The skin treatment therapist will be offered many different technologies to treat their clients during their career, and unfortunately some of these technologies ultimately turn out to be more about good marketing than effective treatments. Case in point: tweezer electrolysis hair removal.
Oxygen facials is another modality that is increasing in popularity but also raising a number of questions about effectiveness and credibility due to both the lack of scientific evidence and the growing awareness of the link between oxygen and free radical damage.
Consequently, it is perhaps a prudent time to discuss the operation and merits of this technology.
What are Oxygen facials?
Oxygen therapies for the beauty industry revolve around the use of medical grade oxygen as a delivery mechanism for active ingredients in to the skin. It is also used as a wash over the face of a client post traditional facial therapies in an attempt to stimulate or feed the skin so new collagen growth can occur. Common promotional statements used usually include a reference to the rejuvenating power of oxygen, and this is where the perception of beneficial results is fostered.
In some cases, the oxygen facial is incorrectly termed "hyperbaric oxygen therapy", as this is something completely different.
As a delivery mechanism, the oxygen is compressed and sprayed at high pressure directly on to the skin surface. A serum of active ingredients such as nutrients or vitamins etc, are introduced to the oxygen stream just before the skin, and the combined oxygen and ingredients in the form of a high pressure jet forces its way past the skins barrier defence systems and in to the lower levels of the epidermis.
The key function of the oxygen here is theorised to be an increased absorption of the active ingredients; much like would be experienced with Iontophoresis or Sonophoresis; the ingredients accompanying the oxygen jet are purported to have beneficial effects due to their specific properties.
In addition to therapeutic compounds, moisturising and other water binding ingredients such as hyaluronic acid can be introduced to the oxygen jet, and this type of use is where the most amount of publicity is being generated and subsequent increased use.
This popularity (particularly in the US) appears to stem from the almost instant smoothing and plumping of the skins surface, a reaction that can have the effect of hiding any tiny imperfections and providing a warm glow to the skin. It is popular in the film and television industry for this very reason, as it makes the job of the make-up artist just that bit easier as the effects can last up to 48 hours.
As a course of clinic treatments, recommended frequency is initially once a week for six weeks followed by monthly touch-ups, and at up to US$200 + per treatment, it can certainly become a profit making proposition with the right marketing.
Music icon Madonna is one of the most recognised celebrities who are regular users of the oxygen facials, and according to her web site, she apparently has her own personal oxygen treatment facialist on staff.
In a world driven by instant gratification and celebrity endorsements, it is easy to see why the popularity of oxygen therapy is increasing. At a recent trade show in the US, there were no less than eleven different brands of oxygen facial devices present, each claiming superior results than the competition.
The devices used to provide oxygen facials are relatively simple, consisting of an oxygen generator/storage tank, a pressure regulator and a spray gun. The high purity oxygen is generated by the same kind of device that has become popular for recreational oxygen users (oxygen bars, offices and oxygen bottlers) that uses a technology called Pressure Swing Absorption (PSA) separation to generate concentrated oxygen (90-95%) from the ambient air that normally contains only 21% oxygen. It is then delivered to a regulator and on to the spray gun.
Interestingly, most of the oxygen spray gun devices look remarkably similar to the spray guns used by airbrush artists, with the only discernable difference being the use of pressurised oxygen instead of compressed air.
But does it work?
The mild inflammatory response caused by the forced breaching of the lipid bi-layers of the epidermis is the most logical reason why the instant smoothing effect is achieved, however there appears to be no scientific evidence to date that substantiates if the therapeutic compounds find their way to the target area at the dermal/epidermal junction. If there is any evidence, then it is not widely available for public scrutiny.
Other than the immediate inflammation effects discussed previously, there is potential that there could also be a limited longer-term restructuring of the collagen matrix due to stimulated fibroblast activity caused by the inflammatory response. As the level of fibroblast stimulation is directly proportional to the level of non-ablative inflammatory response created, it could be concluded that the effect is likely to be less than a peel or Microdermabrasion. There is however, no conclusive evidence of this occurring to any significant degree either.
