The search for a more youthful appearance continues as life expectancy increases for so many individuals. People continue to work beyond what was considered a traditional retirement age. The rocking chairs are collecting dust! This fact also has initiated a cascade of research on ageing and longevity, prevention and healing disease. The skin care industry also has joined the ranks of exploring effective skin care treatments and ingredients to improve the health of the skin. Health plays an essential role for optimum performance in our daily activities. It also influences how our skin appears at any age.
There are telltale indicators that visibly show the milestones reached throughout one’s lifetime. Intrinsic factors based on our genetics, age, and overall health give rise to the natural ageing process. Extrinsic factors, however, superimpose the effects of long-term UV exposure and poor life style. The skin and underlying cell structures definitely will respond to oxidative stress and other aggressors that force biological ageing way beyond our years.
Countless modalities are available today that support skin rejuvenation including laser resurfacing, skin peeling, microdermabrasion and cosmeceuticals. Numerous ablative procedures, however, injure the epidermis and basal membrane. They can cause potential adverse effects such as loss of pigment and dryness. At this point in time, beauty therapists have reached a pinnacle when trying to decipher a correct choice of treatment modalities. Scientific studies are currently exploring the potential long-term effects of treatment choices on the cells and systems within the dermal tissue. Certainly these more aggressive modalities have their place in aesthetic medicine and have provided results. What is now being questioned is the notion that the fibrotic response of the controlled wounding process, such as what occurs in deep peels and lasers and IPL devices will truly render long-term benefits to the skin.
There are specific features of what incorporates a healthy skin and its clinical benefits. Healthy skin is smooth, firm, adequately hydrated, shows even pigment, and has an intact barrier defence system. When the skin is healthy, it has a functioning skin barrier defence with optimum cell-to-cell communication. It is smooth, has an even texture, evenly dispersed melanin, and well hydrated.2 Paramount to keeping it healthy is how we treat it on a daily basis as well as the choices when working with an ageing skin.
Review of the epidermis in wound healing
The external skin layers play a significant role in defending the underlying cells and systems. This includes protection from external interlopers such as pathogenic microbes, excessive exposure to ultra violet rays, and oxidative stressors. Skin defense functions are mostly located in a two-compartment system of corneocytes embedded in a lipid-enriched extracellular matrix.3 Various skin tasks are mediated within this highly metabolically active stratum corneum, especially in the building and maintenance of the bi-layers responsible for regulating water balance, skin permeability, and Natural Moisturizing Factors (NMFs).3 The keratinocytes within the epidermis play a significant role in cell signalling including the activation of the immune system and the fibroblasts. We will briefly review two popular aesthetic treatments and their effect on the skin tissue.
Peels: The principle of this treatment is to partially destroy the epidermis producing an inflammatory response causing forced desquamation and fibrosis. What is observed is that this fibrotic condition results in a tightening of the skin. Skin response is in direct proportion to the strength and depth of the peel. For example, a Phenol peel (used more in the 1980s) is more destructive than a Jessner’s or TCA, or AHA. There is a tendency to continuously peel the skin with the lighter peels thinking that there is a better effect. While the skin appears smoother and tighter as a result of increased collagen in the papillary and reticular dermis, what is not always fully understood are the long term effects to the epidermis.4 Continuous or adding stronger peels may eventually cause destruction in the dermal/epidermal junction resulting in impaired nourishment to epidermal cells.4 Subsequently the skin becomes thinner with reduced cells in the stratum spinosum. Moreover, the stratum corneum may be affected causing disruption in the barrier function and hydration levels.
Lasers: Lasers can either be ablative or non-ablative. Ablative lasers vaporise the skin tissue as in the case of CO2 skin photo rejuvenation lasers that remove the epidermis. Non-ablative lasers are those used for hair reduction and skin rejuvenation including fraxel lasers. Lasers deliver thermal energy and injury to a targeted site by heating the tissue in a process known as photothermolysis. They can differ depending upon the model and type.
