SKIN AGEING THERAPEUTICS DR AARTHI MARIA FRANCIS MBBS (INDIA) MASTERS IN ANTI-AGEING, AESTHETICS & REGENERATIVE MEDICINE (UCSI) DIPLOMA IN DERMATOLOGY (WALES) DIPLOMA IN AESTHETICS (USA) http://www.skinkl.com/
Therapeutic modalities • • • • • • • • • • •
Sunscreen Facials Cosmoceuticals Chemical Peel Microdermabrasion Dermal Roller Light Optic Devices Injectables Platelet Rich Plasma Stem Cells Therapy Prevention
1. sunscreen • Skin damage from radiation is cumulative whether sunburn occurs or not. • Recommended: 2mg/cm2 •
Long-term radiation: •
Malignancy: • • •
•
hazards of skin damage from
Squamous cell epithelioma Actinic keratosis Basal cell carcinoma
Premature aging • •
nevus, seborrheic keratosis, solar lentigo wrinkles, lines,
ULTRAVIOLET RADIATION SPECTRUM UVA (Longwave Radiation)
• •
• • •
Range 320-400 nm Erythrogenic activity is weak, however penetrates dermis Responsible for development of slow natural tan Most drug-induced photosensitivity reaction occurs UVA may augment the effects of UVB
ULTRAVIOLET RADIATION SPECTRUM UVB (Middlewave Radiation) • • •
•
Range 290-320 nm Erythrogenic activity is the highest Produces new pigment formation, sunburn, vitamin D synthesis Responsible for inducing skin cancer
ULTRAVIOLET RADIATION SPECTRUM UVC (Shortwave or Germicidal Radiation) • • •
Range 100-290 nm. Does not reach the surface of the earth. Is emitted from artificial ultraviolet sources.
SUNSCREEN CLASSIFICATIONS •
Physical
Opaque formulations containing: • • • • •
•
titanium dioxide talc, kaolin zinc oxide ferric chloride icthyol, red petrolatum
Mechanism: scatters or reflects UV radiation due to large particle size
SUNSCREEN CLASSIFICATIONS •
Chemical Formulations containing one or more: • PABA, PABA esters • benzophenones • cinnamates • salicylates • digalloyl trioleate • Anthranilates Mechanism: absorbs UV radiation
SUNSCREENS Category Skin Type
SPF
I
Always burns, never tans
15 >
II
Burns easily
15
III
Burns moderately, (avg caucasian)
10-15
IV
Burns minimally, tans well (olive skin�)
6-10
V
Rarely burns, tans profusely (brown skin)
4-6
VI
Never burns (black skin)
none
SUNSCREENS Sun Protection Factor (SPF) = MED of Photo-protected Skin MED of Unprotected Skin
• MED – minimal erythema dose • is minimum dose of radiation which produces erythema • SPF is determined indoors using xenon lamps which approximate the spectral quality of UV radiation
2. Skin routine • • • • • • •
Cleanser Exfoliation Astringent/toner Moisturiser Eye creams Sunscreen Non occlusive make up - woman
Massage Manipulations
Effeurage Light continuous stroking movements Petrissage Kneading movement, performed by lifting, squeezing or pressing the tissue Friction Deep rubbing pressure is applied with fingers or palm Vibration Rapid shaking while fingertips are pressed firmly on point of application Tapotement /Percussion Short quick tapping or hacking movements
3. cosmoceuticals • A cosmetic product claimed to have medicinal or drug-like benefits. • Cosmeceutical products are marketed as cosmetics, but reputedly contain biologically active ingredients.
