Hardware cosmetology: how to avoid complications

Larisa Radetskaya – Ph.D., doctor of the highest category, physiotherapist, dermatocosmetologist, senior physician-methodologist of the SportMedImport Group of Companies (Russia, Moscow).

An increasing number of traditional physiotherapeutic techniques are now used in the fight against cellulite and in anti-aging procedures. Increasingly, promising innovative developments are appearing that can make a technological revolution in aesthetic medicine. And at the same time, manufacturers almost always talk about the absence of complications. Meanwhile, if used unprofessionally, even fairly “soft” hardware techniques can provoke undesirable consequences.

“Hardware cosmetology” is a firmly established phrase in aesthetic medicine that does not have a clear definition. Most often, this term refers to methods of hardware physiotherapy used in therapeutic medical cosmetology for therapeutic and preventive purposes. Hardware physiotherapy in aesthetic medicine, using various physical factors, has a huge number of techniques for working on the face and body. Many devices from different manufacturers often compete and duplicate each other. Therefore, choosing equipment is not an easy task, combining several aspects: economic and clinical efficiency, range of services and potential of the device, “transparency” of parameters and the ability to adjust them and, of course, the safety of the technology used for the patient and specialist.

Necessary control

The constantly increasing quality of services in aesthetic medicine requires scientific validity of treatment methods, evidence of their effectiveness and maximum safety. Official confirmation of the safety and effectiveness of the proposed methods of influence after numerous technical and clinical tests is the registration of technologies with the Ministry of Health. If safety is confirmed, all hardware interventions should be carried out in licensed institutions by doctors and nurses who have professional training in therapeutic aesthetic medicine, hardware cosmetology and who own the physiotherapeutic equipment that is used. The lack of proper professional training when working with cosmetology equipment is the reason for the violation of physiotherapeutic rules and canons developed by domestic and foreign scientists, the substitution of scientific terms with commercial names (for example, pulsed electrical stimulation is called myolifting, vacuum massage is called dermatonia, etc.).

Impact algorithm

The purpose of physiotherapeutic technology requires the dermatocosmetologist to have knowledge of physiotherapy and an understanding of the principles of physical treatment. Since the correction of most aesthetic problems requires an integrated approach, the question inevitably arises about the feasibility and safety of using and combining various technologies and individual adaptation of programs.

Currently, algorithms for diagnosis and treatment in aesthetic medicine have been created, embodied in the concept of systemic cosmetology and helping the cosmetologist draw up a long-term plan for a professional solution to the patient’s problems.

What steps does a doctor need to take to prescribe the optimal therapeutic program?

1. Initial consultation and diagnosis, including:

• a detailed medical history of organs and systems with an emphasis on oncological and systemic diseases, mental, including in the family, tuberculosis, blood diseases, recurrent infections, etc.;
• information about previously used physiotherapeutic procedures (general and local), duration of courses, their effectiveness, tolerability and duration of aftereffects;
• a thorough examination of the patient, especially in the areas of intended exposure, for the condition of the epidermis and dermis, violations of the integrity of the skin, the presence of nevi, increased hair growth or other undesirable phenomena and formations, superficial vessels, pigmentation disorders, etc.;
• making a complete diagnosis.

2. Drawing up an optimal individual pathogenetically substantiated program of physiotherapeutic influence in combination with other methods of aesthetic medicine to solve the problem.

3. Forming a trusting relationship with the patient is the key to mutual understanding and cooperation in working together on his problems.

4. Development of an individualized package of recommendations regarding lifestyle (rational nutrition, physical activity, etc.) and home care during the intensive course.

5. Monitoring the patient over time and adjusting the treatment program taking into account the stages of work and the compatibility of methods.

6. Planning activities aimed at maintaining the achieved result after completion of the active course, both for home care and for maintenance procedures.

Taking into account the energy used

The appointment of any natural or preformed physical factor in a physiotherapy department or in an aesthetic clinic requires taking into account the specificity of its action. It is determined by the type of physical energy, the localization of the impact, the depth of penetration of energy into tissues and the level of its absorption, the structure and functional activity of these tissues, the dose of exposure and the nature of the primary biophysical processes occurring in tissues when interacting with a physical factor.

Physical factors act at different levels of integration - on various tissues, systems, the body as a whole - and initiate primary physical and chemical processes in living tissues to regulate reactions of adaptation, compensation and restoration. Ultimately, a certain therapeutic effect is achieved (lymphatic drainage, myostimulation, improvement of microcirculation and metabolic-trophic processes, etc.).

