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DERMAL
WOUND HEALING IN AESTHETICS By Danielle Hughes
Within the aesthetics arena, a vast array of anti-ageing treatments deliver a controlled trauma and/or wound to the skin to stimulate the wound healing model, contract loose tissue and activate natural collagen production. Tissue damage (controlled or otherwise) initiates a highly complex biological response to reassert balance in the body. The degree and nature of damage will determine the extent of response. To fully comprehend wound healing complexities, a professional must have a detailed understanding of the cell, skin science, and systemic factors that mediate and impair this process. So, what treatments cause a wound? At varying intensities and depths, the following widely performed treatments all work by inducing a wound which the skin recognises as a breach and skips into action to compensate for the disruption: • Skin needling • Laser • IPL • HIFU/MFU • Radio frequency • Micro dermabrasion • Chemical peels • Dermaplaning • Plasma pen/fibroblasting • Cryotherapy Of course, the outcome from any given treatment, both short and long term, relies on the client’s ability to heal and repair the damage. Given that no two clients are the same, this outcome will vary. What happens after the wound inducing treatment has been performed? After the treatment has been administered and the tissue is damaged, there is a multidimensional cascade of responses, reactions and processes that unfold. These overlapping processes take place for varying durations and degrees of efficiency. In fact, the complete process of wound healing may take up to two years, during which time the wounded tissue remodels and tweaks itself to regain as much tensile strength as it had prewound. The simple fact is the wounded tissue will never regain its original strength – and this is a consideration when selecting a suitable treatment and the intensity at which it will be performed. The four phases of wound healing see the damaged tissue sealing off the site, removing debris, proliferating a new epidermis and dermis, and remodelling fibres that were deposited in a rush during the early stages of repair, as much for protection as the restructuring itself.
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Beauty Biz Year 14 Issue 5
Coagulation In the case of an ablative wound, the priority in the wound healing cascade is to ‘stop the bleeding’. Coagulation, or haemostasis, is a process that ensures the wound is ‘closed off’ by manufacturing a fibrin plug to reduce blood loss and protect against the risk of infection. It is important to note that wound healing can initiate without the initial phase of coagulation taking place visibly. When blood isn’t drawn, the healing can begin at a faster rate, and with minimised risk of infection. Inflammation Inflammation is one of the immune system’s primary mechanisms of defence against injury and infection, and it sets the stage for the following phases and ultimate wound restoration. The inflammatory phase is generally active for up to 3 days (but can last for up to weeks post-wound) and is characterised by redness and swelling (caused by dilation of capillaries and capillary leakage). During this phase, damaged cells, bacteria, and pathogens are removed from the wound site. White blood cells, lymphocytes, growth factors, nutrients and enzymes cause extra swelling, pain, heat, and erythema. Inflammation becomes problematic if prolonged, excessive and/or accumulative. Proliferation This multi-dimensional phase of healing comprises of re-epithelisation, angiogenesis, the formation of new tissue and contraction. Kicking off approximately 24 hours after the wound, keratinocytes migrate into the bed of the wound in a strategic effort to form a new epidermis and re-establish barrier function. The formation of new blood vessels enables a nutrient supply to the wound site, delivering oxygen which is essential for collagen production. Day five postwound, fibroblasts proliferate new collagen and fibronectin, and replace the damaged matrix with a fresh extra cellular matrix. The contraction phase is celebrated within the beauty and dermal industry; during this response, myofibroblasts begin stretching the edges of the wound together to close off the site. These hybrid cells are largely associated with scar tissue and in certain individual profiles will be hyper-active. Tissue Remodelling As the wound matures, poorly distributed (organised) collagen is replaced with a stronger type of collagen. However, the final strength of this ‘scar’ collagen has been determined to only reach up to 80% of its original strength. This fact alone emphasises the reduced risk associated with aesthetic treatments that only work within the epidermis.
Multi-Modality Treatments It’s common practice within our industry for therapists to perform treatments that combine technology, for example, radio therapy and skin needling, or a peel and microdermabrasion. The theories behind such practice vary, but ultimately modalities are combined to accelerate and amplify client outcomes. The thing to consider is, this approach compounds the wound healing model and is largely unstudied, particularly in the case of long-term outcome and scar tissue development. It may prolong the inflammatory phase (not ideal), impair proliferation of new tissue (definitely not ideal) and increase the risk of scar tissue development (particularly bad news). When delivering a combination of wounds, the skin must have the capacity to handle multiple signals delivered by overlapping thermal footprints, mechanical trauma and in some cases burn wounds. Until such time where clinical trials can be conducted on a broad cross section of population with a long-term system for metering client outcomes, we are essential flying blind when performing multi-modality procedures, relying predominantly on anecdotal outcomes and subjective review. The Wound Healing Masterclass has been designed specifically for beauty therapists and dermal clinicians to better understand the healing cascade and assess a client’s individual baseline loading to calculate risk profile for a wound inducing treatment. To participate in the Wound Healing Masterclass via our online platform, email support@behindthescenesX.com or visit www.behindthescenesX.com
