Innovations in Integrative Skin Care

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Antioxidants plus devices yield optimal aesthetic outcomes.

One of the greatest things we, as board-certified dermatologists, can do for our patients who seek superior aesthetic and procedural results is to combine available treatment modalities to achieve the best possible results for our patients. 

In my practice, I often curate custom treatment recommendations for patients that result in personalized skin care regimens that include a combination of devices and skin care recommendations. This combination of treatment modalities and topicals is on trend in skin care and termed integrative skin care. 

The prevailing concept of integrative skin care is to provide a comprehensive, integrated treatment plan and maintenance regimen that includes fillers, neuromodulators, devices, and cosmeceutical or medical agents for the optimal patient benefit. 

Cosmeceuticals are essential aspects of an aesthetic treatment plan and serve to maintain and enhance aesthetic outcomes.

Antioxidants and Devices

Through our research and clinical experience, we have found that the paradigm of combining antioxidants and devices to yield complementary synergistic outcomes to be true from a scientific perspective. 

We discovered that the combination has direct benefit in skin fibroblast cells when studied directly in our laboratory at the University of California-Davis. Skin fibroblasts are thought to be one of the primary cellular drivers of beauty and serve to maintain our dermis and collagen that helps provide a youthful appearance. 

At the bench, we found that combining light plus the antioxidant resveratrol resulted in improvements in key parameters associated with enhancing aesthetics, such as scar improvement, by modulating fibroblast function and collagen production.1 

It is important to note that clinical outcomes can be tailored to help achieve the desired outcome of our patients based upon the combination of different doses of energy and antioxidants, and we look forward to translating our findings clinically through rigorous clinical trials. 

Recently published clinical data illustrates some of the key breakthroughs that highlight successful integration of procedures and topical products that we as dermatologists can implement in our practices for patient benefit. One of the leading benchmark cosmeceutical products used in combination with devices that has the greatest amount of published data is SkinCeuticals’ CE Ferulic. CE Ferulic has been demonstrated to provide complementary benefits posttreatment with both ablative and nonablative laser as described below. 

In a study by Waibel and colleagues, the investigators found that CE Ferulic was safe to use immediately postablative laser, and decreased edema on day 7 vs vehicle postprocedure, decreased erythema vs vehicle, and most importantly decreased patient downtime by 2 days vs vehicle.2 

As dermatologists we know that our patients often seek the best aesthetic results that we can provide; however, some dermatologists and patients are hesitant to engage in procedures that would yield downtime greater than a few days. 

The available data demonstrates that by integrating antioxidants, and specifically CE Ferulic, into a skin care regimen postablative laser, we may be able to safely decrease patient downtime and still achieve incredible results. The mechanism of action is the increased delivery of antioxidants directly to the dermis via the ablative laser generated microcolumns, a process known as laser-assisted drug delivery. 

In my practice, I have found laser-assisted drug delivery beneficial for the treatment of several conditions, including to limit postinflammatory hyperpigmentation in darker skin types postablative laser therapy and functional and aesthetic improvement in skin scarring.3

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Figure. Nonablative laser therapy using microscopic epidermal necrotic debris, or MENDS, allows for laser enhanced drug penetration into the skin via microthermal zones. The therapy has been shown to improve photodamge.

Regarding nonablative laser therapy, a study by Geronemus and colleagues investigating the aesthetic use of a home use nonablative laser device (Tria) demonstrated that the addition of a topical antioxidant regimen (CE Ferulic) improved all photodamage parameters evaluated, including hyperpigmentation, skin appearance, and periorbital and perioral wrinkles.4 The mechanism of action here is laser enhanced drug penetration into the skin via microthermal zones known as microscopic epidermal necrotic debris or MENDS (Figure). 

An in-office study examined the complementary aspect of combining CE Ferulic with 1927 nm thulium laser in 40 patients who received a series of 6 laser treatments over 12-weeks.5 Combination treatment using the nonablative laser followed by CE Ferulic demonstrated clinical improvement in skin radiance, texture, and dyschromia. 

