Today’s options for facial rejuvenation
The term ‘facial rejuvenation’ covers a broad spectrum of skincare treatments ranging from laser skin resurfacing to micro-dermabrasion to injectables and fillers to light therapy and combination techniques.
Over the last decade, research and technology development in the skincare and in particular, anti-ageing area has exploded in an industry worth billions of dollars.
The topic is wide and worth exploring in detail if you are considering any form of anti-wrinkle or anti-ageing skin treatment; for example, a topical cream containing one or more active anti-ageing ingredients such as retinoids, antioxidants, emoliants, peptides, vitamins, hormones or phytochemicals, or more semi-permanent or permanent measures (with corresponding side effects) including laser therapy, injections or even plastic surgery.
While it is impossible to cover the myriad of options currently available, in this article we will explore the area of Intense Pulsed Light (IPL) therapy, radio frequency (RF) and a relatively new combination of IPL and RF therapy that has been obtaining positive results in scientific studies, called electro-optical synergy (ELOS) treatment.
What the hell is IPL?
IPL is a facial rejuvenation technique used to improve the appearance of damaged and ageing skin. Instead of a laser (as is used in laser resurfacing, which causes skin to peel and can have significant side effects including burning and scarring), a high intensity beam of light is focused directly onto the skin.
Certain elements in the skin are able to absorb this specific light, while other parts of the skin are less affected. This means that photo-rejuvenation can occur deep in the skin (in the dermis) while the outer surface of the skin is not disrupted.
While IPL produces equivalent cosmetic effects as laser, it is different from laser in a number of important aspects:
- Within each pulse of light, IPL flashes out light over a range of wavelengths (or colours) while lasers deliver only a burst of light at one specific wavelength or colour.
- Laser light is more specific than the multiple wavelengths of IPL that bombard the skin, however the same IPL device can be used to treat different targets by using ‘cut-off filters’. These limit the wavelength reaching the skin to more selectively target the element in skin that need work.
- The IPL spot size (or footprint) is larger, therefore, IPL treatments are generally faster than laser, particularly when treating large areas. However, more IPL sessions are generally required to achieve the desired effect when compared to laser treatment.
The heat generated by IPL is also able to trigger the contracting and unravelling of collagen in the dermis (known as denaturation). Wavelengths in the 1200-nm spectrum are absorbed by water in the skin, which sets off inflammatory responses which remove old or damaged collagen and replace it with new healthy matrix, leading to a partial replacement of the volume of the skin lost with age. This means a tighter, smoother texture, increased softness and reduced lines.
The effects on wrinkles are less dramatic than with injections of botulinum toxin and often require multiple treatment sessions to get the desired effect. More recently the treatments have been combined to significantly improve the effect.
IPL can also be used for treating pigmented area (such as age spots and sun spots). Heating of the skin is thought to make skin cells release their pigment. This is then carried up to, and shed from, the skin surface. Sometimes, practitioners combine IPL with 5-ALA which acts to sensitise the skin to the effects of IPL. This is sometimes known as ‘photodynamic photo-rejuvenation.’
What’s the frequency Kenneth?
Radiofrequency (RF) is another facial rejuvenation technique used to target the deeper layers of the skin in a controlled manner, without damaging the surface. Like laser rejuvenation, RF works by heating the matrix proteins in the skin causing them to denature, contract and tighten the skin.
Like laser, RF procedures are often promoted as ‘a non-surgical facelift’ and used for treating skin laxity and sagging – for example, chin sagging, the folds around the nose, wrinkles and lines around the mouth and the forehead, excess skin on the upper eyelid or bags under the eyes.
Skin is resistant to the passage of electricity. As a result it heats up when an electric current is passed through it. By doing this very gently, it is possible to heat the deep layers of the skin to between 65 oC and 75oC. At this temperature, the collagen fibres of the matrix denature and contract. This produces almost immediate tightening of the skin. At the same time, the outer surface of the skin is kept cool and is therefore unaffected by the process and remains completely intact.
Over a few months, the heat-damaged matrix is progressively removed by the body and replaced with young, healthy collagen, in much the same way as other rejuvenation techniques. Ultimately, this leads to stronger, firmer, smoother skin with a more youthful appearance.
Alone, the effects of RF are modest, and do not equate to a surgical facelift. However, it has the advantage of being safe and quick, and delivered in a single treatment, and avoids the drawbacks of surgery, with its long recovery time and risk of complications.
RF can also be used away from the face, to tighten other areas of the body such as the bottom, thighs and stomach. Radiofrequency can be used safely for patients of all skin types (it is said the treatment is ‘colour blind’) and is not normally associated with pigment changes in the skin, even in those prone to it.
The deep layers of the skin which heat up with RF cannot be reached by conventional laser therapy. This means the effects of RF are different and synergistic to laser (with which it is often used in combination). In theory, this allows the laser (or another application) to treat the outer part of the skin, while the radiofrequency component penetrates deeper into the skin for better and more complete results.
