SPA SERVICES: Smoothing Deep Wrinkles

Dec 20th, 2013

Skincare science now provides more ways than ever to “de-crease” your spa clients’ complexions.

“There is still no cure for the common birthday,” former astronaut and U.S. senator John Glenn famously said. Aging is certain, and skin is often a cruel tattletale of the calendar. With life expectancies on the rise and baby boomers dominating the current population, there’s a lot of mature skin out there. For some people, facial wrinkles are no great drain on their wellbeing, but others afflicted by this outward sign of aging will go to any lengths to try to recapture the smooth complexions of their youth. And then there are those who are somewhere in between; they’d like to look their best without going overboard.

Decades ago, people (mostly women) desperate to “de-wrinkle” had no other option than to visit their friendly cosmetic surgeon, who would perform the old-school facelift that spawned jokes about skin stretched from the kneecaps to the scalp. Meanwhile, the esthetician’s marching chant was “hydrate, hydrate, hydrate.” Today, spas and medical practices often overlap, and there are a wide variety of wrinkle-fighting options, from the topicals and equipment-based approaches employed at traditional spas, to the fillers, injectables and lasers provided at medical spas—and a wealth of combination strategies of all of the above. As a spa owner, you’ve probably got a few tricks up your sleeve, but perhaps it’s time to add a few more, and to see what the industry considers the latest and greatest wrinkle warriors.

This month, DAYSPA is taking a hard look at deep wrinkles, those stubborn furrows often seen in clients over 50 who’ve asked you to wage a war against their aging skin. What do you have for them? While some might argue that invasive procedures are the only real way to fill, buff and smooth, we’ve talked to product and equipment formulators, educators and technicians who offer effective day spa treatment strategies as alternatives.
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Birth of a Wrinkle

All skincare practitioners know what happens to skin as we age: It becomes less elastic and more fragile; it receives less natural oil from the body, which dries it; fat in the deeper levels of skin diminishes, leading to sagging and looseness. And as all of this happens, folds and creases begin to appear on the face, neck, arms and hands—interestingly, the parts of the body most subjected to the elements. The whole process radically breaks down the skin’s connective tissue, causing it to lose strength and flexibility.

“Simply put, deep wrinkles are scars,” says Dr. Charlene DeHaven, clinical director, Innovative Skincare. “Sun exposure causes free radical damage, resulting in inflammation. As the body attempts to heal, scarring results, first on a microscopic scale and then visibly. Deep wrinkles are the result.”

“Wrinkles are caused by both extrinsic and intrinsic elements,” says Danielle Tsoklis, director of education and development for Silhouet-Tone. “Sun damage will result in surface damage such as pigmentation and rougher texture. Intrinsic damage runs deeper evidenced by loss of dermal density and muscle tone.”
Repeated facial movements and expressions also contribute to wrinkles. “Progressive changes to the skin through continual muscle movement like smiling will result in deeper structural damage,” Tsoklis says. “Each time a facial muscle is used, it wears down the skin’s ability to spring back into place.”

Women tend to develop more wrinkles around their mouths than do men. According to the Mayo Clinic, this may be because women have fewer sweat glands and fewer glands that produce oily sebum to lubricate the skin. The Mayo Clinic also considers smoking—which changes the blood supply to the skin—and poor nutrition primary causes of wrinkles. Genetics may also play a role.
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Topical Conversation

Given the complex nature of wrinkle formation, can we really expect topical treatments to make a dent? Yes, say the experts—but plan on using more than one. “A topical rejuvenation product needs to address damage to the skin’s microvascular system, which inhibits the supply of vital nutrients, oxygen and the removal of wastes—all of which promotes the speed and degree of skin damage and visual aging,” explains Glen Lockhart, senior director of research and development for BiON Research skincare products.

“But there is also the issue of collagen repair and production, which requires the presence of another grouping of chemicals in the skin,” Lockhart continues. “Additionally increasing the skin’s population of collagen-producing fibroblast cells can be achieved, but this requires still another assortment of biochemicals. Then, stimulating the fibroblast cells into pre-collagen production requires even more ingredients. There are also co-factors and co-enzymes that must be present. So at some point, a single product cannot contain all of these ingredients at a therapeutic level or volume.”