All existing methods and technologies in aesthetic physiotherapy are classified, first of all, by physical factor or type of energy used (Table 1).

Table 1. Classification of hardware physiotherapy methods by physical factor

However, with all the variety of possibilities for using various hardware methods of influence in cosmetology, one rule remains unchanged: do no harm! And the main condition for the prevention of complications and undesirable consequences is compliance with technologies, which requires an understanding of them and the methodology of their application.

Contraindications: general and specific

All physiotherapeutic methods of influence are united by a list of general contraindications for any influence, but also for each of the methods there are characteristic features and limitations of use.

General contraindications for prescribing hardware methods of influence :

• pregnancy at any stage;
• any acute condition (fever, infectious disease, dehydration, decompensated state in chronic diseases, acute increase or decrease in blood pressure, etc.);
• neoplasms (malignant and benign), tendency to neoplasms;
• systemic diseases (scleroderma, lupus erythematosus, etc.);
• diseases of the cardiovascular system (hypertension, II–III hypertensive crisis, the presence of a pacemaker, increased vascular fragility, rosacea, varicose veins, thrombophlebitis, etc.);
• lung diseases (pulmonary failure, etc.);
• gynecological diseases (fibroma, fibroids, polycystic ovary syndrome, endometriosis, mastopathy, etc.);
• endocrine diseases (thyrotoxicosis, etc.);
• diseases of the kidneys and urinary system (chronic renal failure, acute pyelonephritis, acute cystitis, etc.);
• blood diseases (coagulation disorders, leukemia, anemia, etc.);
• diseases of the musculoskeletal system (arthritis, acute rheumatism, etc.);
• allergic diseases or reactions to various types of energy, contact media or injected agents;
• mental illness (epilepsy, etc.);
• skin diseases (pustular, parasitic diseases, purulent diseases of subcutaneous fatty tissue);
• individual adverse reactions to the procedure;
• violation of the integrity of the skin in the affected area.

In addition to the general ones, it is necessary to take into account the characteristic contraindications and limitations of use for each physical factor, depending on its specificity.

The administration of any type of electrical energy is contraindicated to glandular tissue (thyroid gland, mammary gland, etc.) and the heart area. The use of electrotherapy is strictly prohibited if the patient has an artificial heart pacemaker (pacemaker)!

For methods of electrotherapy and thermotherapy , in which the effect is usually dosed according to the patient’s sensations, a contraindication is a violation of the pain and thermal sensitivity of the skin, especially in the area of influence. A sensitivity disorder that is not identified before the procedure will lead to electrical or thermal burns during the procedure. This complication will require longer treatment than usual, especially for electrical burns.

The number of electrotherapy procedures per course can vary from 6–8 to 16–20, depending on the task at hand and the dynamics of the process, as well as the effectiveness of the technology used. A repeat course can be scheduled no earlier than 2 months after completion of the previous one, but no more than 4 courses are conducted per year.

When prescribing light therapy procedures (photo- and laser rejuvenation, photo- and laser hair removal, etc.), it is necessary to focus on the patient’s skin phototype according to Fitzpatrick to select an adequate intensity of exposure, conduct test flashes, selecting the intensity from minimal to therapeutic power. A gradual increase in the energy dose in the test is required to determine the sensitivity and individual skin response to exposure. The use of phototechnologies is limited for photodermatosis, disorders of pain and thermal sensitivity.

The number of procedures when using light depends on the task at hand, the spectrum or wavelength and the therapeutic result. Technologies registered with the Ministry of Health have a precise description of the methodology for each type of photo procedure.

Ultrasound therapy is not performed in cases of pronounced neurosis, in the area of the heart, protruding bone surfaces (knee and elbow joints, spinous processes of the vertebrae, etc.). Contact media and medications or cosmetics used for ultrasound therapy and phonophoresis may cause allergic reactions. When collecting anamnesis, the patient’s tendency to such phenomena should be clarified. If intolerance to the procedure is detected for the first time, cancel it and use another type of energy without a contact medium. In addition, the duration of the ultrasound therapy procedure is always timed. In case of significant problems and the need to work with a large volume of tissue, the work time for each problem area is significantly reduced. This problem can be solved by devices equipped with several ultrasonic emitters, which can be permanently installed in all necessary areas.

