Emerging Technology and Advanced Treatments
by Annet King
Professional skin therapists know that while our roles in the world of skincare are of high importance, there is an extensive list of products, treatments and procedures that we are not legally allowed to use or perform. This especially goes for electrical modalities. However, this does not mean we don’t need to learn about them! It is our responsibility to learn as much as possible about the treatments that are available out there, as many of our clients undergo these procedures then come to us for assistance with the after care. Knowing what is out there will not only help the client, it will help your own business as well.
Let’s take a closer look at some of the electrical modalities available, including Ultrasonic, Oxygen Therapy, Light Therapy, Intense Pulsed Light Therapy (IPL) for hair removal, Light Emitting Diodes (LED) and Radio Frequency. Keep in mind that some of these modalities may be allowed for use by skin therapists depending on your license or qualifications.
Ultrasonic utilizes low frequency sound waves in a three-stage system for safe mechanical exfoliation, molecular penetration and healing micro-amp therapy. The device helps a variety of skin challenges, including aging skin, wrinkles, acne, rosacea and hyperpigmentation.
Ultrasonic uses a crystal (contained in the sound head), which converts normal 110-volt energy from the outlet using a transformer. The conversion of energy to Ultrasonic occurs through a scientific principle called the piezoelectric effect. This is when an electrical charge is delivered to the crystal, creating mechanical pressure and causing the crystal to vibrate and produce sound waves.
When discussing the use of Ultrasound in skin care, we are of course referring to therapeutic Ultrasound as opposed to diagnostic. Diagnostic Ultrasound uses a completely different frequency than that used for therapeutic purposes. In our industry, Ultrasound is referred to as Ultrasonic.
Ultrasonic for Penetration
In addition to Ultrasonic offering a deep cleansing treatment and allowing for the release of dead surface skin cells and loosening of comedones, Sonophoresis (or Phonophoresis) uses Ultrasonic energy to enhance the skin penetration of active substances.
When skin is exposed to Ultrasonic, the waves increase to a certain level and cause several effects that assist skin penetration. One of these effects is the formation of gas bubbles, referred to as Cavitation. Ultrasonic pulses penetrate into the skin, fluidizing the lipid-bilayer by the formation of the bubbles. The force of Cavitation causes the formation of holes in the Corneocytes, the enlarging of intercellular spaces and the disorder of Stratum Corneum lipids.
Heating, another effect, is mainly a result of the energy loss of the increasing ultrasound wave due to scattering and absorption effects. The resulting elevation of the skin’s temperature is typically in the range of several degrees centigrade. This temperature rise will increase the fluidity of the Stratum Corneum lipids as well as directly increase the diffusivity of molecules through the skin barrier.
Ultrasonic may be used for cleansing, exfoliation, Desincrustation, and Iontophoresis. In some cases, incorporating Ultrasonic into all of these procedures in one treatment could be too stimulating for the client. Always consult the consultation card and assess your client’s skin closely, keeping in mind that you should never leave a client alone when using an electrical modality.
The theory of applying oxygen to the skin is controversial and no peer-reviewed independent studies have been published to prove it works. Still, many skin therapists use this equipment and stand by the results they see. The Oxygen Therapy provided by us as skin therapists is not to be confused with Hyperbaric Oxygen Therapy, which is used by doctors to treat and heal damaged skin, to treat compression sickness and to kill bacteria.
Oxygen is filtered from the air into a compressor, which is then applied to the skin via a mask or handheld applicator, much like an airbrush. Usually a product or mask is applied first to enhance the results. Another method for application is a nebulizer that takes an active ingredient and infuses atmospheric oxygen into it, producing a liquid that is then dispensed much like the mist from a Dr. Lucas Pulverizer.
Oxygen therapy can benefit the skin by:
• Assisting in the penetration of products.
• Creating an antibacterial environment on the skin.
• Increasing cellular respiration.
• Improving skin texture.
• Increasing cell metabolism and microcirculation.
The use of oxygen also kills anaerobic pathogens, increases the skin’s ability to heal and may enhance collagen production. But this is where the controversy begins: 95% of the metabolic processes of the skin are anaerobic. For oxygen to have a biological effect, it must reach the basal layer. But on the surface, it is an effective bleaching agent and gentle germicide; this is how possible benefits are seen. There is, however, a belief that bombarding the skin with oxygen can lead to more skin aging, due to the generation of Reactive Oxygen Species (free radicals).
Light Therapy can cover various methods of application, including laser (Light Amplification by Stimulated Emission of Radiation), IPL (Intense Pulsed Light) and LED (Light Emitting Diode). Skin therapists can use some of these machines, but others are restricted. In the US, most states do not allow the use of lasers and IPL. However, it is important to still understand the modalities to ensure we are able to advise what is available and how it works.
An ablative laser is one that ablates, or removes, skin. Ablative or skin resurfacing lasers briefly direct an intense burst of laser energy onto the surface of the skin. The ablative laser light is absorbed by water, oxyhemoglobin and melanin within the skin to accomplish the task. The more tissue to be removed, the higher the energy used and the more passes performed during the procedure. The procedure is painful and may require topical anesthesia, or in some cases, general anesthesia, and pain medication. Recovery time and skin healing could last from a few days to a few weeks or more.
