As autumn approaches, many of us can look at our skin and see the evidence of backyard barbecues and basking poolside with a good book. Our tans begin to fade and we notice the damage to our skin, wondering with remorse if it was such a good idea to fall asleep at the beach.
SUN WORSHIPPERS’
LIFELINE Reversing skin damage with intense pulsed light
photos: Shutterstock.com
by Kristin Groop
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The sad reality is that enjoying time in the sun leads to visible sun damage. This damage often appears in the form of freckles, age spots, liver spots and sunspots. However, these brown spots are not the only reminder of sunny days outside. Over time, sun damage can also present as redness, broken capillaries or a persistent “sunburned” look to the skin. Fortunately, there are ways to reduce the appearance of sun damage and rejuvenate the skin. One of the more advanced treatments is intense pulsed light (IPL). IPL has come to the forefront of technologies available to treat different forms of sun damage. What is IPL, and how does it work? IPL photofacials or photorejuvenation treatments are non-ablative treatments requiring minimum downtime. These treatments are capable of altering the targeted skin component while leaving the surrounding tissue healthy and intact. Because of the gentle nature of these therapies, complete removal of pigmented spots typically requires several sessions. IPL technology has been around since the mid 90s. The treatment itself works much like a laser, but instead of having just one wavelength of light, the machine produces a spectrum of light
September 2014 • Les Nouvelles Esthétiques & Spa
made up of a range of wavelengths. By selecting an appropriate filter, the trained skin care professional selects the wavelength range to target the damaged area caused by skin aging and sun exposure. The light is applied to an area and is absorbed into the selected target chromophore of the freckle, age spot, capillary, etc. A chromophore is made up of the pigmented molecules responsible for the color of the spot. The absorption of light creates heat, which causes damage to the chromophore of the targeted area (melanin for spots, hemoglobin for capillaries and water for stimulating collagen production for skin rejuvenation). As the light emitted from the IPL is absorbed into the selected target, the “magic” of selective photothermolysis begins. Breaking apart the words “selective” and “photothermolysis” makes it easier to understand what is happening in the skin. Photothermolysis breaks down as photo=light, thermo=heat and lysis=damage. The “selective” part of IPL refers to the tissue surrounding the targeted structures that are spared from any thermal injury. The IPL targeted tissue is broken down by heat, and releases the now damaged chromophores. The body either reabsorbs the chromophore (in the case of hemoglobin) or sheds the cell containing the chromophore (melanin being shed as skin cells are exfoliated). When skin rejuvenation is the goal, the water in the dermis is heated up, helping to start the wound cascade that produces and remodels collagen. The following are some of the conditions and objectives that may be addressed with IPL, and the mechanisms of action for each.
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spa | sun worshippers’ lifeline
SUN DAMAGE Sun damage can produce dark spots, also known as age spots or liver spots, which are harmless, large, flat, gray, brown, freckle-like circular spots that vary in size. Unlike freckles, these spots tend to persist, and do not fade or darken with the seasons. While “liver spots” are often seen on the skin of older adults, they have little to do with the liver or the aging process. These spots develop over time, as exposure to sunlight causes our skin to produce excess melanin. Freckles are similar to sunspots, but can change in prominence from season to season. Fair-skinned people, especially those with red hair, have a natural predisposition to them. The prominence of freckles is related to sun exposure, as sunburn makes them appear darker and larger. While harmless, many people seek treatment to reduce the appearance of sunspots and freckles.
BROKEN CAPILLARIES These are the little red vessels visible on the cheeks, sides of the nose and sometimes the chest and neck. They too are a result of overexposure to the sun on a long-term basis. While not effective on deeper vessels and veins, IPL treatments can help reduce superficial capillaries by their
absorption of light into the hemoglobin, with the resulting heat coagulating the vessels. The clinical endpoint is usually blanching of the vessel, or a darkening of it and mild swelling. Depending on the vessels being treated, the usual time between treatments is 3 to 8 weeks, and it may take three or more treatments for clearing of the broken capillaries.
SKIN REJUVENATION Some fine lines, superficial wrinkles and texture of the skin may be addressed by using IPL. This is most evident in areas of the face where the skin is thinner, such as around the eyes, mouth or forehead. In “photo rejuvenation,” longer wavelengths in the 1,200 nm (nanometer) range are used, as this range has an absorption in water that creates heat to cause an injury in the dermis. This injury stimulates the dermal fibroblasts to produce collagen and hyaluronic acid to help replace lost dermal volume. Usually, five treatments are required to see a softening in fine lines and skin texture. The treatments are performed a month apart, and follow up treatments
photos: Shutterstock.com
Neither sunspots nor freckles can change into cancerous growths. However, some skin cancers may resemble these spots. If you are uncertain about a pigmented spot, recommend that your client have it evaluated by a dermatologist.
When performing an IPL treatment for sunspots and freckles, the clinical endpoint the clinician is looking for is a darkening of the treated brown spots, sometimes with a red halo surrounding them. There may be a slight redness to the treated area, and it may feel like a sunburn. The brown spots will become a coffee ground appearance within 24 to 48 hr, and the spots will exfoliate naturally in 7 to 21 days, depending on the treatment and the client. The client will usually need three to five treatments spaced a month apart to visibly reduce the appearance of sunspots and freckles. It is important to remind the client that going back into the sun will cause more damage and reduce the success of the IPL treatment. Yearly follow-up IPL treatments help keep the skin looking clear.
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spa | sun worshippers’ lifeline are needed to maintain results. IPL is not particularly effective in deep furrows on the face such as the nasal labial folds, which are often called smile lines or laugh lines. There are other treatments, such as fillers, for these issues. While there are many skin issues that can be treated with IPL, it is important to know the contraindications or who should not be treated. Because IPL is attracted to pigment, caution should be used in treating darker skin types. While Fitzpatrick skin types 1, 2 and 3 have little risk, caution should be used with skin type 4. Those with skin types 5 and 6 are not good candidates for
IPL treatments—the risk of burns increases as the darker pigmented skin becomes the target, rather than just the pigmented lesions. Other contraindications are epilepsy, use of photo sensitizing medications and some autoimmune disorders. As IPL treatments may also trigger the herpes virus in clients prone to cold sores, they will usually have their health care professional prescribe them an anti-viral prophylactic, such as valacyclovir, prior to treatment. Sun damage can be reversed with the proper tools and training. Clients love IPL treatments, as they
help to blend the complexion into one smooth, even canvas. Fall is the perfect time to offer this service and get your clients’ skin ready for a great holiday season! n
IPL TREATMENTS Hollywood Dermatology & Cosmetic Specialists in Hollywood, FL charges $300 for one IPL session (15 to 30 min) for the face, $810 for a package of three and $1,440 for a package of six. The practice specializes in cosmetic dermatology and sun damage.
Michelle J. Place, M.D., F.A.C.S. Plastic Surgery Center in San Ramon, CA offers IPL treatments for both pigmentation and vascular issues. The price of their three treatment (60 min each) IPL package for the face is $995. *Note that the price and time of each session can vary greatly depending on the severity of the damage being treated.
Kristin Groop, The Laser Chick®, is the CEO of Esthetic Advisor Laser Academy® (EALA). Groop is a licensed esthetician, esthetic instructor, certified laser technician and instructor. Her EstheCeuticals® line of skin care products was created specifically for microneedling and laser treatments. EALA offers advanced laser and microneedling trainings both live and online. Contact Groop at 480.656.4481 or estheticadvisor@gmail.com. Say you saw it in LNE & Spa and circle #271 on reader service card
Page 78 • LNEONLINE.com Les Nouvelles Esthétiques & Spa • September 2014