COSMETIC UPDATE 2009:  

BEAUTY AND COSMETIC-UPDATE FOR SALONS 2009

The cosmetic-salon, overview and beauty update-2009 covers the following topics including performance-analysis:

 FACE-LIFT OR MINI-FACE LIFT REMAINS “THE GOLD-STANDARD” FOR WRINKLE AMELIORATION, JAW-LINE CONTOURING OF JOWLS AND FACIAL REJUVENATION IN 2009:

For lower-face jowls and wrinkled-neck, a surgical face-lift renders the best results, but comes at a cost and slight morbidity. Beauty salons and clinics are unable to achieve these rejuvenation-outcomes demanded by high-profile clients. It cannot be beaten, however. If you want to get rid of jowls and improve the lower jaw-line, are older than 45-years, then a face-lift is the treatment option of choice, but surgeon selection is important. For a mini face-lift with small incisions placed below the ear, the down-time is about 1-week and the results last for 10-years. RF, IPL, fractionated laser resurfacing does not come near a face-lift results. RF, IPL, and laser treatment only last 3-4 months and have to be repeated. And the client has to come back and back. On the other hand, one must know that complications can occur, and surgeon dependant. One must avoid the “wind-blown or way-over-pulled face”. Botched jobs are recorded when the face has a pulled appearance, swallowing may be affected and the client is left with a glaring-look. The client has the selection of two facelift procedures: the classic SMAS operation or mini-facelift. Whatever approach is used, a pleasing long-term result is obtained with a reduction in jowls, improvement of the neck obliteration of a drawn-expression, and removal of a “tired” look. Sometimes fat-grafting is combined to provide “volume”, but in most cases this effect is lost at 12-months. Although 80% of cosmetic facial procedures are non-invasive, the results are inferior to a surgical face-lift. Also, laser treatment is often so expensive, that clients cannot afford it. So many female clients, short on cash and with a small budget in the current economic recession, will not have access to a face-lift and laser ( mosaic and fractionated). Nose and ear reconstruction are often needed and only the surgical option is effective. Face-lift cost is in the region of R50000. RF and IPL cost about R300 per treatment session. Before undergoing a surgical face-lift, the client should first try application of the Defense-Lift-Serum® described in the next paragraph. For removal of bad jowls, lower-face sagging, the face-lift is the best tried and tested approach and far superior than non-invasive RF , IPL, peels, etc. Clearly, a surgical “ nip and tuck” renders far better cosmetic results than devices that heat-up the skin and cause scarring. See Table 1,2 & 3.

INSTANT NON-SURGICAL FACE-LIFT SERUM: BETTER THAN BOTOX®, LASER AND RF?

Georgi Madison® produces a non-surgical face-lift serum that gives an excellent result within 2-3 minutes, after topical skin-application and lasts for 8-12 hours. Advantages over botulinum are that the serum tightens and lifts the brows, meaning that a brow-lift is achieved. This product freezes and elevates the brow which is excellent on special occasions. The Defense-serum® can also make naso-labial lines disappear in a few minutes. Laser-resurfacing results vary from none too good. Also lasers do not provide brow-lifting, as well as doing nothing for the naso-labial lines or jowls. Defense-serum immediately eliminates wrinkles for 8-10 hours, evens out the pores without any pain. RF on the other hand, is unable to cause any face-contraction, whereas Defense-serum® can offer the same as Thermage® according to reports from the United States. The producers of Defense-serum® claim contracture of forehead cells, brow-lifting, restoration of a more youthful look by wrinkle amelioration, without the thermal effects of lasers or RF, all in a few minutes. Fillers are costly, and used for limited areas on the face such as the NL-lines. The effect is for a short-term and lifting is not achieved, only volumetric. It is suitable for all skin photo-types, but should be handled with care in clients with a sensitive skin. The serum costs $ 100 and that is about R700 in South-African currency. For more details consult U-TUBE. Other products that also have an immediate effect include Epilift® that is a skin firming, anti-wrinkle formulation(see www.epilift.com).

PLATELET-RICH PLASMA ( PRP, ACR, AUTOLOGOUS PLATELET-RICH PLASMA). IS PLASMA RESURFACING OR PRP-MESOTHERAPY SUPERIOR TO LIGHT-THERAPY OR RF?

