Combined use of peeling procedures with revitalizing mesotherapy

If the cosmetologist has a goal to obtain a pronounced clinical effect of rejuvenation (i.e. retraction, thickening, qualitative change in skin texture) and, at the same time, control the process of inflammation, reduce the production of free radicals and melanin in the post-peeling period (i.e. peeling is safe, effective and predictable), then mesopil seems to be the optimal method. Today this is the most promising rejuvenation technology. The result of such a complex procedure is the launch of regeneration processes in the dermis, restoration of its elasticity, improvement of skin color and significant lifting. Powerful exfoliation under the influence of a peeling gel/solution will stimulate the proliferation and differentiation of keratinocytes, and the introduction of revitalizing complexes through mesotherapy will make these processes complete and will additionally affect the dermis.

Pre-peeling preparation with external agents

In addition to mesotherapeutic preparation for peeling, we must not forget what is prescribed by the specific peeling protocol, that is, the use of depigmenting, photoprotective agents and creams with low-percentage acids. Properly carried out pre-peeling preparation allows you to prevent possible inflammatory processes, reduce the risk of post-peeling pigmentation, and optimize the results of the procedure. Unfortunately, this is not always possible in practice and we are often forced to start peeling without appropriate preparation.

Actually peeling

The most common and safest option today is superficial peeling with fruit acids. AHA acids are part of the group of acetic acids, or alpha hydroxyacids (AHA). These are natural organic acids with a hydroxyl group at the carbon in the alpha position.

Today, AHA acids are obtained both from plant materials and synthetically. The most commonly used medicinal acids are glycolic acid (obtained from sugar cane or synthesized), tartaric acid (from grapes and wine), citric acid (from citrus fruits and pineapples) and lactic acid (from sour milk, blueberries and tomatoes). At first, fruit acids were used only in dermatology to eliminate dandruff, eczema, acne and other skin diseases. But then it turned out that these substances give a good aesthetic result: lightening age spots, improving skin condition, minimizing wrinkles. The main effect of their influence is exfoliation, that is, weakening of the connections between corneocytes, accelerating the rate at which they reach the surface of the skin and natural separation. When using AHA acids, cell regeneration is activated, the skin becomes fresher, becomes more elastic, moisturized and softened. The lipid balance is normalized, the ducts of the sebaceous glands are cleaned, therefore, the oiliness of the skin is reduced, and the appearance of acne and comedones is prevented. Skin areas with hyperpigmentation are lightened.

The pH of the acid has a direct impact on the rate of renewal of epidermal cells and the degree of skin irritation. If you introduce a buffer (a substance that will maintain acidity at a certain level) into an acid solution, you can increase the concentration of the acid while maintaining the pH practically unchanged. For example, a solution of 70% glycolic acid has a pH of 0.6 if the acid is not neutralized, and a pH of 2 or more if the acid is partially neutralized with ammonia or soda. At a pH of up to 3, the acid gives a noticeable stimulating effect, but also a fairly high degree of skin irritation. If the acid solution is neutralized to pH 7, the stimulating effect becomes insignificant, but skin irritation occurs much less frequently. When using an acid with a low pH, a number of enzymes involved in the skin renewal process are activated. In addition, the depth of penetration of the acid into the skin depends on the pH (and not just on its concentration and exposure time): the lower the pH, the higher the permeability of the skin to the acid.

Given the abundance of published materials on peelings, we believe there is no need for a detailed analysis of the acids used. Let's remember the main thing.

Glycolic acid (hydroxyacetic acid). Most often in cosmetology, glycolic acid CH 2 (OH) CO 2 H is used (hydroxyacetic acid, i.e. acetic acid in which one hydrogen of the methyl group is replaced by hydroxyl). It was obtained by Strecker and Sokolov in 1851. The molecular weight of glycolic acid is 76.05 g/mol. Contained in unripe grapes, beets, sugar cane. Glycolic acid is relatively weak, its pK (an indicator of the tendency to proton hydrolysis, i.e., the release of hydrogen ions) = 3.85. Whereas for trichloroacetic acid used in mid-peel procedures, the pK value is 0.52.

A special feature of glycolic acid is its high penetrating ability due to the smallest molecular size of all AHA acids. At the level of the epidermis, glycolic acid reduces the cohesion of cells of the stratum corneum, promotes renewal of the epidermis and hydration of the stratum corneum, at the level of the dermis it stimulates the proliferation of fibroblasts and the synthesis of glycosaminoglycans, in particular hyaluronic acid.

