WW Guide To Better Skin

We spend a lot of time researching and talking to Doctors that we put in our Black Book and it occurred to us that it’s quite confusing to know what to expect from the different skin enhancing techniques available – what exactly they do, how much down time it takes and how long the effect will last.

We asked Doctor Dancy of the Bijoux Medi Spa  to give us some guidance.  She has offered the first six WW readers who contact her a complimentary consultation on 8th February from 6pm. Guests should call to book a slot from 6pm through to 7.30pm – each slot will last 15 mins.

“Skin can be revitalised by harnessing the natural healing response.  Trauma to the skin (eg cuts, abrasions, knocks and burns) stimulates a healing “cascade” that ends in the repair of the skin.  In essence, the trauma releases one or two chemical mediators such as histamine which then recruit other factors that work on the blood vessels (to improve blood supply and nutrient delivery) which then activates other factors such as growth factors. This cascade effect ensures a massive arrival of the necessary components (eg oxygen, protein) for rapid successful healing.

Cells such as fibroblasts are also stimulated. These are healing cells that “live” in the dermis of the skin. On activation they elongate, take hold of the skin edges that have been damaged, and contract, pulling the edges together. At the same time they create new collagen to seal the wound and then replace the wound with, hopefully, new skin.

I say hopefully, because some trauma is too deep or too unmanageable for the skin to close cleanly. These are the wounds that end up with scarring.

Medical techniques can harness the natural healing capacity of the skin by providing a controlled, minimal trauma that enables the healing cascade to develop and the fibroblasts to be activated. Without a real wound, the energy held in the fibroblasts can be redirected to create healthier, thicker, taught new skin without the risk of scarring.

All rejuvenating techniques are thus tricking the skin into thinking that there is a wound and bringing about the healing cascade.

What are these techniques?

Skin Peeling

A controlled removal of the upper layers of the skin by using chemical agents. Used since the 1940s.

In general the peel sequence goes like this:

1. Skin preparation – at home – to prepare the skin for the product, to ensure maximum, uniform response and to stabilise any pigment problems that could occur.
2. Treatment – initial cleansing, then application of the peeling product, normally an acid. Either neutralisation of the acid or removal by washing off. Then application of a skin recovery cream.
3. Recovery – use of gentle, healing and soothing creams to encourage the skin to heal. Always contain a sunblock.

Superficial peeling

Superficial peels tend to be fruit acids (eg glycolic, mandelic, lactic acid). These remove the stratum corneum only (dead cells) by penetrating the layers, breaking it up and allowing them to shed prematurely. The strength of the product and the time applied will determine how deep the peel goes, subject to the fact that the acid used is a weak acid and will be neutralised as it works, a built-in regulatory system.

Superficial peels are suitable for all skin types although care should be exercised in coloured skin. They are not painful. Mild flaking occurs after a few days, but nothing more.

Superficial peels should be repeated every two weeks for a total of 4 – 6 treatments. The results of the peel will be at their best after 12 weeks. Using therapeutic skin care products between treatments will double the results of the peeling; most practitioners recommend vitamin C and/or glycolic acid based creams.

Medium depth peeling

Medium depth peeling aims to go deeper and remove some or all of the epidermis and some of the layers of papillary dermis, the living layer from which the skin grows. Stronger acids are used, particularly TCA.  The strength of the product and the time will determine how deep the peel goes. Once the depth has been reached the practitioner neutralises or washes off the product and applies a healing cream.

It can be quite painful, although only during the procedure.

The skin will be red, then quickly feel tight and look shiny as the skin contracts. The skin becomes brown and dry, to peel at day 5, leaving new skin underneath. It normally heals after 7 days. The results are at their best after 12 weeks.

Normally only one or two peels are performed to this level.

Deep peeling

This remains the best treatment for skin tightening and reduction of sun damage. The agent phenol is used which penetrates right down to the papillary dermis, removing the pigment layers. This procedure should be performed by a skilled practitioner with experience. It is normally performed in a hospital environment with sedation or general anaesthesia.

Only one peel is required. Healing takes a few weeks, but the results are amazing. The pigment layer is removed so there can be some colour loss in the skin.

Peeling is recommended for…

Peeling remains the treatment of choice for sundamage. It can be used for skin rejuvenation, pigment changes, fine lines, texture changes, open pores and skin tone. It is inexpensive, easy to perform and the results are predictable with little if any down time.

Microdermabrasion

Fine particles of alumina are brushed under pressure onto the skin, rather like sandblasting. This removes only the stratum corneum.  The skin responds immediately by becoming tight and slightly swollen – this gives an immediate éclat that is short lived. However there are long-term results similar to gentle peeling.

Microdermabrasion is primarily a beauty technique.

Dermaroller

A simple but highly effective technique to apply controlled trauma and release maximum growth factors.

Tiny needles are mounted on a roller which is then rolled over the skin of the face. The skin is made numb and the roller is rolled to obtain redness, some swelling and bleeding points. With numbing cream, the procedure is tolerable.

The face is red for up to 24 hours and then settles by day 3. Some people recover much quicker than this. Best results are seen after 4 weeks but the results will continue to show over the next year.

A series of 3 treatments spaced every 6 weeks is recommended.

Dermaroller is a very safe, effective treatment.

Dermaroller is an innovation that is here to stay. It is recommended for the treatment of acne scars, skin quality, tone, texture and fine lines. It is less successful at treating sun damage.

Dermaroller is a medical device. The length of the needles determines the degree of stimulation and hence results. 1mm, 1.5mm and 2mm are used by practitioners and are disposable devices. Home use devices range from 0.2mm – 0.5mm. These can be used on a weekly basis for up to 4 times each device.

Fractional Resurfacing

Whereas full thickness skin resurfacing removes (like deep peeling) all of the epidermis and part of the dermis, fractional resurfacing removes small fractions, rather like resurfacing through a sieve.

Full thickness skin resurfacing is the best laser treatment to improve skin quality, but has disadvantages of pain, delayed healing, oozing and infection risk. By only resurfacing tiny fractions, the skin heals quickly from the untouched areas.  The most well-known devices for this technique are fraxel (TM) and pixel (TM).

Ematrix

This is the newest of fractional resurfacing. Whereas most other fractional resurfacing devices use laser energy, eMatrix uses radiofrequency energy. The energy profile of laser energy entering the skin is an inverse pyramid; a lot of epidermis is removed whilst the dermis receives only a small amount of energy. Remember that only the damaged areas respond by healing. The profile of controlled damage with the eMatrix to the dermis is the opposite; it acts almost entirely on the dermis leaving the epidermis untouched.  The dermis is the source of collagen production.

EMatrix treatment is quick and tolerable. The skin will be red for up to five days depending on the setting used. Deeper settings will achieve better results but with longer healing time. The skin is healed within 12 hours so recovery creams can be used and normal skin care and make up applied the very next day. The skin becomes a little dry.

Results are seen after 1 week. These continue for the next six months. Repeat treatments can be performed after three months.

EMatrix is a safe, reliable treatment that is recommended for improvement of skin quality, tone and texture. It is used for acne and other scars.

It can be difficult to decide between dermaroller and eMatrix. In general eMatrix will go deeper and provide better results, especially on acne and other scars. It is slightly more effective on fine lines and skin tone.

eMatrix stands out as a fantastic treatment for the area around the eyes and the lips. Good results can be achieved after one treatment on saggy skin and eye bags, plus lipstick lines.