3 cosmetic treatments and the science behind them

Regular exercise and relaxation, a good skincare regime and fresh, natural food can all bring out a natural glow. But sometimes stubborn problems such as acne scarring or hyper-pigmentation require a more focused solution. That’s where non-invasive hi-tech Beauty comes in.

Light therapies

Laser treatments

In the past five years, laser treatments have become the leading in-salon trend. They are touted as being able to treat everything from pigmentation to fine lines to acne scarring, with machines popping up in beauty salons as well as medical rooms.

But before you consider these new miracle workers, a word of warning. Whatever kind of laser treatment you undergo, ensure the person operating the machine is fully qualified — preferably a dermatologist or a doctor who specialises in laser treatments, or a trained nurse. Otherwise, the results may not be what you hoped for.

For example, your skin may be burnt or hyper-pigmentation may be made worse. There are inconsistent laser regulations in Australia, with some states permitting the use of lasers by non-medical personnel and some not. It’s important to do your homework before choosing your laser operator.

So what exactly are lasers? They’re devices that produce an extremely high-intensity light, say dermatologists Drs Carl Vinciullo and Tim Elliot, of Laser Skin Care in Perth. “This light differs from that produced by the sun or a light globe in its purity. Sunlight or globe light is light made up of many different types or wavelengths. In contrast, laser light is light of a single wavelength.”

Fraxel laser

While there are many laser treatments on the market, one of the latest and most popular is Fraxel laser. As well as skin rejuvenation, it can be used to treat deep hormonal pigmentation and is excellent for decreasing atrophic (indented) and ice-pick acne scarring. The reason it’s being widely used for skin resurfacing is there’s no significant downtime or risks traditionally associated with ablative treatment methods.

According to Kaye Scott, co-director of The Clinic, in Sydney’s Bondi Junction: “Until Fraxel, there were two types of available laser treatments. The first was ablative laser treatment, which literally means to vaporise at very high temperatures. Although very effective, it has significant side-effects and requires a lengthy healing period.

“The second is non-ablative, which has little or no side-effects and almost no healing time but requires numerous treatments over many months and has limited results at best.

“Fraxel treatments offer the effectiveness of ablative treatments with the benefits of the gentler, non-ablative lasers.”

Unlike ablative lasers that remove the top layer of skin, the Fraxel laser uses a “fractional” approach to treatment in that it passes through the top layer of skin, reaching into the dermis below, to create millions of tiny, microscopic areas of thermal damage.

These stimulate the body’s own wound healing response, notably new collagen production and replacement of damaged skin surfaces with new epidermal skin. Thus, Fraxel laser strives to achieve the skin improvements obtained with conventional (ablative) CO₂ laser resurfacing, but without the associated side-effects or downtime.

Most people will feel a prickling sensation during treatment and experience some swelling and redness after treatment, but it soon dies down, says Scott. Generally a series of three to five treatments, at a cost of $550 each, is needed to achieve significant results.

Other types of lasers

Several other laser treatments are promoted for anti-ageing, treatment of birthmarks and age spots, and hair removal. These range from the CO₂ laser, which is usually a one-off treatment for severe sun damage and deep wrinkles and requires significant downtime post-treatment, to a pulsed dye laser — a type of laser that produces a short, high-energy flash of light — which is used to treat port-wine stains.

Dee Davis of the Clear Skin Clinic in Sydney’s Double Bay uses a Cutera Class II Medical laser for both rejuvenation treatment and for permanent hair removal.

In hair removal, the laser light travels through the skin until it strikes the hair shafts or bulb of the hair. The bulb is usually where the highest concentration of melanin is. As the light is converted to heat energy, the bulb and most of the hair shaft are instantly vaporised. Because laser treatment impairs the growth of hair follicles when they are in the growth cycle, not all hair follicles are treated at one time, so four to six treatments are usually needed.

Davis says the treatment involves minimal discomfort and the Cutera laser can be used safely on all different skin types and tones. She urges anyone who is considering laser treatment for hair removal, sunspots or simply a fresher look to have a “spot test” first. In fact, Davis says this should be offered routinely by clinics to ensure skin responds favourably to treatment.

Laser for hair removal generally costs around $150 a session for small areas such as the chin or lip.

Intense pulsed light

The difference between lasers and intense pulsed light (IPL) is that IPL systems deliver many wavelengths (or colours) in each pulse of light instead of just one wavelength. Most IPL systems use filters to refine the energy output for the treatment of certain areas. This enhances penetration and allows the skin therapist to target specific chromophores (skin components that absorb light).