Recent research has uncovered concerns regarding heat shocking the skin through the use of thermal light devices. This process may stimulate deeper fibrosis (scar tissue) instead of promoting the growth of the collagen that is natural to the skin. Heat employed in some treatments can inactivate essential growth factors necessary for wound repair.4 Too much destruction means that the skin eventually becomes atrophic and experiences impaired hydration.4 Characteristic of fibrotic tissues (scar) is that it resorbs (remodels) over time. The skin may show signs of impaired hydration and wrinkles can return.4
Protecting the Epidermis
Goals for treating the skin require careful consideration. The emergence of newer paradigms questions how far one must wound the skin in order to rejuvenate the skin. Any wounding no matter how slight causes an interruption of the normal function of the skin. Therefore, our choice of treatment becomes paramount since we have to maintain the integrity of the epidermis and not destroy it. The age and initial skin health of the client should be closely evaluated. Additionally, the client should be applying adequate home care products to support the barrier function and wound healing process after a more aggressive treatment.
Dermal Rolling – How does it work?
Dermal Needling, percutaneous collagen induction (PCI) or collagen induction therapy (CIT), involves pricking the skin multiple times with a rolling device.1 The cosmetic roller makes channels into the epidermis with very fine stainless steel needles.2 It engages the body’s natural response that induces regeneration instead of scar formation.4 The process stimulates a natural wound healing response. Each miniscule wound undergoes the natural healing phases of wound healing. The needle only penetrates through the epidermis and does not remove it. Rollers vary in needle size varying from 0.2mm – 3.0mm.
Treatments that induce an inflammatory response in the skin elicit a wound healing response. This includes the use of a laser, IPL, microdermabrasion, and surgery. The presence of retinoids and a balance of adequate anti-oxidant vitamins are required throughout the healing process.2,4
Table 1 Summary of Tissue Response to Wound Healing
||In the event of an open injury (cut, abrasion, laceration) the immune response goes through numerous phases to close up the opening to prevent invasion of bacteria and then continues to remodel the skin. The “inflammation” seen during this process is a result of what is called “first responders”2 that seal off the area forming a clot. The redness and swelling is a result of this process since white blood cells (neutrophils and lymphocytes) flood the area in order to catch bacteria. The area is “cleaned” with the macrophages engulfing the damaged tissue and debris removing it away from the area. This process is known as phagocytosis.|
Proliferative Phase (3-5 Days)
|The first responders recruit the repair cells – fibroblasts and endothelial and epithelial cells. New blood vessels are formed (angiogenesis) to replace the damaged ones and to act as a transport for building materials and removal of waste from building new tissue. Initially there is an over abundance of blood vessels to cope with the increased oxygen demands of the repair process. Eventually they are destroyed once they are not required. A wound must be hastily closed so new collagen type III is produced to form granulation tissue.|
|Fibroblastic Phase (5-20 Days)||The inflammatory phase reduces as the wounding process is altered for new tissue formation. With the help of growth factors, the wound enters into the fibroplastic phase to produce new tissue at the wound site. A glycoprotein called fibronectin binds to the wound matrix to act as a conduit for the fibroblast cells to fill the space|
Maturative and Remodeling Phase (28 Days–2 years)
|Collagen protein makes up the extracellular matrix including 50% of the scar tissue. In the early stages of wound healing, collagen is quickly laid down in a less organised manner. Over time, cross links of peptides chains are developed during this final stage of remodeling whereby collagenase (enzyme) breaks down inappropriately oriented collagen molecules. A less traumatized collagen is the result. It provides strength and smooth texture.|
Why choose dermal rolling?
Dermal rolling is a versatile, non-invasive procedure for the reduction of wrinkles, thin skin density, hyperpigmentation, rosacea, loss of adhesion and resiliency, photo ageing, scars, stretch marks, hair restoration, and lax skin.2 It can also be used on several areas of the body including the face, neck, hands, and arms and is safe for most skin types. Dermal rolling leaves the epidermis in tact without damage to the stratum corneum.1 It promotes a scarless healing while encouraging an even deposition of collagen and elastin.6
Dermal rolling has numerous benefits.
- Cell function is optimised through increased quantities and access of cell nutrients to the skin.
