In the recent years aesthetic medicine has come to rely heavily on technology, and rightfully so — the impact that laser, radio frequency or ultrasound make on the skin brings about objective and visible, even with naked eye, changes. Energy-assisted technology is applied to the treatment of scars and pigmentation, restoration of skin firmness and wrinkle correction. The same technology makes it possible to remove a tattoo, polish stretch marks, reduce fat depots and even partly restore the lost contractibility of stretched skin.
The mechanics of action differs from method to method, but the side effects, which are, sadly, possible, have a lot in common, because they’re all linked to the same characteristics of physical impact.
Energy-assisted correction methods share several key similarities:
- Laser, ultrasound and radio frequency therapy always heats up the tissue, and the very same thermal effect that we rely upon for aesthetic correction is linked to the negative consequences, which we try to avoid.
- All kinds of energy-assisted correction imply a varying degree of damage to the skin’s barrier function and changes in the skin microbiome.
- All high intensity treatments start an inflammatory response in the skin, which aids the correction, but can lead to specific post-inflammatory complications.
The heating of deep skin layers is a powerful therapeutic tool as it leads to the release of heat shock proteins and other biologically active substances activating regeneration process and the syntheses of dermis’ structural elements. Heating accelerates epidermal renewal and improves the skin’s look as a result. However, excessive heating during a treatment can cause a cascade of cell reactions characteristic for thermal damage. These cell reactions cause the appearance of burns (small area burns of mild and medium degree are considered negligible side effects of the treatment), changes in skin sensitivity and even persistent skin anaesthesia, prolonged painful sensations, the formation of seromas and focal depression in tissues.
Despite the fact that most of these side effects are reversible, the patients tend to have a strong negative reaction to them and are often hard to persuade that these are not serious. The complications of energy-assisted treatments are so common, that their prevention has become a recurring theme of many studies.
Fortunately, these complications are not too difficult to prevent
For one, many aesthetic medical devices have built-in temperature sensors allowing to control the degree of skin heating and avoid overheating. There is also a simple method of preventing heat-related side effects: instant cooling of the skin with various applications. Cooling the skin immediately after treatment prevents the thermoreceptors’ reaction to the heat and stops the pathological cascade of cell reactions which causes complications.
Clinical Recommendations for the Application of Red-Apax Mask
Any thermal impact on the tissue bears the risk of side effects and complications due to the nature of physical impact as well as the patient’s individual reactions. Temperature control, different methods of measuring the skin’s temperature and applying minimal sufficient heating allow the practitioners to prevent and minimise most common complications.
According to Diana Duncan and Michael Kreindel, leading experts in the safety of high-intensity energy-assisted treatments, one of the simplest and most effective methods of increasing the safety of radiofrequency and laser therapy is the application of cold compress immediately after the treatment and for a few days after. (See Duncan, D. I. (2014). Complications of Treatment with Radiofrequency in Aesthetic Medicine. Aesthetic Dermatology, 81–96; Duncan, D. I., & Kreindel, M. (2014). Basic Radiofrequency: Physics and Safety and Application to Aesthetic Medicine. Aesthetic Dermatology, 1–22.)
In her article Complications of Treatment with Radiofrequency in Aesthetic Medicine (Aesthetic Dermatology magazine, 2014) D. I. Duncan writes:
Because the possibility of thermal damage is always present with heat-mediated treatments, the immediate availability of cold compresses is a vital element during the procedure. Application of a cold damp compress is indicated when focal erythema, an arc burn, or blister is noted during treatment. If, during treatment, the practitioner feels a ‘hot spot’ with his or her hand, serial application of a cool compress can significantly reduce the risk of a burn, focal depression, or seroma…
Cooled down unwoven sheet masks can be used as cold compresses with a few added benefits. When Meder Beauty Science Red-Apax Mask is applied, therapeutic low-temperature impact is combined with the biochemical impact of the mask’s active gel containing low and medium molecular weight active ingredients (panthenol, bio fermented extract of rice sake, chamomile and centella asiatica extracts).