Types • • • • • • • •
Alpha & Beta Hydroxy Acids Antioxidants Botanicals Depigmenting Agents Exfoliants Moisturisers Retinoids Sunscreen
4. Chemical Peels Classification:
Superficial – very light to light (epidermal exfoliation) • AHAs • Retinoids • Salicylic Acid • Jessner solution • Up to 30% TCA
• Medium Depth (papillary dermal) • 35-40% TCA
• Jessner’s solution combined with 35% TCA
• Deep (reticular dermal) - - not done anymore • Phenol peel • Baker-Gordon • TCA in concentration > 50% • Erb:YAG/CO2 laser resurfacing
classification of chemical peels Depth of Peel Penetration • AHAs • Retinoids • Salicylic acid • Jessner’s solution • Up to 30% TCA • 35-40% TCA • Jessner’s solution combined with 35% TCA
• Phenol peel • Baker-Gordon • TCA > 50% • Erb:YAG/CO2 laser resurfacing
Superficial
Cornified Layer Granular Layer Squamous Layer Basal Layer
Medium Depth
Papillary Dermis
Deep Depth
Reticular Dermis
Factors that impact CP • Peeling agent • Concentration of the peeling agent
• Layers of the agent applied • Application technique • Prepping of the skin • Patient skin type • Location of the peel
• Underlying skin pathology – sunburn, xerosis, dermatitis
immediately following treatment day of treatment
following morning
day 2
day 3 - 5
day 5+
skin appearance and feeling
▪ tight ▪ moist and dewy appearance ▪ mild to moderate edema and erythema
▪ tight ▪ dry ▪ mild to moderate edema and erythema
▪ skin may begin to peel
▪ heaviest peeling
▪ typically peeling is complete
precautions
▪ apply products in an appropriate post- procedure solution ▪ keep cool
▪ reapply products in an appropriate postprocedure solution ▪ keep cool
▪ do not pick at loose skin ▪ reapply products in an appropriate postprocedure solution
▪ reapply products in an appropriate postprocedure solution ▪ avoid direct sun exposure
▪ restart recommended daily care regimen
5. Microdermabrasion • Microdermabrasion treatments use a minimally abrasive instrument to gently sand your skin, removing the thicker, uneven outer layer. • This type of skin rejuvenation is used to treat light scarring, discoloration, sun damage, and stretch marks.
MDA - uses • Improve age spots and black heads. • Improve hyperpigmentation • Exfoliates • Lessen the appearance of stretch marks. • Reduce fine lines and wrinkles. • Reduce or eliminate enlarged pores. • Treat acne and the scars left by acne.
MDA - types • Natural crystals – common • Aluminium oxide crystals – better exfoliation as they are dense with irregular edges • Sodium Bicarbonate crystals – more gentle • Diamond – safer, non crystal so risk of corneal injury is less
• MDA & dermalinfusion – vitamin C, Hyaluronic acid, Salicylic acid, Hydrating serum etc
6. Dermal Roller • a.k.a microneedling • The dermaroller is a drum-shaped roller studded with 192 fine microneedles in eight rows, 0.5-1.5 mm in length and 0.1 mm in diameter. • 0.5mm – 2mm: home use • Made of silicon using reactive-ion etching techniques or manufactured from medical-grade stainless steel • the microneedles pierce the stratum corneum of the skin to create micro-conduits/punctures without damaging the epidermis. • rolling over an area about 15-times will result in approximately 250 holes per square-centimeter. • 4 to 8 weekly intervals
• Healing phase • Inflammatory Response • Platelet aggregation • Release of GF’s • Neo-collagenesis • Neo-vascularisation • Skin Type insensitive
7. Medical Grade Devices • IPL • Lasers – ablative, sublative, non ablative, fractional, chromophore specific • Radiofrequency • Ultrasound
8. Injectables • Botulinum Toxin A - dynamic wrinkles - mesolifting - facial contouring • Dermal Fillers - HA, Ca Hydroxypatite, aquamids, PLA - static wrinkles and folds - percutaneous collagen induction
9. PRP • Autologous blood is centrifuged with an anti coagulant • PRP + PPP + RBC + buffy coat • Rich concentrated source of platelets & GF from alpha granules • Additional substances are released from dense bodies and lysosomes. • Soluble proteins also present assist in hemostasis. • Electrolytes and soluble plasma hormones are required for cellular signaling and regulation. • Leukocytes and erythrocytes are present in PRP and function in inflammation, immunity, and additional cellular signaling pathways.
10. Stem Cell Therapy • • • • •
Plant origin – apple Animal origin – sheep, rabbits Umbilical cord SC Mesenchymal SC – PRP Adipocyte Derived Stem Cells (ADSC) – from lipoaspirate or fat grafts