Micro-focused Ultrasound Skin Lifting

 How does ultrasound technology is offering non invasive surgical facelift results?

How it works:

Micro-focused ultrasound uses ultrasound energy to create an interaction with tissue. This causes tissue to reflect, scatter and be absorbed. The reflective and scatter effects enables an ultrasound imaging to be created which then the energy is focused and absorbed in the tissue. A transducer is used to visualise the treatment area so when treating it will target focused areas and deliver the energy below the skin. This will also help to avoid treating unwanted areas for example bone and blood vessels.  

The tissue is heated to about 60-70 degrees, coagulating tissue and denaturing collagen. The coagulation of tissue occurs in evenly spaced thermal coagulation points surrounding by healthy tissue which promotes immediate tissue tightening, neocollagenesis and the wound healing process. 

Figure 1.1 

Wound Healing Phases

Inflammatory phase - The heating of tissue at 60-70 degrees will denature and coagulate tissue causing thermal coagulation points which is an injury or controlled wound. This will then stimulate an expected natural wound healing process to take place. During this phase  the uninjured healthy surrounding the thermal coagulation points will help to speed up the inflammatory period. 

Proliferative phase- During this phase the deposition of new collagen is formed by a process called neocollagenesis 

Remodelling phase- As new healthy and organised collagen fibres are deposited this results in lifting and rejuvenation of the skin.

Structure in Facial Tissues with Ultrasound visualisation

It is very important to understand the structure of the facial tissue to find a treatment that can deliver results at the depth required. For effective results energy must be deposited a specific depths below the surface of the skin. Because of ultrasound's mechanical properties, it is able to be micro-focused below the skin's surface at any depth without causing injury to competing chromophores or the surface of the skin. 

Figure 1.2

Depth of energy delivery 

Figure 1.3

Skin Needling AKA Collagen Induction Therapy (CIT)

Now this is a treatment that has a lot of talk about in the beauty industry! I have mixed reviews on this treatment as I strongly feel there needs to be more education given to anyone performing these treatments. You may be wondering why but I will tell you when you read this post and it may change your minds about walking into an average beauty salon and asking for a skin needling treatment to be performed! 

Collagen Induction Therapy (CIT)

 This treatment should only be performed by dermal clinician, doctor or equivalent! CIT is a treatment that involves repetitive puncturing of the skin with very small needles. The aim of the treatment is to induce collagen production through the stimulation of the wound healing process. A roller device, stamp or pen are currently used to perform this treatment. The differences between each are:

Pen device on the left and roller device on the right image

Roller device: When using a roller device the needles are penetrating the skin on a shallow angle, and as the roller is rotated across the skin it will penetrate deeper. The deepest point of penetration is midway point of the rotation, this is where the dermis is penetrated. Needle lengths can range between 1mm, 1.5mm, 2mm and 3mm (medical needling). Only experienced clinicians or doctors should be treating with longer needles. The 1mm roller would penetrate the skin approximately 1.5mm-2mm into the dermis and therefore reach the papillary dermis. 

Pen device: When using a pen device, the device uses an oscillating stamp-like pen motion to harmoniously vibrate and glide over the skin. The needles can range from 0.0mm to 2.5mm and can be modified according to the skin condition on each device. The pen produces 1300 micro channels per second as punctures the skin. It is fully adjustable with the speed and needle depth and is automated. It is held vertically and can also treat small areas as well as curved areas.

Treatment Depths

* Dermal clinicians are able to treat from 0.0mm to 1.0mm and Doctors are able to treat from 0.0mm to 3.0mm which is medical needling

Effects on the skin 

Immediately following treatment the punctured skin will go through re-epithelialisation this can take place between 2-3 days. The epidermis can be seen thicker during this phase and lasting up to 1 year. As hundreds of punctured wounds occur in the papillary dermis the wound healing process is immediately stimulated and starts with the inflammatory phase. This is where platelets, neutrophils and fibroblasts are found to gather to the wounded area. Which then proliferation can occur by releasing their essential growth factors. With the up regulation of growth factors collagen deposition forms in a lattice-weave like deposition  which only certain growth factors can heal in a scarless manner. 

It is approximately 48 hours post treatment the proliferation phase takes place which then the remodelling phase completes the wound healing phases and continues unto 12 to 18 months after the treatment to create collagen and tightening of the skin. There will be noticeable results of the papillary dermis thickening by the 6 month stage and Type III collagen ending in favour of Type I collagen to increase the skin rejuvenation.

