SKIN ANALYSIS PRIOR TO PHOTO-LIGHT THERAPY, TONING, SKIN TIGHTENING OR ACR/PRP NON-ABLATIVE RESURFACING
Florence Barret-Hill (2004) has shown the importance of advanced skin analysis in the salon. This is needed to lend credibility to aesthetic medicine. A comprehensive assessment is needed prior to IPL, RF, ACR/PRP and fractional photothermolysis because a failure to do so will invariably result in poor outcome and client dissatisfaction. Basing therapy on skin ultrasound analysis alone, results in poor measured outcomes. Because ultrasound alone of the dermis ignores the following important skin characteristics ( superficial anatomy) and elements:
Texture (renewal and desquamation of the stratum corneum). Surface texture of the epidermis must be established in a consultation prior to therapy.
Colour (abnormal production of melanin resulting in hyper- or hypopigmentation must be established).
Secretion (acid mantle, sebaceous and sudiferous glands).Is the skin oily or dry? What is the lipid status?
Skin analysis is a chargeable service because clients insist on acceptable measurable and visible skin results after non-invasive treatment to improve tone (i.e. IPL, lasers) or use of creams. Skin surface anatomy and morphology should be studied before considering a rejuvenation option. This must include analysis of dermal collagen and elastosis, in order to make reasonable predictions. Therefore, skin diagnostic devices are needed and the following elements need to be established:
Oilyness of skin
Dryness of skin, pore status
Melanin depth (dyschromia, lentigenes, sun-spots, telangiectasis, melanoma, freckles, melasma).
Epidermal and dermal atrophy
Underlying structured damage induced by photo-aging . Ultrasound possibly can demonstrate dermal collagen, but is inconsistent on epidermal 3D morphology, skins secretions and elastin content (elastosis). For these important aspects the VISIA supplies superior images that can be quantified and used for follow up.The VISIA system allows the therapist to assess wrinkles, mid-face ptosis, sagging as well as pigmentation. Because the patient and therapist can evaluate the skin complexion and effects on pigmentation.
As a skin care professional you somehow need to measure lipid, hydration, melanin depth and erythema levels (i.e. determine presence of lipid dry and oily skin). For this a skin scanner is useful, with colour differentiation. Work out skin type and perform condition analysis.
SKIN ANALYSIS DEVICES: NEED FOR ANTI-AGING TREATMENT PLAN
- Dermascan ( CORTEX: ultrasound and measures "dermal collagen").
- Cameras ( NIKON, CANON,SONY).
- Skin Visio ( Licorna Laboratories).
- Visia ( Canfield Imaging Systems).
- Magic lamp and magnifying glass.
- Skin scanners (Black light, Woodslamp).
- SD202 skin analyzer (Courage and Khazaka Electronic) - accurate for measuring hydration, lipid, melanin and erythema levels.
- Biotherm Bioscan 7.00.
- Dermatologica Face Mapping.
- SK-11 Beauty Imaging System.
- C+K (SPA 99, SD 202, MDS 800).
- Beau Visage Skin Analysis (data provided on distribution of facial blood, melanin , sun damage and skin age)
WHAT WILL BE THE END-POINT OF YOUR REJUVENATION TREATMENT PLAN USING IPL, ACR/PRP , RF OR LASER?
Following your skin diagnostic analysis you may have to correct:
Skin tone by tightening the skin. This takes time and many sessions are needed as well as maintenance therapy (RF, IPL, Aesthera, E-max, Titan, Fraxel). Correcting skin wrinkles is not a quick fix affair, and there is no magic bullet. The problem is variability of results or predictability, as the speed of progressive chronological skin aging differs from person to person, with different genetic backgrounds.
Are you trying to correct the texture of the skin? Do you want to improve skin renewal and desquamation of the stratum corneum? Consider glycolic acid peels, microdermabrasion and light emitting diodes (LED) such as the light source provided by Omnilux (distributed by Genop Healthcare in the RSA). In your rejuvenation endeavours you will be trying to improve excess keratinisation, loss of structural integrity leading jowls and sagging, especially of the lower face and mandibular areas, address loss of resiliency and adhesion (fibroblast and keratinocyte dysfunction) and improving glycation (see Barrett-Hill, 2004).
