popularity (particularly in the US) appears to stem from the almost instant smoothing and plumping of the skins surface, a reaction that can have the effect of hiding any tiny imperfections and providing a warm glow to the skin.
It is popular in the film and television industry for this very reason, as it makes the job of the make-up artist just that bit easier as the effects can last up to 48 hours.

As a course of clinic treatments, recommended frequency is initially once a week for six weeks followed by monthly touch-ups, and at up to US$200 + per treatment, it can certainly become a profit making proposition with the right marketing.
Music icon Madonna is one of the most recognised celebrities who are regular users of the oxygen facials, and according to her web site, she apparently has her own personal oxygen treatment facialist on staff.

In a world driven by instant gratification and celebrity endorsements, it is easy to see why the popularity of oxygen therapy is increasing. At a recent trade show in the US, there were no less than eleven different brands of oxygen facial devices present, each claiming superior results than the competition.

The Hardware
The devices used to provide oxygen facials are relatively simple, consisting of an oxygen generator/storage tank, a pressure regulator and a spray gun.
The high purity oxygen is generated by the same kind of device that has become popular for recreational oxygen users (oxygen bars, offices and oxygen bottlers) that uses a technology called Pressure Swing Absorption (PSA) separation to generate concentrated oxygen (90-95%) from the ambient air that normally contains only 21% oxygen. It is then delivered to a regulator and on to the spray gun.

Interestingly, most of the oxygen spray gun devices look remarkably similar to the spray guns used by airbrush artists, with the only discernable difference being the use

of pressurised oxygen instead of compressed air.

But does it work?
The mild inflammatory response caused by the forced breaching of the lipid bi-layers of the epidermis is the most logical reason why the instant smoothing effect is achieved, however there appears to be no scientific evidence to date that substantiates if the therapeutic compounds find their way to the target area at the dermal/epidermal junction. If there is any evidence, then it is not widely available for public scrutiny.

Other than the immediate inflammation effects discussed previously, there is potential that there could also be a limited longer-term restructuring of the collagen matrix due to stimulated fibroblast activity caused by the inflammatory response. As the level of fibroblast stimulation is directly proportional to the level of non-ablative inflammatory response created, it could be concluded that the effect is likely to be less than a peel or Microdermabrasion. There is however, no conclusive evidence of this occurring to any significant degree either.

The mild inflammatory response caused by the forced breaching of the lipid bi-layers of the epidermis is the most logical reason why the instant smoothing effect is achieved

That the oxygen used during the facial actually provides therapeutic effects from a topical application, and the premise that we can increase the energy in the skins cells by topical application of oxygen is flawed for a number of reasons. We need to consider the following factors:

• The human skin does not respire to any perceptible degree; in fact the skin does not require being in an oxygen environment other than respiration via the lungs.
• The skin barrier defence systems effectively render the skin waterproof, as nature limits our exposure to a specific concentration of oxygen for good reasons.

Although the skin can absorb some substances (some drugs are typically administered through a skin patch, humans do not absorb any substance through the skin that is important to life function. So from that perspective, we can logically live without air on the skin. (Except for temperature regulation)

Marketers of oxygen therapies often refer to the proven effects of oxygen on unhealthy or damaged tissues to state their case, with the vasoconstrictive effects, reduction of inflammatory cytokines, increase in growth factors, and antibacterial effects often mentioned.

There is indeed a degree of truth to those statements, as oxygen has been successfully used to assist wound healing for over fifty years.
It is however, the increase in oxygen concentration in the cells via the pulmonary vascular system introduced by the oxygen rich environments in hyperbaric chambers and oxygen tents rather than direct contact of the wound with the oxygen.

And what about Free Radicals?
There are the negative aspects of oxygen to consider.
Specifically free radicals and oxidisation. We know that unstable oxygen molecules cause free radicals and it is widely understood that oxygen is the conduit for the delivery of free radicals to tissue.
It is also known that oxygen is the most common oxidiser, and oxidative process contributes to skin ageing and the development of wrinkles, so why would a skin treatment professional who understands this want to increase our exposure to oxygen above the natural dose and subsequent potential oxidisation in the epidermis?

Particularly why would we want to force the oxygen past the lipid bi-layers under pressure to an area where we really need to control any oxidisation?
As mentioned previously, oxygen as an energy providing fuel is delivered to the dermal cells via the microcirculation along with other vital nutrients. It is a critical balance.
The fact that other topical oxygen bearing applications (such as hydrogen peroxide and oxygenated purified water) have lost favour with skin professionals due to free radical issues makes one wonder why less knowledgeable aestheticians and therapists have not made the connection between the similarity of the two modalities.

Official recognition
It is also interesting to note that where the technology is the most popular, the United States regulatory body FDA has not approved oxygen facials and the devices that provide the treatments, as in the United States, oxygen in concentrations above 90% is considered a precsciption drug.
The lack of approval is because manufacturers are astutely not making any claims of any therapeutic effects. To make those claims would involve providing proof of efficacy, lengthy clinical trials (with long-term results and contraindications determined) to be conducted, and possibly the same kind of regulation and treatment provider qualifications that the use of hyperbaric oxygen treatment requires. Certainly a dampener for quick profit.

The FDA has a consumer warning on it's web site that discusses the use of oxygen for non-prescription therepeutic use. A fact that is little known is that that dispensing oxygen in the US without a prescription violates FDA regulations. Other countries (such as Australia and New Zealand where oxygen is considered a drug) may have similar regulations, and presently oxygen facials have managed to keep under the radar.

In the United States, Dr. Christopher B. Zachary, a professor and the chairman of the department of dermatology at the School of Medicine, University of California has been quoted as saying The concept that high-pressure oxygen would do anything to help the skin is such nonsense as to be laughable. "

Some quick quotes of interest from marketers and users of oxygen devices:

"We hope that the oxygen is creating a pressure bubble that drives vitamins and nutrients into the skin, but we have no data to support that."
Dr. Fredric Brandt, Dermatologist, Miami and New York.

"We haven't run any medical-style clinical trials because we are not making any biological claims, the instant results speak for themselves."
Mr. Anthony McMahon, CEO, Intraceuticals.

"It's a spa device with limited benefits, it has no more and no less validity than a facial."
Dr. Bradford R. Katchen, Dermatologist, New York.

Make up your own mind
Despite the lack of credible evidence to date that oxygen facials actually have a long term benefit will not stop aestheticians from purchasing these devices because of the money making ability due to the amount of publicity surrounding them.
With an ill-informed consumers demanding instant gratification with a seemingly unlimited budget, we can expect no less. A case of deja vu or "sales before science" perhaps?

The question that begs of course, is one of professional ethics; for both the suppliers who market the devices, and the aestheticians who use them.

2007 Virtual Beauty Corp