The use of implements, devices, and cosmetic procedures has seen tremendous growth over the last 10 years. This is partly driven by the aging of populations in the developed areas of the world and a desire to maintain a more youthful appearance. The technologies used have significantly improved in the last decade with better efficacy and a reduction in undesirable side effects. The procedures are also backed by numerous published peer viewed papers attesting to their performance.
The main mechanism of action of many of the devices and procedures is to cause a skin wound which induces the release of growth factor cytokines which stimulate collagen, Hyaluronic acid, and elastin production. The wound can be caused by micro punctures or removing the top layers of skin using abrasives. Many devices can also improve the bioavailability of topically applied actives by reducing the barrier function of skin.
Types of implements
- Abrasive pads/sponge/brushes which can help exfoliate skin. These can be used daily or weekly depending on the degree of roughness of the implement.
- Dermaplaning blades and razors which are used for exfoliation by shaving off the top layers of skin.
- Micro needling or the use of micron or millimeter-sized needles to penetrate skin to induce a wound. Numerous studies have demonstrated micro needling efficacy and safety for the treatment of scars, acne, melasma, photodamage, skin rejuvenation, hyperhidrosis, and alopecia (11). An additional benefit is increased penetration of actives (13). A cosmetic derma roller is a handheld consumer micro needling device that has protruding needles on the roller that prick skin. The length of the needle can vary from 0.01mm to 0.05mm. Claimed benefits include increased collagen production. (12). Medical micro needling utilizes needles between 1 – 1.5mm which are long enough to induce bleeding. Typically, 4 and 6 treatments over six weeks are needed to get optimum results (14).
Types of devices/procedures
- Dermabrasion skin resurfacing medical procedures use a rapidly rotating device to remove the outer layer of skin. A numbing topical anesthetic is used to reduce pain. Dermabrasion can decrease the appearance of fine facial lines and improve the appearance of many skin flaws including acne scars, scars from surgery, age spots, and wrinkles. Dermabrasion can be done alone or in combination with other cosmetic procedures (14). Home devices are very inexpensive and utilize replaceable brushes or discs to clean and exfoliate skin. These devices are much gentler and take much longer to produce visible results.
- Microdermabrasion is a mild exfoliation procedure done in a doctor’s office that involves spraying abrasive crystals onto skin to slough away surface cells and smooth skin. Claimed benefits include a more even skin tone skin, and lighter hyperpigmented spots. Multiple treatment of 5-16 are normally required to see significant benefits (10). Consumer devices are available.
- Ablative laser procedures can resurface skin using an intense pulsed light and fractional lasers, or CO2 lasers to target discolored skin, scars, or sun/age damage. The lasers remove the top layers and trigger new collagen formation to make the skin look smoother. There is some redness and peeling afterward. Nonablative lasers such as pulsed dye lasers do not remove the outer layers of skin but directly stimulate the production of collagen within deeper tissues. Both procedures are performed in a doctor’s office (16).
- Red LED/near infrared devices utilizing 633 or 830 nm wavelengths and flux rates of 126 J/cm and 66 J/cm have been shown to stimulate collagen production, tighten skin, reduce wrinkles/fine lines, and make skin smoother/softer (5, 6). Both consumer and professional devices are available
- Blue LED light devices with 420 and 470nm wavelengths have been shown to effectively treat acne. It is believed that the mechanism of action is killing P. acnes, the bacteria responsible for causing acne. It may also reduce sebum production which helps reduce clogged pores. Red LED light (660nm) can also be used in combination with blue light to help reduce inflammation and redness (7,8). Consumer devices are available.
- Radio frequency (RF) devices work by using an alternating current at a frequency between 0.3 and 10 MHz. This causes the formation of new shorter, denser collagen fibers which are claimed to help tighten sagging skin and reduce wrinkles (9). Consumer devices are available.