Mandelic acid. This is an 8-carbon alpha hydroxy acid HOCH(C6H5)COOH (pK = 3.41), which is partially soluble in water and completely soluble in isopropyl and ethyl alcohol. Contained in the fruits of bitter almonds (in the form of glycosamygdalin), from where it can be isolated by hydrolysis of the latter. This acid is also found in bound form in elderberry. It has been used in medicine for quite a long time as an antiseptic. The main difference between mandelic acid and others is the absence of a photosensitizing effect. Therefore, almond peels are considered all-season and are widely used in spring and summer. The use of almond peeling allows you to even out your complexion, eliminate inflammation, minimize closed comedones, moisturize, tone and rejuvenate the skin.

Lactic acid (acid umlacticum). It is alpha-hydroxypropionic acid, CH3 CH(OH)COOH, which was isolated in 1780 by the Swedish chemist Carl Wilhelm Scheele. Its molecular weight is 90.08 g/mol. In eukaryotes, lactic acid is a product of anaerobic glycolysis. Subsequently, aerobic metabolism of lactic acid leads to the formation of carbon dioxide and water. Lactic acid is part of NMF (Natural moisturizing factor), which provides a hydration membrane around keratinocytes.

NMF is found within the epidermis and makes up 20% of the dry weight of the stratum corneum. NMF consists of amino acids (40%), sodium PCA (12%), lactate (12%), urea (7%), ions (18.5%), sugars (like glycerol - 8.5%) and other substances. They are hydrophilic and thus provide hydration to the epidermis.

When applied, lactic acid has an exfoliating, moisturizing, antiseptic and anti-inflammatory effect. As a component of the peeling gel, it potentiates metabolic processes in the dermis, while preventing the development of post-peel complications, which allows peeling even on sensitive skin. The advantage of peeling with lactic acid is that as a result of its use in low concentrations, post-peeling skin peeling does not develop and patients do not lose social adaptation.

Pyruvic acid. This acid was discovered by Berzelius in 1835; it is formed during the process of glycolysis, as a result of the breakdown of the glucose molecule into pyruvic acid. Subsequently, under anaerobic conditions, pyruvic acid is converted into lactic acid, and during aerobic respiration, it is broken down into carbon dioxide and water. It improves the barrier properties of the skin, activates metabolic processes and, most importantly, participates in the processes of aerobic respiration in the mitochondria, in which pyruvic acid is broken down into carbon dioxide and water with the release of energy (Krebs cycle).

Multi-acid peels. The most common complications after peeling are the manifestation of acne and the occurrence of hyperpigmentation. To avoid this, it seems optimal to combine acids in the peeling solution that, in addition to exfoliating capabilities, also have anti-inflammatory properties and the ability to inhibit tyrosinase. Due to the combined action and minimization of risks, multi-acid peels can also be used without seasonal restrictions.

Peeling is carried out according to a protocol that stipulates all the nuances of pre-peel preparation, the procedure itself and subsequent epithelization.

The effect of peeling on the skin consists of two components: a specific action (for which the acid needs to penetrate living cells) and a nonspecific action (a peeling effect that requires only superficial action of the acid). An increase in the thickness of the epidermis is a manifestation of the so-called peeling effect (increased division of cells in the germinal layer during exfoliation of part of the stratum corneum). The reduction in wrinkle depth is partly a consequence of exfoliation of the thickened stratum corneum, and partly due to an increase in the thickness of both the epidermis and dermis. Exposure to acids stimulates reparative processes in the skin in response to damage, which leads to accelerated cell renewal, increased synthesis of proteins, glycosaminoglycans and other components of the dermis.

The epidermis is a dynamic tissue, the cells of which are in constant, non-synchronous movement. In the stratum corneum, the migration of keratinocytes stops and corneocytes, i.e., horn cells are rejected from the surface of the skin. The epidermis is connected to the dermis by a special structure - the basement membrane, on which the germinal layer of the epidermis is located - a single-row layer of cylindrical cells that have an unlimited ability to divide. Among the germ cells are:

• melanocytes - cells that synthesize melanin-containing organelles (melanosomes) and transfer them to keratinocytes;
• Merkel cells, or tactile cells, which perceive irritations that occur when the skin comes into contact with environmental objects and transmit them to the sensitive cells of the spinal ganglia;
• Langerhans cells, which control the activities of other cells using regulatory molecules. Under stressful influences, when chemical or physical traumatic factors act on the surface of the skin, Langerhans cells give the germ cells a signal for increased division. Also, through these cells, the epidermis can influence the cells of the dermis, causing them to increase or slow down the synthesis of various substances.