That the oxygen used during the facial actually provides therapeutic effects from a topical application, and the premise that we can increase the energy in the skins cells by topical application of oxygen is flawed for a number of reasons. We need to consider the following factors:
- The human skin does not respire to any perceptible degree; in fact the skin does not require being in an oxygen environment other than respiration via the lungs.
- The skin barrier defence systems effectively render the skin waterproof, as nature limits our exposure to a specific concentration of oxygen for good reasons.
Although the skin can absorb some substances (some drugs are typically administered through a skin patch, humans do not absorb any substance through the skin that is important to life function. So from that perspective, we can logically live without air on the skin. (Except for temperature regulation)
Marketers of oxygen therapies often refer to the proven effects of oxygen on unhealthy or damaged tissues to state their case, with the vasoconstrictive effects, reduction of inflammatory cytokines, increase in growth factors, and antibacterial effects often mentioned.
There is indeed a degree of truth to those statements, as oxygen has been successfully used to assist wound healing for over fifty years.
It is however, the increase in oxygen concentration in the cells via the pulmonary vascular system introduced by the oxygen rich environments in hyperbaric chambers and oxygen tents rather than direct contact of the wound with the oxygen.
And what about Free Radicals?
There are the negative aspects of oxygen to consider. Specifically free radicals and oxidisation. We know that unstable oxygen molecules cause free radicals and it is widely understood that oxygen is the conduit for the delivery of free radicals to tissue.
It is also known that oxygen is the most common oxidiser, and oxidative process contributes to skin ageing and the development of wrinkles, so why would a skin treatment professional who understands this want to increase our exposure to oxygen above the natural dose and subsequent potential oxidisation in the epidermis?
Particularly why would we want to force the oxygen past the lipid bi-layers under pressure to an area where we really need to control any oxidisation?
As mentioned previously, oxygen as an energy providing fuel is delivered to the dermal cells via the microcirculation along with other vital nutrients. It is a critical balance.
The fact that other topical oxygen bearing applications (such as hydrogen peroxide and oxygenated purified water) have lost favour with skin professionals due to free radical issues makes one wonder why less knowledgeable aestheticians and therapists have not made the connection between the similarity of the two modalities.
It is also interesting to note that where the technology is the most popular, the United States regulatory body FDA has not approved oxygen facials and the devices that provide the treatments, as in the United States, oxygen in concentrations above 90% is considered a precsciption drug.
The lack of approval is because manufacturers are astutely not making any claims of any therapeutic effects. To make those claims would involve providing proof of efficacy, lengthy clinical trials (with long-term results and contraindications determined) to be conducted, and possibly the same kind of regulation and treatment provider qualifications that the use of hyperbaric oxygen treatment requires. Certainly a dampener for quick profit.
Back in 2007, the FDA had a consumer warning on it's web site that discusses the use of oxygen for non-prescription therapeutic use. A fact that is little known is that that dispensing oxygen in the US without a prescription violates FDA regulations. Other countries (such as Australia and New Zealand where oxygen is considered a drug) may have similar regulations, and presently oxygen facials have managed to keep under the radar.
In the United States, Dr. Christopher B. Zachary, a professor and the chairman of the department of dermatology at the School of Medicine, University of California has been quoted as saying The concept that high-pressure oxygen would do anything to help the skin is such nonsense as to be laughable. "
Some quick quotes of interest from marketers and users of oxygen devices:
"We hope that the oxygen is creating a pressure bubble that drives vitamins and nutrients into the skin, but we have no data to support that."
Dr. Fredric Brandt, Dermatologist, Miami and New York.
"We haven't run any medical-style clinical trials because we are not making any biological claims, the instant results speak for themselves."
Mr. Anthony McMahon, CEO, Intraceuticals.