IPL therapy is considered to be a non-ablative technique. The results are not as dramatic as with ablative resurfacing, but the downtime is minimal. Like lasers, IPL technology is used to correct a variety of benign skin conditions, such as pigmentation, freckles, spider veins and other blemishes, says Kaye Scott, as well as hair removal. However, IPL is more likely to be used for less serious skin damage.

Lisa Sullivan, a trained nurse with The Clinic, says IPL also works well to pick up the “reds” in mottled skin, rosacea and broken capillaries.

Damaged skin that has been targeted by IPL treatment can become darker, as it moves toward the surface and flakes off within one to three days.

The cost of an IPL treatment for the full face is around $500 and usually three treatments are required to see significant results.

Q-switched Nd:YAG laser

This is a very short, high-energy pulse laser that has a photo-mechanical effect on its target. This means that rather than heating the pigment like conventional lasers do, it literally shatters it. Dr Gavin Chan of the Victorian Cosmetic Institute says it is his laser of choice for treating pigmentation and the removal of tattoos.

“I think this is the best laser for pigmentation, but for other conditions that need heat to disperse them, such as broken capillaries, other lasers are preferable.” When treating pigmentation, it’s possible with this laser to tailor the settings to have little or no downtime. See below for “Lowdown on laser pigmentation”.

Omnilux

Omnilux is a painless, non-surgical, non-laser light therapy that hydrates and plumps the skin, says Davies. As you lie under the light machine, your face is surrounded by thousands of light-emitting diodes (LEDS) that radiate pure (non-laser) light. Omnilux treatments can be used to help rejuvenate skin, with a series of ongoing treatments usually recommended.

Omnilux new-U is a handheld, light-emitting diode (LED) device for the treatment of fine lines and wrinkles that bathes the skin in alternating red and near-infrared light. The different-coloured lights target specific cells that are responsible for the synthesis and repair of the skin’s supportive structures.

For those with acne, the Omnilux Combination Light Therapy uses blue LEDs in conjunction with red LEDs to destroy bacteria responsible for the inflammation, stimulate cell growth, decrease pore size and stabilise oil production in the future.

Explains Davis: “One of the key bacteria responsible for the inflammation is Propionibacterium acnes, or P. acnes. These bacteria produce natural chemicals called porphyrins, which are sensitive to light at different wavelengths.”

Omnilux combination light therapy also targets specific cells that are responsible for the synthesis and repair of the skin’s supportive structures, she says. Because of this, Omnilux can also be used to help soften fine lines and improve skin tone.

The cost is around $120 a session, with about 10 sessions recommended for significant results. The Omnilux new-U is available for use at home for a cost of $690.

Oxygen therapy

Rumour has it that Madonna uses hyperbaric oxygen (HBO) therapy to rejuvenate her body and skin. In Australia, most of the machines required for the treatment are contained within hospitals (to treat the “bends”) and, for the everyday person, using them would be either impossible or too expensive to consider.

Hyperbaric oxygen therapy is the breathing of 100 per cent oxygen while inside a treatment chamber, at a pressure higher than sea-level pressure, according to Royal Adelaide Hospital. The treatment is carried out in a chamber and the patient breathes 100 per cent oxygen by masks, head hoods or endotracheal tube.

The extra oxygen is used by the body in many ways: to improve wound healing by reducing swelling, for infection control and to stimulate new blood vessel growth.

If you’d like to try oxygen therapy, consider having an oxygen facial, available at a large number of salons throughout Australia. A hand-held, pen-like device sprays the skin with a serum containing hyaluronic acid, vitamins, antioxidants and peptides. Oxygen is then applied to help deliver the serum into the cells.

Pure oxygen has a calming effect on the skin, but the real benefits lie in its ability to stimulate cell renewal and the production of elastin and collagen.

Thermage

Thermage is a non-invasive, no-downtime, single-treatment cosmetic procedure that is said to tighten, contour and rejuvenate facial skin. It’s done in a doctor’s office using capacitive radio-frequency (CRF) technology, which is delivered through a hand-held device. Radio-frequency waves penetrate the dermis to stimulate the production of new collagen.

“Immediate results are visible and continue to improve for up to six months,” says Scott. The procedure works by heating deep collagen fibres in the skin and underlying tissue, while protecting the skin’s surface with a cooling spray. You do feel a heating sensation — the doctor may offer you pain relief before the procedure begins.

More than 190,000 treatments have been carried out to date and the reported incidence of side-effects is less than 0.4 per cent. Those that have been reported include swelling, redness, bumps and blisters on or around the treated area. However, these have disappeared in a few days or weeks.

The cost is about $2800 for a treatment, which lasts around two years.

Presor-03 therapy

Presor-03 therapycomputerised gentle air pressure

This gentle pressure continually moves across the lower body and over the abdomen, pumping into the different compartments at varying dosage rate. Treatments cost around $75 and a number of machines are in operation at salons around Australia.