- Iontophoresis is a procedure in which a continuous electrical current (~15mA) is passed through skin soaked with tap water or normal .9% saline. If an active is used in combination with Iontophoresis to improve skin penetration the procedure is commonly referred to as Electrophoresis. A common use is the reduction of excessive hand, feet, and underarm sweating using Iontophoresis and a solution containing an anticholinergic drug. Iontophoresis/Electrophoressis is a safe, effective, and inexpensive procedure (16,18). Consumer devices are available.
- Micro vibrational therapy (MVT) gently stimulates facial muscles at a frequency of 20-60 Hz producing up to 9000 micro-massages per minute. MVT works by deeply massaging each layer of skin with rapid vibrations that helps promote lymphatic drainage. It may also help increase cell turnover and microcirculation leading to younger, healthier looking skin. Consumer devices are available.
- Ultrasonic (also referred to as phonophoresis) devices utilize low-frequency sound waves to promote exfoliation, skin tightening, healing, and active penetration (1,2). Ultrasonic waves create cavitation forces which can lead to the formation of holes in the intercellular spaces and cause a disorder of Stratum Corneum lipids leading to an increased penetration through the barrier lipid layer. The in vitro skin penetration enhancement of nine drugs was studied using ultrasonic irradiation at 150 kHz. The penetration of lipophilic drugs after sonication was similar with or without sonication. Skin penetration of hydrophilic drugs after sonication was increased 6.9-7.4X (3). Consumer devices are available.
- Injectable fillers to reduce lines and wrinkles. Typically crosslinked Hyaluronic acid is used.
- Botox injections to paralyze the nerves causing the contraction of facial muscles which create line and wrinkles.
Doctor supervised cosmetic medical procedures can produce a dramatic improvement in the appearance of skin. Synergistic improvements are often seen when several of these procedures are combined. No topical treatment can produce similar results when used alone but many will provide additive or synergistic benefits when combined with these procedures. Over-the-counter devices can provide significant benefits but normally take much longer to produce noticeable effects. Using a skin exfoliation device with a good moisturizing antiaging cream will provide increased cell turnover and an increase in the bioavailability of actives used in the cream. Skin texture will also be immediately improved.
References
- https://pubmed.ncbi.nlm.nih.gov/35003992/
- https://pubmed.ncbi.nlm.nih.gov/20115948/
- https://www.sciencedirect.com/science/article/abs/pii/0168365995000879
- https://www.researchgate.net/publication/318997589_Microneedling_A_Review_and_Practical_Guide
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926176/
- https://www.inbmedical.com/9-clinical-studies-that-demonstrate-the-anti-aging-benefits-of-infrared-light-therapy
- https://pubmed.ncbi.nlm.nih.gov/21637900/
- https://pubmed.ncbi.nlm.nih.gov/23278295/
- https://pubmed.ncbi.nlm.nih.gov/21315951/
- https://www.medicalnewstoday.com/articles/323443#overview
- https://pubmed.ncbi.nlm.nih.gov/28549948/
- https://www.drmtlgy.com/blogs/drm-digest/derma-rollers-worth-the-risk?nbt=nb%3Amicrosoft%3Ao%3A424653496%3A1354599817791222%3A84662837065826&nb_mt=b&nb_bmt=bb&nb_oii=2336462209469251&nb_qs=derma%20roller&nb_fii=&nb_li_ms=&nb_lp_ms=72587&nb_pi=&nb_pc=&nb_ci=&msclkid=25c711b28d731f14b69272a22e253071
- https://pubmed.ncbi.nlm.nih.gov/21148047/
- https://www.thebeautyissue.com/micro-needling/
- https://www.mayoclinic.org/tests-procedures/dermabrasion/about/pac-20393764
- https://dermcollective.com/laser-skin-resurfacing-acne-scars/
- https://link.springer.com/article/10.1007/s10409-020-01026-2
- https://dermnetnz.org/topics/iontophoresis
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