Dry skin therapy

2019-12-04

When the skin of the face becomes dry or tight and sensitive, this condition is associated, first of all, with a violation of the uppermost, protective layer. But is this always the only reason for dry skin?

Polina Laiter , cosmetologist, specialist in the field of restorative cosmetology and natural rejuvenation of the face and neck, author of the method of restorative layered therapy Reface Laitlift System (Israel)

OBJECTIVE FACTORS LEADING TO DRYITY

I proceed from the following interpretation of the problem: if skin type is a genetically determined set of functional and organic properties, then skin condition is its response to the influence of external and internal factors that change barrier properties, physicochemical functions and protective responses, as leads to the formation of visible aesthetic defects.

It is known that dry skin problems can be caused by numerous external and internal triggers such as:

• unfavorable climatic conditions (by the way, this includes heating);

• limiting dietary fat intake;

• age-related changes in body systems;

• general diseases affecting lipid metabolism (hormonal disorders, diabetes, hypothyroidism, etc.);

• skin diseases (for example, atopic dermatitis and psoriasis);

• use of cosmetics;

• factors contributing to oxidative stress (UV radiation, frequent long-term flights);

• psychological stress;

• complete or partial removal of the stratum corneum;

• carrying out invasive procedures (medium and deep peelings, plastic surgeries).

All these factors can be combined into three large groups, namely:

• dry skin caused by the destruction of the barrier structures of the stratum corneum or a deficiency of essential fatty acids;

• pathological dry skin caused by chronic skin diseases or general diseases affecting lipid metabolism;

• age-related dry skin and dryness caused by invasive influences.

In fact, most often several unfavorable triggers are superimposed at once, and, as a rule, one is the leading one, determining the nature of the changes occurring in the skin. Naturally, in each specific case, the tactics of cosmetic care will differ.

If in the first case, properly formulated home and professional care can give a quick effect and help avoid complications, and in the second - significantly alleviate the condition of the skin and relieve unpleasant subjective sensations, then with age-related dryness or dryness caused by the consequences of plastic surgery, the correction will be more difficult, since in these cases the main cause lies not in the stratum corneum, but in the subcutaneous connective tissue structures of the face and neck. More precisely, in the ability of connective tissue structures to recover.

FUNCTIONAL CAUSES OF DRYITY

According to modern concepts, the key to the development of inflammatory, dystrophic and involutional processes that trigger negative changes in the functions and structure of cells during age-related changes and complications caused by invasive influences are disturbances in microcirculation and innervation.

From the point of view of embryology, the dermis (the skin itself) is a fascial structure that originates from the connective tissue of the mesoblast, as, in fact, blood, lymph, bones, vessels, ligaments...

The dermis contains hair roots, glands, blood vessels, free cells of the immune system, and nerve structures. The dermal layer is characterized by a large number of connective tissue fibers: elastin, reticular and collagen.

Since the number of fibers is strictly balanced for each type of fabric, if the balance and quality of the fibers are disturbed, changes (damage) to the tissue occur. The process of tissue damage formation is its scarring.

Regardless of form or function, connective tissue is composed of three parts:

• cells (erythrocytes, platelets, leukocytes of vascular tissue, fibroblasts of fascial tissue, osteocytes of bone, etc.);

• fibers (reticular, elastic, collagen);

• metabolic environment for these cells and fibers.

Embryonic connective tissue (mesenchyme) gives birth to all the different types of adult connective tissue. Precisely because any connective tissue includes all three constituent elements (cells, fibers and metabolic environment), we can say that the skin, bone, myofascial, and vascular systems are closely related to each other structurally and functionally. For example, bone tissue provides an insertion for the fascia, and blood cells are formed there. Fascial tissue surrounds and supports the osteoarticular system, muscles, and blood vessels. Blood tissue irrigates all connective tissue. Consequently, individual tissue lesions never remain isolated. Any disturbance in one of the structures will lead to changes in other structures, causing tissue damage or change in function (dysfunction).