This new option of biological is now offered by salons for skin-rejuvenation of the aging-face and is therefore directed at anti-aging. PRP is not a filler and cannot fill in hollows on the face, improve hyper-pigmentation or sagging. PRP is extracted from a venous blood-sample taken from the fore-arm of the client in the salon, and the plasma-fraction is drawn up in a syringe after the blood (16-ml) is centrifuged in the doctor’s chambers or salon. The clients own plasma is used to resurface and rejuvenate the aging-face. The plasma is separated from the red-blood cells and the active PRP-component, drawn up into a syringe. This takes about 30-minutes. Then the plasma is used as PRP-mesotherapy, and multiple tiny injections are used to deliver the plasma into the dermis, by tiny pricks. The face, neck and back of the hands can be considered. It is not a miracle drug and no better than Botox or fillers. The best that can be offered is skin-rejuvenation. Further later treatment with RF etc is still needed and the PRP effect only lasts about 3-4 months. It cannot reverse lipo-atrophy or sagging of the face. PRP should not be considered in Fitzpatrick Type-1 faces and others with sensitive skins. A few negative reactions have been reported including allergies despite the autologous nature of the plasma. PRP should not be administered near the eye because severe complications can affect the orbital contents. An experienced doctor is needed to give PRP. The process will need repeating every year. Dramatic results do not occur and sometimes clients are disappointed with the result. PRP-mesotherapy cannot offer what conventional fillers, such as Juvederm®, Radiesse®, and Sculptra® can. It will not give a Botox® effect. Most clients are impatient and do not want to wait months before a result is seen. PRP cannot be given at the same sitting with RF, IPL, Fraxel®, microdermabrasion. Available products in South Africa include, Regenlab®, MyCells®, Plateltex® and the results are more or less the same when compared ( confirmed by Boland Cell©). Common to all is that the platelet-rich fraction is separated from the plasma and used to rejuvenate the face by the process of PRP-mesotherapy which relies on the multiple small injections of plasma under the skin. No magic stem-cells are injected. Modest results are usually seen but only visible after a few-months. The largest experience has been with REGENLAB-PRP© and the results seem better than other new emerging generics. All three are available in Cape Town, but Regen® is the preferred choice. Costs vary from R250-R8000, depending on the salon selected. So shop around. Because the treatment is cheaper at one salon, does not mean that the service is any inferior than a more pricy salon. Minor side-effects include, itching, redness, bruising which can be disturbing. Down-time can be as long as a week, due to puffiness of the eyes. PRP is unaffordable for clients on a limited budget, and in these cases the client should spend smarter on Botox© or a Filler that gives a more gratifying and predictable result. PRP does not replace Botox®, RF, peels or fillers. Its weak area is that it cannot reverse solar-damage, cannot improve hyper-pigmentation and wrinkling at best, especially lip-lines and crow-feet. For wrinkles, Botox® and fillers such as Juvederm® are preferable because a definitive result is always achieved. On balance, fillers are a smarter first-choice compared to PRP, and are cheaper. There are smart salons that can do PRP-facial mesotherapy for under R1000. See Table 1,2 &3.

 JUVEDERM® LEADS AS SELECT FILLER BECAUSE OF CLIENT-COMFORT DURING 2009:

Most clients will remember the extreme pain when fillers where injected in the past, even with the use of local or topical anaesthesia.  Allergan™, have come up with a winner filler that incorporates the local anaesthesia in the syringe with product. In a landmark publication from Switzerland, Levy et al 2009, have demonstrated the new advance in filler-technology regarding client-comfort during lip or face augmentation (see references 1-3). All fillers are costly and are limited at best to restoration or amelioration of naso-labial lines. Results using various fillers vary dramatically, and client-expectations should remain modest. Fillers do not ameliorate wrinkles immediately but are good to plump the skin or lips ( plump-up or volumizers). Most fillers can be considered an affordable procedure and client satisfaction is high.  Sculptura® is another highly effective dermal filler.

The application of “The liquid –facial” is highly effective in treating facial wrinkles and the approach includes the incorporation of planned combined Botox® and Juvederm®. This approach is far superior, from an aesthetic point of view, and predictable than the use of platelet-rich plasma ( Regenlab® or Mycells®), which clearly does not render the same results. For wrinkles, the filler is the treatment of choice and not PRP. Fillers are affordable and cost-effective and can be done for between R1500 and R2500. See Table1 & 2. Dermyal®, manufactured in Switzerland, is a new natural hyaluronic-acid filler and early impressions in South-Africa are that it is as efficacious as Juvederm® and Restylane®.

RF IS LESS EFFECTIVE THAN BOTOX® OR JUVEDERM® IN 2009:

 For the rapid amelioration of frown-lines and crow-feet, Botox® renders results far superior than RF. A few quick tiny injections, a shade of skin redness for a short while, and the wrinkles are gone within 7-days, provided enough units are injected. In these areas peels are not appropriate and cannot compete with Botox®. RF does have place in facial rejuvenation, however, and a number of devices are used in salons (Alma®, Quad™, E-Matrix/Syneron®, the latter of which has a unique fractionated mode). Botox® can cost between R850 and R1200 per area treated, depending on the salon.