Who should have this treatment performed

This treatment will particularly benefit candidates with scarring, rhytids/wrinkles and laxed skin, striae dispense and enlarged pores. 

How often can this treatment be performed?

This treatment can be performed 4-8 weeks intervals with a minimum of 2-3 treatments being performed.

Treatment Post Care

A benign hydrating cream needs to be applied frequently for 2-3 days after the treatment to enhance wounding healing. The used of vitamin A products needs to be avoided for 2 weeks post treatment. No picking, scratching or pulling of the skin. Avoidance of scrubs, loofas and abrasive products is recommended. Direct sun exposure is to be avoided. Make up should not be worn until 4-5 days post treatment. Avoid exercise, sauna or steam rooms for the next 48 hours.

Potential Side Effects and Complications

If sterility has not been maintained throughout the treatment infection of the wound can occur, scarring is also a possibility especially with candidates with a background of keloid and hyper tropic scarring. Millia and pigmentary changes can also result from skin needling treatments. Potential side effects can often occur when post care instructions are not followed.

Contraindications

Keloid scarring, diabetes, warts, bleeding disorders, presence of skin cancers, pregnancy, skin infection etc.

Skin Barrier Function

Hi everyone! This is my first post for my blog. I'm amused at how many clients have come to me in the past few years with an impaired skin barrier function and have no idea why and how it became so stripped or impaired! So let's focus on the importance of having a healthy skin barrier function.

SKIN BARRIER FUNCTION

What is the function and purpose of the skin?

Our skin has many important functions being a physical barrier to the environment, being waterproof, providing protection against micro-organisms, ultra-violet radiation, toxic agents and mechanical insults. 

What makes our skin barrier function?

1. The structure of the Stratum Corneum
2. The Acid Mantle 
3. Sebaceous Secretions 

The stratum corneum consists of keratin filled corneocytes surrounded by a lamellar lipid bilayer as demonstrated in the above bricks and mortar model. This arrangement is what makes it an effective environmental barrier, reducing environmental permeability and providing a waterproof properties while reducing dermal evaporative water loss. 

The lipids are known as barrier lipids as it is essential for the barrier function. These lipids consists of ceramides, cholesterol and free fatty acids. 

The corneocytes are connected desomosomes which provides integrity to the stratum corneum reducing the risk of damage by shearing forces and penetration.

The acid mantle is known for describing the acidic nature of the stratum corneum. pH can range between 4.2 and 5.9. The acid mantle is important as it is influenced by age, anatomical site, genetic predisposition, ethnic differences, sebum secretion, skin moisture, sweat, cosmetic products, medications and diseases e.g. Dermatitis. 

Sebaceous secretions are the excretions of sebum which also provides barrier environmental protection including antibacterial and water resistant properties. 

So what are the factor affecting our skin barrier function?

Different areas of the body will differ in barrier properties. This is due to the variance in structure. Prevention of transepidermal water loss can be affected, as well as permeability and repair of barrier properties. As we age, our skin is more susceptible to environmental insults thereby decreasing the optimum barrier function. Stress can increase our skin permeability as the adhesion between our corneocytes are reduced. Trauma and mechanical damage to the skin is another factor skin permeability increases this can be due to UV damage. Stripping of the skin by chemicals can also increase the permeability of exogenous substances. Use of medications that include antibiotics, chemotherapy, radiotherapy, cortisone and roaccutane affect the skin barrier function. Skin diseases and conditions can also play a role in altering the skin barrier function as well. 

Getting our skin barrier function ready for treatments 

With some dermal therapy treatments to have clinical efficacy from treatments the skin barrier function might need to be compromised. This is to allow for penetration of ingredients, higher absorption of products and to achieve clinical results. Commonly in our treatments we may use degreasing agents to clean the skin, perform microdermabrasion treatments or apply chemical peels. However, when the skin barrier function is compromised treatments should not be performed, as this will cause more disruption and more downtime may be required to heal the skin. 

How to maintain the integrity of the skin barrier function

There are many ways to maintain your skin health and the integrity of the skin barrier function. As we know from above. We need to protect our skin from so many different insults. Using the right products can help, as well as doing treatments to encourage optimal skin barrier function. The best way to start is to have a skin consultation with a dermal clinician and address all your skin concerns and tell them all your goals for your skin. You will be provided with a detailed treatment plan tailored to your specific needs and proper home care instructions with information about different treatments suitable for you.