STRUCTURAL THEORY OF FACIAL AGING

A symptom of tissue damage is loss of micromobility at the level of any structure. The facial system functions as a result of the complex interaction of the upper and lower jaws, teeth, skeletal system of the facial and cranial skull, temporomandibular joints, ligaments, muscles of the face, occiput and neck, vascular system, central and peripheral nervous systems. Free (without difficulty) physiological interaction of all these structures is a sign of the norm.

In other words, the structural theory of facial aging is based on E. T. Still’s idea of the integrity of the three-dimensional unity of the musculoskeletal, nervous and mental systems, which constantly adapt to changing conditions of the external and internal environment.

The key principles of the theory include:

• anatomical, physiological, biomechanical unity;

• structure drives function and function drives structure;

• A prerequisite for the normal functioning of cells, tissues, and organs is the free movement of blood, lymph, and intercellular fluid.

According to the structural theory of facial aging, in my practical work I proceed from the postulate that over time, the muscles of the face and neck generally do not stretch, but spasm and shorten. This leads to changes in muscle tone, distortion of the tension of the tissue field of the face and neck, changes in the position of the bones of the facial skull and temporomandibular joints, migration of submuscular fat deposits, and muscle imbalance. These changes are called biomechanical.

A change in the tone of even one muscle disrupts the balance of the entire muscle and bone structure of the face and neck, which leads to blockage of the lymph nodes and contributes to the accumulation of excess fluid, causing swelling. If the stage of edema is very pronounced, very long-lasting or is regularly renewed, then the edema, turning into stagnation (lymphostasis), disrupts the mobility of myofascial structures - and the muscle cannot perform its function in its entire volume and throughout the entire contraction or stretching.

Myofascial structures weaken, which invariably leads to disruption of microcirculation and the launch of a tissue damage mechanism that changes the biochemical, neurophysiological and mechanical properties of tissues along the vector “inflammation (edema) – fibrosis – sclerosis.” The fabric ages prematurely.

This cycle (Fig. 1) not only forms external signs of aging, the so-called age shadows (folds, “bags”, furrows, wrinkles), but also leads to a deterioration in the barrier functions of the skin, disruption of nutrition, hydration and regeneration of the skin due to impaired circulation blood, venous and lymphatic drainage.

Biomechanical changes in the face and neck will certainly affect the ability of tissues to recover after any invasive influences, especially those that add long-term post-traumatic swelling to the existing lymphostasis.

(Fig. 1)

PERSONAL EXPERIENCE IN CORRECTING AGE-DRY SKIN

Based on the above, we can conclude that the condition and role of connective tissue structures both in the correction of age-related changes in the skin and in improving the condition of the skin after surgical interventions are primary. Indeed, in this case, it is the connective tissue structures that are the target of damaging factors.

Therefore, when I solve the problem of age-related dry skin or dryness caused by a reaction to plastic surgery, then most often I consider the cosmetic care procedure as an opportunity to restore (physiologically normalize) the condition and balance of the connective tissue structures of the face and neck. That is, not only the dermal layers of the skin, but also muscles, fascia, ligaments, bones, joints, blood vessels and vascular bed, body fluids, etc.

In this case, my therapeutic strategy for caring for dry skin of the face and neck is based on the method of physiological layer-by-layer restoration of connective tissue, both in a separate procedure and in an individually designed program of procedures.

The strategy includes the following stages:

• restoration and maintenance of skin barrier function;

• diagnosis, correction and prevention of the biomechanical condition of the subcutaneous structures of the face and neck;

• diagnosis, correction and prevention of microcirculation disorders and lymphatic stagnation;

• long-term (age-related changes) or short-term (as indicated) home care strategy;

• recommendations for lifestyle correction and prevention of psychological stress.