"It's a spa device with limited benefits, it has no more and no less validity than a facial."
Dr. Bradford R. Katchen, Dermatologist, New York.
Make up your own mind
Despite the lack of credible evidence to date that oxygen facials actually have a long term benefit will not stop aestheticians from purchasing these devices because of the money making ability due to the amount of publicity surrounding them.
With an ill-informed consumers demanding instant gratification with a seemingly unlimited budget, we can expect no less. A case of deja vu or "sales before science" perhaps?
The question that begs of course, is one of professional ethics; for both the suppliers who market the devices, and the aestheticians who use them.
About the Author
New Zealand born Florence Barrett-Hill is an internationally acclaimed independent dermal scientist, aesthetic technical educator, practitioner, researcher, and author with a vast experience covering all aspects of professional aesthetic therapy and paramedical skin care. Florence's internationally respected "Advanced Skin Analysis" training program is a breakthrough post-graduate curriculum launched in 1994, and was the first to recognise and teach the importance of linking skin structure and function to skin condition. It is the core of this training program that has provided the content for the book of the same name, first published in 2004.
More information about her e-learning and seminars can be found here: www.pastiche-training.com
Her books "Advanced Skin Analysis" and "Cosmetic Chemistry" can be purchased direct from the publisher: www.virtualbeauty.co.nz
In the ever-increasing modalities of skin treatment therapies comes LED Photomodulation, the latest form of Phototherapy.
This relatively new process has the unique ability to stimulate and/or inhibit cell-signalling pathways for skin rejuvenation and potentially represents the next frontier in anti-aging medicine.
Photomodulation is a process that manipulates or regulates cell activity using light sources without thermal effect. This is achieved using portions of the visible light spectrum that does not contain any Ultra Violet or Infra-Red, thus achieving a non-thermal, non-invasive, and non-ablative method of skin rejuvenation.
The primary goal of non-ablative rejuvenation is the stimulation of new collagen and dermal extra-cellular matrix substance, which visibly improves the appearance of wrinkles without disturbance or damage to the overlying epidermis.
Until recently, our thinking about how to accomplish this has involved primarily thermal methods, whether it is heating of the dermis to stimulate fibroblast proliferation or heating blood vessels for photocoagulation. Intense Pulsed Light and Laser treatments are the most common modalities used that employ thermal methods. Although highly effective, there are the thermal discomfort considerations that some clients will not be prepared to accept. This is where LED Photomodulation has its place in the market.
How does it work?
LED Photomodulation uses low intensity light emitting diodes to create a process similar to plant photosynthesis whereby plants use chlorophyll to convert sunlight into cellular building blocks.
The light emitted by the LEDs is absorbed by epidermal cells and produces a remarkable cascade of events.
ATP, (Adenosine Triphosphate) the form of energy that cells utilise, is produced in this process and used to power the metabolic processes that synthesize DNA, RNA, needed proteins, enzymes, and other biological materials needed to repair or regenerate cell and tissue components; foster mitosis or cell proliferation; and/or restore homeostasis.
Studies of LED Photomodulation have shown skin textural improvement accompanied by increased collagen deposition with reduced MMP-1 (collagenase) activity in the papillary dermis. Using Photomodulation, scientists theorise that we are both slowing down collagen breakdown and building up new collagen.
One of the benefits of LED Photomodulation is that a wide range of Fitzpatrick skin types can be treated safely. Because of the low-intensity and specific bandwidth control of the light source, (Absorbed energy typically less than a 25-watt light bulb) there is no thermal damage to the epidermis.
With this in mind, LED Photomodulation offers novel, safe, non-ablative approach to photo ageing when used in conjunction with specific skin care products.
Light doses ranging from 1.0 to 6.0 Jcm-2 in the frequency range of 560nm 780nm (Orange-Red) have been proven to be most effective for skin rejuvenation treatments that relate to rehabilitation of the microcirculation and encouragement of fibroblast activity. Techniques that pulse the light at specific cycles or codes (on-time and off-time) have reportedly proved most effective and this technique has been patented as the term LED Photomodulation by one US based company.