The challenge in sticking to topicals only, then, is the need for a combination of agents that provide active ingredients working in tandem to address the problem: Antioxidants, retinoids, peptides, stem cells, minerals, botanicals and enzymes are among the star players that work to repair, stimulate and rebuild skin. “My philosophy is to not combine all products into one package, though,” says Gül Zone, president of DermAware. “It is better to isolate each active in highly concentrated products. Mature skin needs a balanced diet of different wrinkle busters, used intermittently.”

That is not to say that products can be combined willy-nilly. “They must be carefully selected so they work in harmony, rather than negate effects or cause harm,” cautions DeHaven. And, as with any multi-faceted protocol, cooperation of the client is a major factor.
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Product Delivery

But can topicals even penetrate enough to have an effect? “This is the $64,000 question,” says BION’s Lockhart. “Some product ingredients can be ‘loaded’ into the epidermis and successfully migrated into the dermis where they can have their effect upon the cells and chemistry orchestrating significant repair and ‘remodeling.’ Other ingredients don’t need deep penetration to achieve their desired impact upon the dermis.”

“A product delivery system is extremely important to a formula,” says Christian Jurist, global educational director for Pevonia. “Such a system will allow the specified ingredient(s) to penetrate immediately and deeply into the skin when it may otherwise be more difficult, or impossible, due to molecular size or the skin’s protelytic activity.“

“In recent years the formulation of active ingredients has become more sophisticated and the molecular size of ingredients has become smaller,” explains Karen Asquith, national director of education for G.M. Collin. “For example, in the case of peptides, lipidic components now act as chaperones to allow them to pass through the skin’s hydrolipidic barrier.”

Depending upon the technology, ingredient(s) may also be able to be placed on a time release, thus introducing a much more effective, strong ingredient into the skin at a progressive pace in order to prevent irritation. For a simple yet effective strategy, Dasha Saian, operations manager of SAIAN, recommends applying a layer of peptide-rich cream over a hyaluronic acid-based serum. “This ensures the serum doesn’t evaporate, and provides a two-punch wrinkle-busting effect,” she explains.
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It’s All Mechanics

Is there one magical device that will turn back the clock on your clients’ faces? Probably not, the experts agree. “Simultaneous aging of both the superficial and deep structural elements of the face cannot be treated using only one device technology,” says Silhouet-Tone’s Tsoklis. “Only a multidisciplinary approach can access the different layers of skin.” To that end, the company’s Smooth Skin device features ultrasound combined with microcurrents, pulsating frequencies, alternating DC current and mesofusion.

“Microcurrent therapy helps restore natural current flow to regenerate soft tissue to heal damaged scar tissue,” explains Ray Baker, president, Beautiful Image. “It can be applied at specific frequencies to address a variety of lines and wrinkles. It also increases the uptake of nutrients within cells, and stimulates the excretion of waste product, such as heavy metals, within them.”

Brandon Smithwick, business developer for manufacturer 7eWellness, considers three technologies, as utilized in its Myolift Ultra, to be at the forefront of non-invasive equipment.

“First, ultrasound evenly penetrates to the deeper layers of the skin with a precise level of heat to stimulate collagen synthesis and supercharge the natural production of collagen,” Smithwick explains. “Second, microcurrent stimulates the production of adenosine triphosphate (ATP), which is stored cellular energy that allows a cell to function. This, in turn, triggers the body’s natural healing process. Electrolyte levels are replenished and nutrients are better absorbed. Amino uptake is increased, and blood circulation and lymphatic flow are also increased. These vital functions are increased four to five fold with microcurrent technology. And third, galvanic stimulation improves osmotic flow, which enhances delivery of key ingredients to areas with denser skin.”

According to Smithwick, such results are magnified when combined with effective topical skin products and “can produce very similar immediate and cumulative results to invasive procedures. I consider today’s non-invasive combination facial treatments to be the preference.”

Ray recommends using a conductor that is “aloe-based and enriched with peptides, rather than a basic gel,” when employing mechanical equipment to combat wrinkles.

The Radio Frequency system with Cryo Cooling and Vacuum Therapy from Onyx Medical is another multi-technology machine designed to attack the enemy on several fronts. Explains president Roger Machson, “The radio frequency energy is converted to heat in fluid-bearing tissue, reorganizing broken collagen and stimulating the production of new collagen.” Different depths of heat are used; deeper wrinkles and thick tissue require more heat.

“The Cryo cooling immediately afterward shocks cellular activity into overdrive to generate stronger lifting, tightening and firming of the skin,” continues Machson. “And vacuum therapy has been used for decades for contouring. It repairs skin damage by stimulating lymphatic drainage and breaking apart clusters of fat cells.”