DIAGNOSTIC-THERAPY ALGORITHM OF THE PROCEDURE

The diagnostic and therapeutic algorithm of the procedure for the physiological layer-by-layer restoration of the connective tissue structures of the face and neck can be divided into five important complementary points:

• taking anamnesis;

• triple diagnosis of the condition of the skin and subcutaneous structures of the face and neck;

• drawing up an algorithm for a program of procedures;

• integration impact in the procedure algorithm;

• appointment of home care.

Stage 1. History taking

When collecting an anamnesis, I am interested in many points. Below is a short list of factors that I try to clarify, define, find out and consider. Important:

• determine skin texture disorders (the presence of dry skin, peeling, tightness, pigmentation, telangiectasia, hyperkeratosis, skin dermatoses, etc.);

• identify the presence of systemic diseases and concomitant pathologies that provoke dry skin (hypothyroidism, diabetes mellitus, hormonal changes, vitamin deficiencies, oncological, hematological diseases, dermatitis, psoriasis);

• get an idea of lifestyle (place of residence, smoking, alcohol, diet, medication, level of psychological stress, insufficient sleep, excessive sun exposure, low-fat diet, etc.);

• discuss individual characteristics (age and gender, anatomical, functional features of the face and body);

• find out whether hardware or chemical peels were performed (which and when);

• find out whether there are fillers, botulinum toxin, threads in the tissues;

• determine and take into account the type of muscle activity, the morphological type of facial aging, the state of the vascular system of the face and neck;

• choose the type and find out the scope of possible (present or past) aesthetic surgical correction;

• take into account the severity of side effects of the operation;

• take into account the presence of complications after surgery;

• take into account the patient’s capabilities (amount of free time, financial capabilities, etc.).

Stage 2. Triple diagnosis

Includes visual, palpation diagnostics and photo documentation from three angles, which makes it possible to analyze as accurately as possible (as far as possible) the biomechanical changes in the subcutaneous structures of the face and neck.

Stage 3. Test procedure

I always start therapy with a test procedure. This gives me the opportunity to analyze the condition of the skin's barrier properties and prescribe appropriate home care.

The test is a standard cosmetic care procedure during which I monitor the skin's reaction to the products that I will use later in the program.

Stage 4. Selection of therapeutic strategy

If the diagnosis and test procedure confirm the patient’s complaints and first impression of dry skin, then in most cases I suggest the following treatment strategy.

First of all, it is necessary to give the patient specific recommendations, usually the following:

• exclude from home skin care products drugs that can have a destructive effect on the barrier functions of the skin;

• use mild cleansing products (for example, based on a complex of fruit acids, probiotic complex, yogurt powder, silver mallow extract, bioflavonoids);

• add soothing and anti-inflammatory lotions (for example, based on chamomile extract or centella asiatica);

• to moisturize the skin of the face, use preparations that contain substances that can attract and retain water (glycerin, sorbitol, hyaluronic acid, aloe gel, etc.);

• use drugs that normalize the composition and structure of lipids in the stratum corneum (vitamin E, sweet almond seed oil extract);

• use drugs that improve the condition of the vascular bed (for example, niacinamide, fruit acids, vitamins C and K);

• use preparations enriched with antioxidants in cosmetic care (for example, vitamin C, Q10, alpha-lipoic acid, etc.);

• add protective creams containing not only a broad-spectrum chemical filter, but also reflective particles; avoid tanning (as much as possible);

• Avoid high temperatures and dry air if possible;

• adjust the drinking load (daily dose – 30 mg of water, green tea per 1 kg of body weight);

• balance the diet, increase the amount of fat in the diet (eat at least three times a week);

• reduce sleep deficit;

• add physical activity that improves the muscular balance of the body (Pilates and the Feldenkrais method);

• Avoid uncontrolled use of acids, laser techniques, dermabrasion and chemical peels.