Injectables and Body Contouring

One of the most exciting aspects of integrative skin care is providing a comprehensive regimen for patients being treated with injectables. Patients who receive in-office neuromodulators and filler injections often ask for recommendations regarding what home care regimen best complements their injectable treatment.6 A study investigating SkinCeuticals Advanced Brightening System in conjunction with facial injections demonstrated that integrating the Advanced Brightening System home care to facial injections treatment yielded a 23% greater improvement in global aesthetics and a 34% more improvement in wrinkles than facial injections alone.7

Body contouring procedures are a growing global aesthetic area, and patients are turning to dermatologists with expertise in these techniques to achieve their body goals. A recent study demonstrated that body contouring outcomes can be enhanced with the integration of topical regimen to the treated area. Goldberg and colleagues found that use of Body Tightening Concentrate (SkinCeuticals) yielded 23.1% increase in firmness/tightness compared with the 15.4% improvement achieved by the radiofrequency body contouring procedure alone.8 Anecdotally, we have found that use of Body Tightening Concentrate works well with other body contouring modalities, including laser diode-based body contouring (SculpSure, Cynosure, Hologic).

As dermatologists, it is important to remind patients after energy-based procedures to use sun protection to prevent increased risk of posttreatment pigmentation. A recent study evaluating the addition of a topical skin care regimen post-intense pulsed light found significant improvements in facial aesthetic outcomes and decreased posttreatment side effects.9 

This study is an important addition to the scientific and medical literature as it provides key clinical trial data to support the integration of sun protection in combination with topical skin care regimens postaesthetic procedures. 

 

Dr JagdeoDr Jagdeo is an associate professor of dermatology at University of California, Davis in Davis, CA.

Disclosure: Honorarium (Nutrafol, L’Oreal/SkinCeuticals, Global Med Technologis), speaker (L’Oreal/SkinCeuticals), scientific advisory board (Heliocare, Global Med Technologies).

References

1. Mamalis A, Jagdeo J. The combination of resveratrol and high-fluence light emitting diode-red light produces synergistic photobotanical inhibition of fibroblast proliferation and collagen synthesis: A novel treatment for skin fibrosis. Dermatol Surg. 2017;43(1):81-86.

2. Waibel JS, Mi QS, Ozog D, et al. Laser-assisted delivery of vitamin C, vitamin E, and ferulic acid formula serum decreases fractional laser postoperative recovery by increased beta fibroblast growth factor expression. Lasers Surg Med. 2016;48(3):238-244.

3. Kraeva E, Ho D, Jagdeo J. Successful treatment of keloid with fractionated carbon dioxide (CO2) laser and laser-assisted drug delivery of triamcinolone acetonide ointment in an African-American man. J Drugs Dermatol. 2017;16(9):925-927.

4. Geronemus R, Du A, Yatskayer M, Lynch S, Krol Y, Oresajo C. Enhanced efficacy of a topical antioxidants regimen in conjunction with a home-use non-ablative fractional diode laser in photodamaged facial skin. J Cosmet Laser Ther. 2016;18(3):154-161.

5. Data on file. SkinCeuticals.

6. Wisniewski JD, Ellis DL, Lupo MP. Facial rejuvenation: combining cosmeceuticals with cosmetic procedures. Cutis. 2014;94(3):122-126.

7. Dayan S. Integrating skin care into an injectable practice. Modern Aesthetics. http://modernaesthetics.com/pdfs/MA0815_ES_Skincare.pdf. July/August 2015. Accessed April 24, 2018.

8. Goldberg DJ, Yatskayer M, Raab S, Chen N, Krol Y, Oresajo C. Complementary clinical effects of topical tightening treatment in conjunction with a radiofrequency procedure. J Cosmet Laser Ther. 2014;16(5):236-240.

9. Jones IT, Guiha I, Fabi SG. Open-label study assessing the efficacy and tolerability of topical skincare and sun protection products following intense pulsed light treatment [published online November 21, 2017]. J Cosmet Dermatol. doi:10.1111/jocd.12463