RF, can be used on all skin-types, but special care is needed on sensitive skins. There is usually no down-time and with time there is an increase in texture and appearance. Generally speaking, there is little redness post-procedural in Boland Cell’s experience. And the skin gets better over time. Results can last up to two years. See Table 1,2 & 3.

HYPERPIGMENTATION AND HYPERMELANOSIS: ACHILLES-HEEL OF THE SALON:

This due to an excess of melanin pigment in the epidermis and dermis. It is very common and an aging problem, reaching a peak at 70-years.The treatment of chloasma or melasma is a challenge to any salon, because of the high incidence of recurrent or relapse of pigmentation after treatment. Cloasma or the “mask of pregnancy” usually subsides over months and after breast-feeding is stopped and until the next pregnancy occurs. In persons on the contraceptive pill, may also develop troublesome chloasma or melasma as it is sometimes called. Small localized areas can be treated with 2% topical hydroquinone that can be prescribed by the dermatologist. Provided pregnancy and birth-control pills are not causative, this cream will clear the pigmentation over a period of 2-years, without complications, provided sunscreen is also applied. Wide-spread use of skin lightening creams using hydroquinone is associated with side-effects. Sun induced solar spots (“ouma spots”) on the face and back of the hand is common in elderly ladies. Some salons resort to the use of IPL or lasers and the results are poor with induction of post traumatic hyperpigmentation. Post-acne pigmentation and forehead melasma in persons of colour is very resistant to any form of treatment.

Cosmelan® (for salon), Dermamelan® (for professional doctor) and Yellow peels® are available as depigmenting-masks for the treatment of facial hyper-pigmentation. The initial mask is applied in the salon and then washed off at home after a few-hours. Then maintenance-cream is applied daily for a few-months. Results again are very variable. The biggest drawback is very high-cost, variable results or no result. The initial pack can cost up to R6000 depending on the salon and then R1000 per month thereafter. This exceeds most budgets, and because of the invariable results at times, is impractical. But this approach or the application of the Yellow Peel can be considered if money is no problem. Boland Cell has found that Cosmelan® and the Yellow Peel® are niche treatments for hypermelanosis, in non-cash strapped clients. For most clients these masks are unaffordable, beyond most budgets, cost-ineffective and in some cases no result is recordable.

Small “ouma spots” on the back of the hand usually respond well to local topical application of Neostrata® Pigment Lightening Gel (10 AHA and PHA) and contains kojic acid. The gel is applied locally for a few days at a time to the spots with an ear-bud. Slight redness will be detected after a few days at which stage the gel is stopped. It is a painless approach. The spots then fade slowly over 3-6 months and become very faint. Re-application may be needed later on. It is very cost-effective and costs less than R200 for a tube of gel, and lasts months. Excellent results can be achieved without the use of IPL or laser, and spots become almost invisible. Sun activation is a problem and so sun-screen is needed when exposed to sun-rays. There is no quick fix for hyperpigmentation and treatment is often needed up to 2-years.

CELLULITE: CAN BE TEMPORARILY AMELIORATED BUT ALWAYS COMES BACK:

To succeed with cellulite the client must be on a special diet, do exercise and be involved in life-style adjustments. The hardest ones to treat are younger ladies without obesity and genetically-predisposed cellulite on the back of the legs, lower abdomen, love-handles and saddle-bags. And cellulite can occur in young athletes. Cellulite is not a disease.

In the past, clients seeking treatment, were subjected to liposuction or abdominoplasty for big sagging bellies. Liposuction works well in experienced hands but costs money. Smart-lipo®, that is a variant of liposuction, renders excellent results in the hands of experts. These services are available in Cape Town and Johannesburg.

Clients who cannot afford liposuction can gain minor relief with the non-invasive treatment of fat-deposits. The problem is that cellulite is stubborn to treatment, results are variable or no result may be seen. Multiple treatments stretching over many months (labour intensive) is needed to render any decent result. Circumferential weight-loss at best could be about 2-cm. Claims of 5-cm circumferential loss are far-fetched and no better than wraps applied in the salon. There are so many devices used to reduce cellulite, most of which make no impact at all and clients are disgruntled. A few are mentioned and are used in salons dealing with cellulite: Velasmooth®, Velashape®, Synergie®, Endermologie®, Lipolase®, Ultrashape®. The Power Plate® also has a role to play in toning the body. Endermologie® set the standards, and clients are happy with results. Acoustic wave therapy (AWT) will enhance the results of Endermologie®. AWT is administered via the D-ACTOR 200® applicator. For small localized areas mesotherapy or carboxytherapy can be attempted but many treatment sessions will be needed. For more information on AWT, see www.advancedmakeoverclinics.com.