One of the many advantages of Red-Apax Mask is that it is supplied in bacteriologically tested disposable packaging eliminating the risk of infectious contamination of the patient’s skin damaged in the course of energy-assisted treatment.
To increase the safety of energy-assisted treatments we recommend:
- Apply cooled down Red-Apax Mask immediately after treatment. (Ask your aesthetic doctor if they offer this option!)
- Put the remaining 4 masks into the fridge at home.
- Use the masks daily for 4 days following the treatment, preferably in the morning, to minimise redness and discomfort during the day.
The use of Red-Apax Mask reduces discomfort and redness immediately following the treatment. The application of Red-Apax Masks daily in the 4-day post-treatment period activates regeneration processes in the skin, reduces inflammatory changes and the risk of post-inflammatory hyperpigmentation.
The disturbances of microbiome balance and of the skin’s barrier function lead to post-treatment infectious process: papulopustules, manifestation or relapse of acne. As it turned out, persistent erythema (continuous redness characteristic and quite common complication of ablative laser and other high intensity treatments) is also infection-related. Most often the cause of erythema is the development of biofilms with the presence of Micobacterium cosmetici and some fungi, inevitably found in the open cosmetic jars. It is crucial to inform the patients about this and convince them to give up their conventional skincare, including ‘natural’ and ‘organic’ cosmetics. After a high-intensity treatment the patient should only apply skincare that meets strict pharmacological and dermatological requirements, i.e. is protected from contact with environment even after opening. Skincare in jars, droppers, bottles, pump bottles, etc. must be avoided, instead the patient can opt for solutions in disposable single dose packaging or airless vacuum pump bottles.
For optimal recovery after skin injury (we must remember, that laser, radio frequency or ultrasound impact causes skin trauma) a speedy restoration of microbiome is essential. Therefore, it is important that skincare solution applied at this time contains prebiotics promoting the growth of beneficial flora and suppressing the development of pathogenic and unwanted bacteria. To this end we recommend applying Derma-Fill Prebiotic Moisturising Cream, a hyaluronic acid-based emulsion with prebiotic BioEcolia®. Derma-Fill moisturises the skin creating a thin breathable layer, helps the skin grow healthy flora and restores the skin’s own barrier function. Derma-Fill can be applied immediately after most treatments, and on the 5-6th day after ablative therapy.
Finally, one of the key inflammatory complications is post-inflammatory hyperpigmentation: the appearance of dark spots in the impact areas several weeks after the treatment. This complication is very common, for instance it can occur in 8 out of 10 cases after ablative laser resurfacing with CO2 laser. PIH is reversible, but therapy can take months and obviously it will cause significant discomfort to the patient. The common remedy is applying various brightening solutions based on hydroquinone, arbutin, retinol, hydroxy-acids and other active ingredients. Unfortunately, most of them make the skin more sensitive, increasing the risk of sun burns and pigmentation even after a short stay in the sun. For the prevention of post-inflammatory hyperpigmentation, Meder Beauty Science offers Nrj-Soin Serum, an anti-oxidant serum with niacinamide. Niacinamide suppresses the synthesis of melanin pigment and its migration to the skin’s upper layers, ‘soothes’ pigment cells, while antioxidants in the serum’s formulation help accelerate regeneration and healing process after high-intensity treatment. A research of the skin reaction in a group of patients applying Nrj-Soin Serum prior to laser resurfacing and phenol peeling showed none of the patients getting PIH after their treatment. Their skin recovered faster, and the scabs were shed a few days earlier. We recommend applying Nrj-Soin Serum 2 weeks before planned treatment and continue application afterwards for 1–2 months, same as Derma-Fill Prebiotic Moisturising Cream.
The use of these 3 solutions will not take up much time, but it will save a lot of effort and funds which may otherwise be required for the treatment of complications post high-intensity treatment.
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