Other combination treatments can also be used. For example, RF in combination with volumisers can be used to improve and augment the collagen responses; RF in combination with botulinum toxin helps relax the muscle while the skin contracts. RF in combination with microdermabrasion may also stimulate increased collagen formation and improved blood supply.
Radiofrequency is far less effective in overweight people and in smokers, while the tightening effect of RF may be more marked in younger people. This is thought to be because bonds that hold collagen together are more easily broken by heating young skin compared with older skin, where the collagen is less easily denatured by heating. Finally it works best for modest changes. Major sagging and deep lines will not be addressed by RF alone.
As with IPL treatments, there is little or no downtime from RF and patients can quickly return to normal activities. The most common issues are moderate discomfort during the procedure, and redness and swelling afterwards which typically lasts for a couple of hours.
It is common for a soothing restorative cream to be applied following the procedure and continued for several days. Makeup can be applied immediately after the treatment session as the epidermis is unaffected.
Some people develop abrasions (known as crusting) in the treated area. These usually heal or drop off within three to four days. In rare instances, some people can also experience temporary changes in sensation in the treated area, including itching or numbness. These symptoms are usually mild and resolve completely in days to weeks.
Studies have been conducted on a specific combination of IPL and RF, in a relatively new facial rejuvenation therapy called electro-optical synergy (ELOS).
A 2006 study conducted by Hammes, Greve and Raulin, on ‘ELOS technology for nonablative skin rejuvenation’ found that 58 percent (14/24) of the subjects reported a notable wrinkle reduction.
Scarring or pigmentary changes were not detected and the average pain score was 0.6 (where 0 = no pain, 5 = intolerable pain). The study concluded that ELOS shows multiple application potential, including hair removal and reversal of photo-ageing.
Another study on ELOS titled ‘A New and Effective Nonablative Approach to Skin Aging’ published in 2010 in the Journal of Clinical and Aesthetic Dermatology, found that IPL and RF are two examples of effective nonablative treatments of skin aging and the combination of both in the same pulse profile to produce electro-optical synergy (ELOS) improved textural changes and rejuvenation of photo-aged skin.
The study also found that ELOS is an effective treatment for contouring facial skin laxity by stimulating the repair processes and reversing the clinical, as well as the histopathological, signs of ageing, while also being a relatively risk-free procedure with minimal recovery time.
There are several ways to experience ELOS treatment. One option is called TRINITI, a system which uses three different types of applicators to enhance the application of both IPL and RF in combination.
The SR or SRA applicator, combining IPL and RF, provide contact cooling which facilitates higher frequency and safety of the skin, compared to the use of RF or IPL individually, while the ST applicator delivers infrared light with 700 – 2,000-nm wavelength and RF to the skin to stimulate collagen production.
Finally, the Sublative Rejuvenation applicator uses radio frequency energy alone. The RF energy is precisely placed on the skin in a matrix of tiny spots. The healthy skin around the spots accelerates the healing process of the affected skin. New collagen is produced and mild to moderate wrinkles are reduced. Skin texture becomes smoother and more elastic.
Any cosmetic procedure should be performed by trained medical practitioners or nurses. Most cosmetic procedures are performed in specialised cosmetic medicine clinics, based around specific procedures or technologies, like laser clinics or fat sculpturing (lipolysis).
Many of these clinics offer both medical and surgical procedures, which will usually be delivered by different specialists within each clinic. Today, some general practitioners now offer a range of cosmetic procedures, such as anti-wrinkle injections and fillers along with laser or IPL therapies.
The best practitioners are those who perform a procedure many times daily, who are thoroughly familiar with the treatments and products and who can provide treatments that are best suited to you and your skin.
It is most important that when interested in any anti-ageing skin treatments you thoroughly investigate and research all options any therapies and practitioners available to you. This will ensure you are making an informed choice and one that will work best for you.
For a limited time we are offering $1200 off of our Triniti Elos Facial Rejuvenation package. Learn more and get your discount here.
- The Skin Book by Kate Marie and Professor Merlin Christopher Thomas, 2015.
- Electro-optical synergy (ELOS) technology for nonablative skin rejuvenation: a preliminary prospective study. Hammes S1, Greve B, Raulin C. Accessed 20/11/2015 at http://www.ncbi.nlm.nih.gov/pubmed/16987260/20/11/2015.
- Journal of Clinical and Aesthetic Dermatology. 2010 Dec; 3(12): 22–30. Electro-optical Synergy Technique: A New and Effective Nonablative Approach to Skin Aging. Moetaz El-Domyati, MD,a Tarek S. El-Ammawi, MD,a Walid Medhat, MD,a,b Osama Moawad, MD,c My G. Mahoney, PhD,b and Jouni Uitto, MD, PhD. Accessed 20/11/15 at ncbi.nlm.nih.gov/pmc/articles/PMC3013553/
- http://www.yanhee.net/treatment-procedure Accessed 23/11/2015.