HAIR REMOVAL: A SUCCESS STORY WITH EXCEPTIONS:

Unwanted hairs can be effectively removed by multiple treatment sessions either by IPL (including Aesthera®, Mona-Lisa®) or laser (Epi-light®). This applies to the back, pubis and extremities but multiple treatment sessions are needed. White facial and chin-hairs are tough to remove and the clients might be better off with waxing or periodic plucking with a small tweezers using an enlarging mirror.

 TELANGIECTASIS ON THE NOSE: RECURRENCE IS COMMON:
IPL (Mona-Lisa®) or laser (Alexandrite®) can be used to buzz the tiny veins on the side of the nose in repeated treatment sessions. Quite a painful procedure. Quite effective and the telangiectasis can disappear completely for months and the re-occur, needing further buzzing in the salon.

Small varicose-veins and telangiectasis of the lower-extremity can be very effectively managed by micro-sclerotherapy (tiny injections) that renders far better cosmetic results than lasers, once the deeper varicosities are stripped at a separate time.

TABLE 1: Shows performance–analysis of treatment modalities on skin- rejuvenation parameters (after BOLAND CELL© 2009).

 EYE-LASH ENHANCEMENT: RENDERS GOOD RESULTS

Salons can consider enhancement of the eye-lashes with a biological, if they do not want to be bothered with false-eyelash application. Boland cell has been pleasantly surprised with results. Eye-lash enhancement can be achieved with Revita-Lash®, Enormous Lash® or Latisse® which is a prescription topical treatment. All need to be applied to the eye-lash base on a regular basis. Boland cell sees results after 40-60 days of application. Some products are a waste of time and do not work at all. Spillage into the eye must be avoided. Discolouration of the iris, irritation and visual blurring have been reported.

TABLE 2: Shows performance-analysis of rejuvenation modalities on beauty and cosmetic parameters. Face-lift, RF and filler perform well compared to PRP and IPL. Botox has an excellent anti-wrinkle effect (after BOLAND CELL© 2009).

PROFESSIONAL NEOSTRATA® CHEMICAL PEELS FOR REJUVENATION: BACKBONE OF SALON TREATMENTS 2009:

This is the gold standard of peels: Chemical peels for exfoliation  are as popular as ever before. Neostrata® (glycolic-acid) is the most cost-effective, safe and renders the most consistent outcomes. A range of 20-70% is available but it is seldom necessary to exceed 50%. Pre-peel Antioxidant and Brightening peel boosters are available (30 AHA). One can select between contents of citric acid/ kojic acid/ arbutin or citric acid alone. Neostrata® Bionic Face Cream (12 PHA: lactobionic acid) applied after the peel and LED renders excellent rejuvenation results and far cheaper than laser-therapy.

Combined with LED 633nm red-light (Omnilux®), also referred to as a photofacial, one gets an excellent facial-glow that lasts about 2-weeks. See comparisons of rejuvenation outcomes of peels versus other modalities in Table 3.

Table 3: Performance-analysis and effects of common salon treatments on rejuvenation of the face (after BOLAND CELL© 2009).

 REFERENCES:
1. Levy PM, De Boulle K, Raspaldo H. A split-face comparison.  J Cosmet Laser Ther.  2009 Apr 1:1-5. [ Pubmed]
2. Levy PM, De Boulle K, Raspaldo H. Filler data. Dermatol Surg. 2009 Feb; 35 Suppl 1:332-6 (Pubmed).
3. Pinsky MA, Thomas JA, Murphy DK, Walker PS; Juvéderm vs. Zyplast Nasolabial Fold Study Group. Juvederm injectable gel. Aesthet Surg J. 2008 Jan-Feb; 28(1):17-23 (Pubmed).

DISCLAIMER: This site does not supply any cosmetic advice or treatment. The client must visit an aesthetic practitioner, plastic surgeon, dermatologist or beauty salon.

POSTED 20/5/2009 and the contents has been reviewed by a Biomed Consultant for accuracy. BOLAND CELL TECHNOLOGIES accepts no responsibility for the contents of the text, does not view it as treatment, and the client must see a dermatologist for advice, treatment, options, informed-consent, side-effects etc.