Wide bandwidth devices have the ability to provide a number of therapeutic treatments in addition to cellular rejuvenation. The chart below shows the various properties of the light spectrum.
Frequency of use
To achieve optimum results, an average of eight treatments over a four week period are recommended in conjunction with tailored skin care and home care regimen, followed up by maintenance treatments at three to six month intervals. Because the technology is still relatively new, it is unclear how often maintenance treatments will be required, but clinical experience to date suggests once a month minimum.
Improvement has been noted to occur even three to four months after finishing the last treatment, indicating that the collagen deposition is an ongoing process, which continues months afterwards.
There are two stipulations for treatment: Firstly, (and quite obviously) the clients skin must be meticulously cleaned prior to exposure to LED light source, with heavy make-up completely removed.
As with all technology, there are some obvious but simple rules for gaining maximum effectiveness from photomodulation treatment devices.
The most obvious, (but the least mentioned by device marketers) is that the light energy coming from the device should be stronger than the ambient light in the room it is being used.
What this means is the darker the room used to perform the treatment, the more energy in the bandwidth of light chosen for the treatment will reach the skin. To put this in context, if a typical LED device was used in a room with 40 watts of fluorescent lighting, the effectiveness of the LED panels would be reduced to less than half. This is because the skin surface is being bombarded with parts of the frequency spectrum that we don't want to be present at treatment time. A good analogy is a camera flash on a sunny day - mostly useless.
Post treatment protocols
As with IPL and microdermabrasion, the strict post treatment use of sunscreen with SPF 30 or higher must be employed; especially if the client is going straight out in to bright sunlight. This is because the cells are still quite "active" and can be more susceptible to UVR.
Although Phototherapy is relatively safe if used properly, it is not without risks.
As with all treatment modalities and technologies, some essential basic knowledge in Phototherapy is important before one proceeds to use this modality.
Phototherapy has been used in medicine for three decades, with Hungarian physician and researcher, Dr Endre Mester first demonstrating the beneficial effects of monochromatic light in the late 1960s.
Substantial research has been conducted since for the wound healing properties of various bandwidths of light, with NASA funding research for burn rehabilitation and cell activity studies, with the concept of using low energy, narrow band or coherent light with specific pulse sequences and durations consequently termed photomodulation.
LED Photomodulation terminology
A LED (light-emitting diode) is a semiconductor device that emits incoherent narrow-spectrum light when an electrical current is applied to it. Because LEDs are low intensity, they are used in arrays or banks of up to 2000 individual units to deliver therapeutic levels of light.
There are two types of LEDS used for light delivery:
Using individual monochromatic LED banks for each specific colour band. Colours are used individually or in combination to deliver bandwidth required.
Microprocessor controlled polychromatic LEDs using RGB technology. This state-of-the-art digital technology produces up to seven different colours similar to the method used in LCD and Plasma TV and computer screens.
Light in the visible spectrum is often termed Monochromatic or Polychromatic. The two terms are explained simply as the following:
Monochromatic: A single bandwidth of light. i.e. red.
Laser light is a good example of a Monochromatic light source.
Polychromatic: A light source consisting of multiple bands of light (ie violet, blue, green, red, yellow) in the visible spectrum. (Approximately 380nm – 770nm)
Intense Pulsed Light (or daylight) is an example of polychromatic light.
About the Author:
Ralph Hill is the technology writer, illustrator and editor for Virtual Beauty Corporation. He has a background in science, electronics and electro-mechanical devices, but enjoys researching and writing on a myriad of skin care related topics including cosmetic chemistry and anatomy & physiology.
Of all of the methods used in the delivery of active ingredients in to the skin, Sonophoresis has much to offer to the contemporary skin treatment therapist.