- Promotes epidermal cell growth factor (EGF) and cell turnover.
- Micro-injury to the keratinocytes supports the release of several growth factors including EGF. It results in
epidermal thickening and the upregulation of cell function.
- Increases cell-to-cell communication with the keratinocytes.
- Supports delivery of targeted ingredients to the fibroblasts including vitamins A and C.
- Helps restore the skin during the ageing process and helps tighten the tissue and reduce the appearance of fine lines.4
- Promotes scarless healing with the deposition of normal woven collagen rather than scar collagen.
- It is beneficial for the reduction of acne scars.4
- It can help tighten the skin after liposuction.4
- It supports the tightening of slackened skin on the arms and abdomen and reduces the appearance of stretch marks.4
dermaviduals® protocols for dermal rolling
It is essential that a thorough skin analysis be completed prior to performing any procedure. Dermal rolling creates micro channels in the skin and it is imperative that corneotherapy principles be observed. Avoid any products that contain fragrance, parabens, mineral oils and emulsifiers. Initial skin preparation begins with a home regimen that includes cleansers and toners, topical vitamins A, C, antioxidants, copper peptides, topical growth factors and sunscreen.2 Biomimetic ingredients gently prepare the skin for treatment and then support the wound healing process and the skin barrier post-care.
The in-clinic procedure for dermal rolling is simple with little to no down time. The skin requires a thorough cleansing prior to commencing with the rolling.
- Cleansing Gel
- Lotion P
- Boswellia mixed with Liposome Concentrate Plus
- Follow with LED (if no LED leave the cool eye gel mask on for 10 minutes. Remove and apply High Classic neat.
- Home care includes Boswellia and a regimen of products that addresses the first priority skin condition.
There are some contraindications for collagen induction therapy.4,2 We have listed most but we recommend that you refer to The Concise Guide Dermal Needling – Medical Edition for a complete guide.
- Follow a home skin regimen prior to commencing treatment.
- Do not perform if there is presence of skin cancers, warts, solar keratosis or any skin infection.
- Do not perform whilst undergoing chemotherapy, high does of corticosteroids, or radiotherapy.
- Anticoagulant therapy.
- Active acne or herpes breakout.
- Aspirin should be stopped 3 days prior to the procedure.
- Allergy to local anesthetic agents.
- Uncontrolled diabetes.
- Strong tendency for keloid scarring.
Dermal rolling has been shown to support the skin non-invasively. It is a great modality to use in supporting the correction of ageing skin, scars, and other issues.
Aust M.C, Reimers, K., et al (Nov. 2008) Percutaneous collagen induction: minimally invasive skin rejuvenation without risk of -fact or fiction? Plast Reconstr Surg. 122(5):1553-63 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18971740
Setterfield, L. (2010). The Concise Guide to Dermal Needling – Medical Edition. p 2-3, 40
Elias, P. M., Feingold, K. R. (2006) Skin: Chapter 1, Stratum Corneum Barrier Function: Definitions and Broad Concepts. Taylor & Francis Group LLC. NY.
Fernandes, D. (2005) Minimally Invasive Percutaneous Collage Induction. Oral Maxillofacial Surg Clin N Am Vol 17, Issue 1, p 51-63.
Alam, M., Dover, J.S. Nonablative Laser and Light therapy: An Approach to Patient and Device Selection. Advances in Dermatologic Surgery. Retrieved from http://www.skintherapyletter.com/2003/8.4/2.html
Setterfield, p. 30-32
Pugliese, P.T. (2005) Advanced Professional Skin Care – Medical Edition. Topical Agent, Bernville, PA. p 281-283
Fernandes, D., Signorini, M. (2008) Combating photoageing with percutaneous collagen induction. Clinics in Dermatology, Elsevier 26, 192-199. Retrieved from here
This dossier has been prepared on behalf of dermaviduals Australia and New Zealand as a reference that relates to various skin conditions. In no way does it replace the advice of your medical practitioner or a dermatologist. All views represent the research and findings of the writer in conjunction with derma aesthetics.