Non-ablative lasers have been a more recent addition to aesthetic equipment for skin improvement. These lasers have lower energy levels than ablative lasers (which resurface or remove the outer layer of the skin completely) and cause damage to the dermal layer of the skin without removal of the outer epidermal layers. In other words, the laser treats the dermis, mainly through heat, to increase thickness through new collagen and elastin synthesis, therefore firming and regenerating the skin. The epidermis is not damaged. This lessens the recovery period after the procedure and reduces the number of complications that can occur.
Intense Pulsed Light (IPL)
Intense Pulsed Light (IPL) systems, although technically not lasers, use flashes of light that work in a similar way to non-ablative lasers, thus causing heat damage to dermal tissues without disrupting or removing the outer epidermal layers of the skin. Medical offices and medical spas usually describe treatments using both non-ablative lasers and IPL systems as a procedure called photo rejuvenation.
Intense Pulsed Light: Hair Removal
Hair removal by means of Intense Pulsed Light (IPL) works by heating, damaging and destroying the melanin in the skin (which occurs naturally in both the skin and hair). Melanin is considered the primary chromophore (a chemical group capable of selective light absorption resulting in the coloration of certain organic compounds) for all hair removal lasers currently on the market.
During an IPL hair removal treatment, a wand is used to apply the light to the surface of the skin, which penetrates through, reaching the hair shafts or the bulb (root) of the hair. Of the bulb and the hair shaft, the bulb typically contains the highest amount of melanin. As the light converts to heat, the bulb and most of the hair shaft are instantly vaporized. In addition, the hair radiates heat that also destroys the hair-producing papilla or the entire hair follicle.
Due to the selective absorption of photons of laser light, short wavelength lasers (500-800nm) are used to treat individuals with light skin and light brown or blonde hair; lasers with a thin diameter and long wavelength (800-120nm) are used for darker skin and coarse dark brown or black hair.
Light Emitting Diodes (LED)
Light Emitting Diode (LED) photomodulation emulates photosynthesis in human skin cells, using the cell’s own cytochromes to build new proteins just as plants use chlorophyll to convert sunlight into structural building blocks. Low wattage light is directed through the skin’s epidermis and aimed at fibroblast cells, which produce collagen and elastin. The light stimulates the cell’s own energy transport system, therefore helping to stimulate and renew the skin. The low wattage produces cool temperatures, reducing the risk of burns or scars potentially caused by laser treatments.
Blue 410-417nm (nanometers)
Blue LED is the most expensive because it is harder to create. The FDA has cleared this as an acne device that may be used for 15-20 minutes of exposure three times per week. It works like Benzoyl Peroxide in that it kills bacteria. It is used for acne suppression and is successful when paired with photodynamic therapy.
Amber LED is performed for 35 seconds with gentle waves devices. The FDA has cleared it for wrinkle reduction and skin rejuvenation. It stimulates fibroblasts and suppresses MMPs (Matrix Metalloproteinase enzymes that break down collagen).
Red LED has undergone studies by NASA on wound healing, but currently the FDA has not approved it for skin rejuvenation. This light improves vasodilation and oxygenation.
Both Amber and Red LED have been approved by the FDA to provide topical heating to promote increased blood flow for the temporary relaxation of muscles and relief of pain.
Radio Frequency Technology
Radio Frequency (RF) is neither a laser nor an IPL. Rather, it is a form of electromagnetic energy very similar to microwaves. It is considered a non-ablative resurfacing treatment. The treatment passes Radio Frequency electricity through the skin to heat up the tissues. This is supposed to make the tissues contract and, as is true with any injury to the skin, it begins collagen production. The most popular device associated with RF is Thermage.
As with lasers and IPL, the goal is to target tissues that will selectively absorb energy to produce thermal changes without injury to the surrounding tissues. But there are challenges when directing light to the skin surface. Photons must first penetrate the epidermis where they are scattered or absorbed by melanin, which reduces the number that will reach the target and increases the potential for epidermal complications such as crusting and dyschromia (discoloration of the skin). In addition, the correct wavelength for a particular target may not penetrate deeply enough to produce sufficient dermal heating.
The main goals of Radio Frequency are to tighten and firm skin, which in turn can help to reduce wrinkles.
When purchasing any piece of equipment, it is important to know what you are buying. When searching for a device, it is best to:
• Look for a company that has been in business for at least three years, and ask for studies that back up their claims.
• Be cautious of claims that products penetrate to the dermis.
• Always ask for a demonstration first.
Protocols for each device will depend on the type of machine purchased, and each manufacturer will have a specific procedure to follow.
Healing the Skin Pre and Post Treatment
When the skin has undergone trauma of any kind, a treatment protocol that addresses redness, irritation, inflammation and sun protection is key. If the client has undergone an invasive surgery and/or re-epithelialization, skin healing must be apparent and the physician must first give the go ahead for the client to receive treatments. If the treatment was non-invasive or non-ablative, the skin therapist can focus on hydrating and regenerating the skin. Just remember: the more invasive the procedure, the more soothing and anti-inflammatory the protocol. Treat the skin as you would a sensitized skin.
While we may not be permitted to utilize some of these pieces of equipment ourselves, we can still ensure our clients see the results they want by incorporating pre and post treatments to complement the procedure they are undergoing. If you are permitted to utilize these amazing electrical modalities, consider incorporating them into your treatments to ensure your clients get the optimum results they desire.