The technology of using sound or sonic waves as a form of treatment has been around for a number of years, however this has been largely in the area of therapeutic treatment of deeper tissues by Physiotherapists using ultrasound.
The use of Sonophoresis in skin treatment therapy is to provide enhanced permeability of the skin.
This permeabilisation of the skin allows a far higher absorption of the active ingredients the therapist is attempting to infuse. The result will be both a more economical use of the therapeutic agents applied, and a greater response to the agent due to better penetration.
How does it work?
To understand how Sonophoresis works, we must first understand the mechanics of the lipid/water bi-layers in the stratum corneum. They act as one of the principal lines of barrier defense to protect the lower layers of the dermis. It is at this point many of the substances with high molecular weights are repelled.
This is due to the microscopic gaps between the lipid heads of the bilayers being too small to allow them through.
Unfortunately, many of the active ingredients used in skin treatment therapy are complex molecular formulations, and fail to fully pass through this protective layer due to the alternating layers of lipid & water performing their functions correctly.
Sonophoresis acts by temporarily reducing the density of lipids in the intercellular domain of the bi-layers. This disruption occurs due to a combination of micromechanical, thermic and cavitation effects that effectively open up the intracellular pathways, allowing substances with high molecular weights a higher degree of penetration. These openings are known as Lacunae.
With this combination of activity in the intercellular domains, the first question that arises is how safe is this and is there any damage caused? It is true that uncontrolled Sonophoresis can cause excessive thermic reactions, however all modern devices use microprocessor control to limit power output, timing, and set the specific frequencies used, so when used with the correct technique of continual sonicator head movement, there is no side-effect damage to the epidermis.
In this regard, sonophoresis is a safe to use as electrolysis and iontophoresis. However, as with all electromechanical devices used to treat the skin, training in the correct operation and techniques is imperative.
The history of sonophoresis
Ultrasound has been used since the 70s to enhance penetration through the skin, and in the mid 1990s, extensive research was conducted to find attractive alternative delivery systems to injections and oral Medications. A number of these studies focused on facilitating transdermal permeability of various medicinal substances (e.g., insulin) by low frequency (20-25Khz) sonophoresis (LFS).
During clinical evaluation of the effectiveness of sonophoresis, experiments demonstrated that a significant fraction (~30%) of the intercellular lipids of the stratum corneum, were displaced or removed during the application of low-frequency sonophoresis, increasing the skins permeability by up to 800%.
It was this initial research that provided the data for the sonic frequency, safe power output levels and the design of the sonicator heads to develop the devices currently used.
Sonophoresis is a viable and highly effective method to permeabilise the skin. When used alone or in combination with iontophoresis, it is a favorable infusion procedure for the modern skin treatment therapist wishing to achieve maximum results for their clients with a minimum of discomfort.
Many professional skin care companies already have a range of products suitable for use with sonophoresis, with the leading exponents producing their own proprietary sonophoresis devices.
- Sonophoresis has been shown to be effective in the formation of microscopic aqueous channels (Lacunae) through the bilayers of the epidermis.
- The optimum frequency range of the sonic waveform to achieve this is in the region of 20-25Khz with power outputs of less than 125mW/cm2. This waveform is pulsed for very short periods (typically 100ms) usually once per second.
- Sonophoresis has been shown to be even more effective when combined with iontophoresis, with further spectacular increases in the efficiency (up to 4000%) of active ingredient absorption in to the lower levels of the epidermis.
About the Author
Florence Barrett-Hill is an internationally acclaimed dermal science educator, practitioner, researcher and author with a vast experience covering all aspects of professional aesthetic therapy and paramedical skin care. Florence holds over a dozen diplomas and international qualifications covering every aspect of modern skin treatment therapy, and is well respected by her industry peers for her 30+ years of knowledge she loves to share.
Florence is the programme director of Pastiche Resources, an Internationally recognised postgraduate beauty industry education provider.