Does your client present with skin colour problem (pigmentation, vitiligo, rosacea, telangiectasis grades 1-5, melasma, cloasma or lentignes)? You will be tested as most treatments give variable results in this category. This includes the use of IPL and fractional photothermolysis. And recurrence of the pigment is possible, the moment the client is re-exposed to sunlight. So sunscreens, during and after photo-light therapy is critical. Melasma is tricky to treat and recurrence is common. This is also the case with freckles.
Will you be treating combination of 1-3, including a secretion problem ? Are you dealing with a deficient acid mantle, impaired lymphatic system, skin atrophy, thinning and acne? Will your treatment be directed at epidermal lipids, sebaceous or sudiferous secretions or restoration of glycosaminoglycans (see Barrett-Hill, 2004)?
Do you think the skin disorder you are treating in front of you (i.e. photoaging, vertical and horizontal crepe lines, fine line, sagging of the chin, creasing of the décolleté, is permanent or temporary?
What are your primary priorities ? Do you want to treat the pigmentation, crowfeet wrinkles or vertical/horizontal crepe lines affecting the face, chin and décolleté? Both are testing areas for the therapist in the following respects. The dyschromia may well respond initially, but melasma will return. At best, whatever machine is used (IPL, LED or fractional laser), a 68.5% improvement in wrinkles will be detectible at 12 weeks. Mid-face ptosis is different to treat in persons older than 60-years. Skin tightening is not always easy to achieve, and it does not occur after only one treatment. Loss of structural (collagen) integrity will test the best of therapists, and often one has to resort to a filler. Botox after 60-years renders generally poor results. Correction of the lymphatics with the structural integrity is important (see Barrett-Hill, 2004). Knowledge of all these elements, including background skin histology, is important so that your client can enjoy maximum response in the shortest possible time. Aspirations of the client must be determined and it may be required to tell them that it is only possible to achieve one level of improvement in the skin at the time. No guarantees can be given and multiple treatments (including maintenance therapy) are needed to give a gradual and subtle effect. In depth knowledge of ECM, glycosaminoglycans, skin histology and physiology and light physics is needed if one gets to get any results.
END-POINT ANALYSIS OF NON-ABLATIVE SKIN REJUVENATION: WHAT IS BEST FOR YOUR CLIENT?
You have to have a 1 hour consultation with the patient/client to determine visual analysis and consultation of skin . You must be trained in skin histology. Wide background experience is needed to prescribe rejuvenation options.
VISIA provides superior skin morphology analysis than ultrasound because it gives the therapist more data i.e. VISIA provides analysis of: spots, UV spots, melanin or brown spots, red areas ( malar cheek telangiectasis), wrinkles ( vertical and horizontal crepe lines including crow feet) , texture, pores and porphyrins. These epidermal and morphological features, critical to facial rejuvenation, are not available with current ultrasound devices. An alternative is the Beau Visage skin analysis system.
- Ultrasound ( DERMASCAN ) that can provide data on the dermal collagen status. Possibly 3D versions may overcome some of the drawbacks of the first generation models.
- SD202 skin analyzer, as this provides excellent data on hydration, lipid, melanin, and erythema data at affordable prices and limited Salon budgets.
- Determine and exclude/identify skin disorders.
- Address important skin quality issues: colour (melanin), texture, and secretions.
- Grade pigmentation and wrinkles. Identify precancerous areas in clients with severe damage, and know about squamous cell carcinoma and melanomas. Are the naso-labial folds unsightly. Remember these lines are often the distinguishing features of great statesman.
- Check upper-lip creases/lines/folds/wrinkles. Assess crow-feet, and periorbital fine lines.
- Classify facial aging: Fitzpatrick grades/Glocau scores.
- Treat. Many sessions are needed, plus follow-up and maintenance therapy supported by quality creams some of which may be vitamin-A based. New developments include use of trophic factors and peptides in the moisturizers.
BOLANDCELL ACADEMIC REFERENCES
DERMASCAN ( ULTRASOUND) IMAGE OF SKIN
VISIA SKIN ANALYSIS
COSMETICS VARY IN CHEMICAL COMPOSITION.