Chemical peels

Chemical peels use a chemical solution to improve and smooth the texture of skin by removing its damaged outer layers, according to the Australian Society of Plastic Surgeons. They are used to treat blemishes, wrinkles and uneven skin pigmentation.

Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids, are the mildest of the peel formulas and produce light peels, says the ASPS. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result.

Dr chan says glycolic peels (glycolic acid is derived from sugar cane) are mild peels that are very effective for stimulating new collagen and improving tone and texture of skin. “They’re a good, inexpensive treatment,” he says. He also recommends retinoic acid peels, which are slightly deepeer then the glycolic peels but also work well for stimulating collagen in the dermis. They are not as deep as TCA (trichloroacetic acid) or phenol peels.

AHA peels can cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems usually subside.

Trichloroacetic acid (TCA) can be used in many concentrations, but is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. You’ll need to avoid sun exposure for several months after treatment to protect the newly formed layers of skin.

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths, says the ASPA. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor in whether you can have a phenol peel.

With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that, not only will the skin be lighter in colour, but you’ll always have to protect it from the sun.

While chemical peels are normally safe procedures when performed by a qualified, experienced plastic surgeon, infection and scarring can still occur. It’s important to remember that the more serious peels take off many layers of your skin.

Note that, according to the EWG, both trichloroacetic acid and phenol are potential carcinogens, so it’s important to take this into account when choosing the type of peel.

Dr Chan says, “Chemical peels are an effective means of improving skin texture, however for the treatment of pigmentation, broken capillaries and wrinkles, laser may provide a more controlled and effective response.”

Green peels

The green peel is a natural plant- and herb-based peel that both increases blood flow to the skin and deeply exfoliates the skin. The peeling action is done by the micro-particles in the herbs themselves. These particles gently polish the skin’s upper layer or epidermis, while other active ingredients penetrate the deeper layers. Over the 48 hours afterwards, they release a variety of vitamins, enzymes and plant hormones that cleanse and revitalise the skin.

The results are similar to those of chemical peels, but apparently without the side-effects. Herbal peels were developed in Germany in the early 1950s and have been used successfully since. They do not contain any chemicals or synthetic peeling agents. They can be used for oily skin, skin with a rough appearance, skin impurities, fine lines and wrinkles, pigmentation and sun spots.

Herbal peels produce gentle peeling of the outer layers of skin while providing the sensitive newly growing skin with nutrient-rich protection. They don’t cause burning or tears if they come in contact with the eyes. The skin peels away after three to four days after treatment.

However, Dr Chan warns: “There are different types of green or herbal peels available. While some are probably quite mild, there are some on the market that are quite invasive to the skin and require the same downtime as the deeper chemical peels.”

Alternatively, Davis uses a mixture of Chinese and Russian herbs to detoxify skin and help shed epidermal layers. She says it’s safe for all tones of skin and can be used for a light peel or a deeper peel, depending on how forcefully it’s rubbed in. The cost is around $700 including an at-home care kit.

The lowdown on laser and pigmentation

First, understanding what sort of skin type the patient has and what causes the pigmentation is key in type of treatment.

Melasma, or hormonal pigmentation, according to Dr Chan, is usually symmetrical on both sides of the face and covers a larger surface area, whereas pigmentation caused by the sun is more discreet — a spot or a blotch here and there.

Laser treatments are more effective in the treatment of skin pigmentation caused purely by the sun and not as effective in the treatment of melasma, because with melasma, hormones will keep bringing it back, says Dr Chan.

“Some women have more oestrogen receptors in their skin, making them more sensitive to oestrogen. Melasma is one of the most difficult pigmentation problems to treat, especially in darker skin tones. if you’re not careful, laser can exacerbate it.”

Darker skin types are more prone to adverse events during laser treatments, as the trauma from laser can cause melanocytes to make more melanin. Melasma is more common in darker skin types, says Dr Chan.

Most lasers target melanin (pigment) in the skin, heat it and destroy it. If you have a darker skin tone, pigmentation is harder to treat as the laser targets all pigment. “I prefer to try lightening creams first, to stop the melanocyte from producing melanin, alongside a retinoid such as tretinoin, which helps turn over skin cells and therefore flushes out pigmentation — and then perhaps a series of light laser treatments. But with the treatment of melasma, it is about maintenance, not cure.

For this kind of pigmentation I would avoid any ablative laser treatments. Dr Chan recommends a series of low-energy laser treatments for melasma, such as the Q-switched Nd:YAG, rather than one big blast to the skin from some of the more ablative lasers. ”It takes more time but also minimises risks of side-effects.”

#Tags: anti-ageing, research , skincare