If dry skin is associated with air travel, weather changes, stress, excessive insolation, dermatoses (rosacea is not in the acute stage, for example) and the skin needs to be instantly soothed and moisturized, then the procedure of choice in my office will be a moisturizing procedure (program of procedures) and Meder preparations. HF." In this case, home and professional care will be based on gentle cleansing and preparations containing hyaluronic acid of various molecular weights, algae extract, tranexamic and thioctic acid, skinasensil.

If dry skin is caused by a violation of the barrier structures of the stratum corneum or a deficiency of essential fatty acids associated with pathological conditions of the facial skin, then the procedure of choice in the clinic and home care will rely on preparations that include complexes of fruit acids, retinol, a probiotic complex, antioxidants, vitamins E, B and K.

Let me give you an example of a universal way to accelerate the restoration of the skin barrier in an office setting:

• cleansing the skin with a soft emulsion based on a probiotic complex designed to restore the skin barrier and a soothing lotion;

• superficial enzymatic peeling;

• regenerating agent;

• protective cream.

COSMECEUTICS + RESTORATIVE LAYER THERAPY

In my understanding, the correction algorithm for age-related dry skin and dry skin associated with surgical intervention should always be integrative and not limited only to the use of cosmeceutical drugs. An exception may be cases associated with certain pathological conditions of the facial skin.

Therefore, in addition to using superficial peeling serums, leading to the restoration of barrier functions and reducing skin sensitivity, I use the method of restorative layer-by-layer therapy, which includes: direct and indirect (diagnostic and corrective) soft manual techniques, kinesiological taping and physiological hardware effects.

Why peeling serums?

Due to periodic moderate irritation of the skin with peeling serums, physiological stimulation of metabolic processes occurs and microcirculation, innervation, lymphatic drainage are improved, keratinization is regulated, the epidermis is renewed, and synthetic processes in the dermis are improved without unnecessary trauma. The peels I use include: multifruit complex, ascorbic acid, red grape seed extracts, spirulina, witch hazel and green tea, retinol, papain, fig extract, etc.

Why kinesiology taping?

Recovery of the skin and subcutaneous structures after surgery is impaired due to edema and lymphostasis. In order to increase lymphatic drainage of the dermis and hypodermis at an early stage, I include kinesiological taping in the rehabilitation procedure algorithm.

Why hardware impact?

I include hardware effects in the procedure algorithm in order to improve the structure of muscles and ligaments. Restoring elasticity, length, volume of muscles, opening reserve capillaries helps to normalize muscle function, which leads to the outflow of venous stagnant blood and improves microcirculation and lymphatic outflow.

A global structural effect on facial tissues, the purpose of which is to restore interactions between tissues and microcirculation, and the achieved effect allows us to enhance the regenerative abilities of the skin and its barrier function, and prevent the future return of dry skin syndrome.

List of contraindications

It should be remembered that both peeling serums and hardware physiotherapeutic effects have direct and relative contraindications. These include:

• inflammatory or unclear changes in the lymph nodes;

• eczema;

• psoriasis;

• acute stage of allergic dermatoses (rosacea, seborrhea);

• herpetic infection;

• intolerance to photoprotective agents;

• pregnancy;

• the presence of multiple pigmented nevi on the face;

• hypertonic disease;

• epilepsy;

• oncological diseases;

• special psychological type of the patient;

• individual intolerance.

Thus, therapy for dry skin is not just applying another “moisturizing” product, it is a properly structured, carefully thought-out full-fledged care that requires the cosmetologist to have a good understanding of the physiology of the skin and the basics of cosmetic chemistry, and the client to be careful in following all recommendations. A normally moistened stratum corneum and the introduction into the algorithm for correcting age-related manifestations of a mandatory stage of therapy aimed at restoring the structure and functions of connective tissue is the best prevention of skin aging and the key to its health. And no anti-aging methods will help the skin if its stratum corneum is not in order and the connective tissue structures do not perform their functions.

This article is part of the special project BIOHACKING

You can read all the articles on this topic:

SPECIAL PROJECT. BIOHACKING

First published in Les Nouvelles Esthetiques 2015/№2