The stimulating factors of biosynthesis in the dermis are micro- and macroelements and vitamins.

NB!! The combined procedure of peeling + mesotherapy can be carried out only with the superficial effect of acid peeling, i.e. when the chemical damage to the epithelium is not deep, the dermis is not involved in the inflammation process and epithelization takes place in a short time. Mesopil is not used with enzyme peels, for, we hope, understandable reasons. Please note: the effect is superficial, and the acids can be different. The common idea that glycolic peeling is superficial and TCA is intermediate is completely untrue. Exposure to 70% glycolic acid at a low pH may well cause frost, and 10-15% trichloroacetic acid applied in a thin layer with a short exposure time will result in superficial effects. Cosmetologists often confuse the degree of impact, i.e., the destructive effect of the acid with its qualitative characteristics.

Classification of peelings (L. Dewandre, 2006):

• metabolic - do not disrupt the structure and synthesis of cells, have a stimulating effect (fruit acids, pH 1.5-2.5, azelaic, retinoic acids, etc.);
• caustic - have a local destructive effect (trichloroacetic acid);
• toxic - have not only a local destructive effect, but also a general toxic effect (phenol, resorcinol, salicylic acid, etc.).

The classification of the destructive effects of peelings is in Table 1.

Table 1. Classification of the destructive effect of peelings

As a result of controlled damage to the epidermis, powerful stimulation of the germinal layer occurs, proliferation and differentiation of keratinocytes increases, lipid balance is normalized, the ducts of the sebaceous glands are cleaned, therefore, the oiliness of the skin is reduced, the appearance of acne and comedones is prevented, and skin areas with hyperpigmentation are lightened. Strengthening the synthetic activity of dermal fibroblasts leads to accelerated production of everything that fibroblast produces, i.e., an increase in both metabolic and immune processes, and, of course, an increase in the production of proteins. During this period, it is quite logical to provide the dermis with vitamins, macro- and microelements, amino acids, which are necessary for complete biosynthesis.

NB!! It is impossible to include harsh lifting mesopreparations in the mesopil program; only revitalizing complexes should be used. The drugs of choice for the mesotherapeutic component of the mesopil program are multivitamin complexes with amino acids in combination with macro- and microelements. It seems ideal to introduce hyaluronic acid into cocktails for mesopil.

The question of the time interval between peeling and mesotherapy is controversial. Some authors recommend performing both manipulations simultaneously, some - with an interval of several days. Based on data from clinical studies conducted in our educational and methodological centers, we can recommend the following: mesotherapy should be performed 3-4 days after peeling, depending on its depth and, accordingly, the duration of epithelization. In the early post-peeling period, skin exposed to acid stress is deprived of a water-lipid mantle, and its barrier and bactericidal functions are reduced. Application of anesthetic cream requires a long exposure (20-60 minutes), as well as the use of an occlusive dressing. This manipulation can complicate subsequent epithelization or lead to infection, that is, as a complication, at best, the manifestation of acne will arise, and at worst, pathological scarring. To avoid these complications, it seems rational to divide the procedures into two sessions. A few days after the superficial peeling, the stratum corneum has already completely recovered, but there is still no water-lipid mantle, so anesthesia will occur quickly, and the risks of complications will be reduced to a minimum.

Thus, with the combined effect, skin restoration occurs much faster than with any other peeling of similar depth. This is caused by enhancing the regenerative functions of the skin due to the additional introduction of active components into the dermis. This combined effect is the method of choice for the prevention of aging, the treatment of photo- and chronoaging, the elimination of hyperpigmentation, stretch marks, and the treatment of acne.

Peeling is carried out in accordance with the Protocol for the use of superficial peeling, mesotherapy - in accordance with the Protocol for the use of a revitalizing drug.

Literature:

• Yulia Zlotnitskaya, director of the Aesthetics Hall Training and Methodological Center
• Alexey Danilov, director of the Este Plaza Educational and Methodological Center