The number of ultrasound therapy procedures per course can be up to 15, repeated courses are prescribed no earlier than 2 months after the end of the previous one, but no more than 4 courses are carried out per year.

A special contraindication for magnetic therapy is severe hypotension, although in this condition no procedures should be performed in an aesthetic clinic or beauty salon.

Carrying out mechanotherapy, thermotherapy and barotherapy procedures requires a careful examination of the skin vessels. The presence of dilated veins and capillaries, spider veins, fragility of the vascular wall, and the frequent appearance of hematomas with minor bruises is a warning for their use.

The use of high-frequency electromagnetic fields in the radio frequency range, which has become widespread in recent years in aesthetic medicine, requires careful patient selection. To prescribe RF therapy to a patient, it is necessary to take into account all contraindications for both high-frequency and thermal physical factors. If there are papillomas on the patient’s skin in the affected area, their preliminary removal is necessary due to the high risk of spreading the viral process.

To avoid complications such as exacerbation of any chronic nonspecific diseases the patient has, the first procedure, and sometimes the first few procedures, are performed with milder parameters and sensations. This will ensure the launch of numerous reactions of adaptation, compensation and restoration, regulation of biophysical processes in tissues, at the level of organs and systems of the body. This warning is especially important for patients in the older age group - they experience a slowdown in metabolic processes and adaptation due to chronological changes in hormonal levels. Patients who have recently suffered from any acute diseases or conditions also require a slight reduction in exposure dosage.

Complex Impact

Using any factor once does not make it possible to obtain the entire complex of desired adaptive reactions - both local and general. Obtaining a result always requires exchange rate influence, which provides a cumulative effect with many technologies. Some technologies, even after completing a course of procedures, give rise to positive dynamics within several weeks.

But it has been scientifically proven that the most pronounced and sustainable result with a long period of aftereffect is observed with a complex influence on the problem using several therapeutic synergistic factors of different physical nature. They work by mutually reinforcing each other's effects, stimulating various pathways of physical and chemical processes. At the same time, a larger number of organs and systems are involved in cross-protective effects, the functional power of cells is higher, and adaptation is more stable. Consequently, a long-term and more perfect structural trace is formed in the “target tissues”, a long period of aftereffect after the course of procedures received.

Thus, the complexity of patient management is a holistic view of the body and the influence, if possible, on all parts of the etiopathogenesis of the problem and its consequences. To do this, the following activities are carried out:

• firstly, correction of the patient’s lifestyle, diet, physical activity, recommendations for home care are provided;
• secondly, prescribing a course of physiotherapeutic procedures, including several synergistic physical factors, combined (simultaneously) or sequentially (one at a time in one visit);
• thirdly, the use of cosmetics for the problem is completed by professional procedures in a cosmetologist’s office and applied independently at home to prolong the effect.

In addition, based on a holistic vision of the problem, it is advisable to carry out the impact not only on the area indicated by the patient, but also on the body as a whole. General procedures trigger compensatory reactions at the level of the whole organism, and against this background, an improvement in metabolic processes in the problem area at the segment level is already observed. Local exposure after a general one will give a locally significantly more pronounced effect than local procedures alone.

Therefore, it is important to adhere to the following principles:

1. It is advisable to include a general procedure in the treatment program:

• There can be only one general procedure per day! And it is carried out first;
• all local procedures are carried out after the general one;

2. Local effects “rise” from deeper layers of tissue to superficial ones, i.e., technologies and methods of more deeply penetrating energy are used first;

3. The effects are completed with the use of cosmetics.

Long-term retention of the results achieved is achieved through maintenance procedures between courses of active physiotherapy. Their necessity lies in maintaining the body’s adaptation system at the high level that was achieved in complex treatment.

So, the practical application of physiotherapeutic methods in the practice of a dermatocosmetologist provides a number of undeniable advantages and is based, first of all, on deep theoretical foundations. The condition for the successful work of a specialist is an understanding of the technologies used and adherence to the methodology for making a rational choice of a treatment program or correction of aesthetic defects without the risk of undesirable consequences for the patient.

This article is part of the special project HARDWARE MEDICINE

You can read all the articles on this topic:

SPECIAL PROJECT. HARDWARE MEDICINE

Literature:

KOSMETIK international journal, No. 1(39), 2010, pp. 30-34