Belleza & Beauty manufactures a powerful radio frequency unit for both face and body lifting, reports CEO Leticia Giron. This portable-sized Ultracavitation machine accelerates circulation and promotes lymphatic stimulation for faster elimination of toxins, which can wear down even healthy skin.
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Power Couples

A simple equation: equipment plus product equals better results. A multifaceted approach is needed for minimizing deep wrinkles and then maintaining progress, and a multitude of product options enable you to develop signature in-spa treatments as well as home-care regimens.

Guinot’s director of education Elizabeth Murchison advocates such combination programs. “For instance, microcurrent stimulates ATP, and our company’s home-care product contains ATP to extend the effect, stimulating the cells that become dormant with time,” she says.

For more than 25 years, Pat Lam, co-founder and vice president of Skin Care Consultants, has been using a deep microdermabrasion treatment in conjunction with the embryonic extracts in her company’s Instant Skin Serum to produce results. “The skin looks youthful and radiant, and there is an instant reduction of wrinkles,” she says. “It is available for physicians as an injectable, but estheticians can use the topical application of this serum and still get amazing results.”

Kate Somerville, founder of the Kate Somerville Clinic in Los Angeles, often recommends a combination of facials and laser treatments for clients with mature skin. “Pearl Fractional is a procedure that combines two types of lasers: Pearl and Titan treatments,” she says. “It vaporizes and removes damaged tissue, and it’s great for acne scarring as well as deep lines, enlarged pores, pigmentation and skin laxity. Most people only need one treatment to see quite dramatic results. LED treatments are also great for antiaging results.”

Even more invasive strategies such as surgery require a combination of techniques for ongoing results. As San Francisco plastic surgeon Dr. Edward Miranda reminds patients, “After structural surgery such as a face, neck or brow lift, tissue has been repositioned but aging will continue to occur. We haven’t stopped the aging process. Prevention and maintenance are still needed.” Miranda sometimes recommends to a surgical patient that she graduate to injectables, or to spa-level treatments such as ultrasound, coupled with a skincare regimen.

Enhanced product penetration is a key advantage to the equipment/product approach. “Without delivery, it is impossible for active ingredients to penetrate, due to nature’s own way of way of protecting the skin,” reminds Sonia Boghosian, president of Bio Jouvance. She notes that, because every inch of skin has more than 2,500 pores, it’s helpful to use products with ingredients containing small molecules, such as those found in essential oils and CoQ10. “Stem cells also have the ability to penetrate deep into cellular layers of skin,” Boghosian adds.

And some devices can do much to facilitate delivery of topical products. Onyx’s Pulse Electroporation System employs a transdermal technology specifically designed to help deliver large-size molecular skincare ingredients into skin. At Belleza and Beauty, radio frequency treatments are used to help maximize penetration of a complementary topical cream that combines hyaluronic acid, collagen, grape seed extract, green tea and rose extract.

“A good push from equipment can be beneficial,” acknowledges BiON’s Lockhart. “Mild electrical current, radio frequency, LED, microneedling, magnetically generated channels and even massage can enhance penetration and provide ‘pulse’ treatment levels that the patient cannot achieve at home.”

Wendei Spale-Smith, owner of Peace of Mind Skin and Body Care in Studio City, California, combines product with equipment for optimal results. “I incorporate my chosen antiaging serum into my Advanced Ultrasonic Facial, to aid penetration into the skin,” Spale-Smith says. She then sends her clients home with the home-care version to maintain results.

The effectiveness of the product/equipment “power couple” justifies the initial investment, say experts, with the right antiaging equipment quickly paying for itself and yielding substantial profits for your spa. As Silhouet-Tone’s Tsoklis points out, “These combined treatments produce a high-impact result that clients are willing to pay for. And the technology does not replace existing services. It provides expanded service to present clientele, but it also attracts new customers.”
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There’s No Place Like Home

For as much good as you can do for a client during a session, it’s up to them to maintain the work you’ve done. “You see what happens from lack of home care when clients come back weeks or months later and all the esthetician did in the last visit has been undone,” says Bio Jouvance’s Boghosian. “If you can get the client to take care of her skin and buy the right products, you will have put her on the right path.” Make sure your antiaging line includes the appropriate home-care options for follow-through, and make it clear to clients that part of their investment in antiaging lies in purchasing products for home use.

“Home care should be a custom regimen, recommended only after performing a thorough skin analysis and consultation,” notes Pevonia’s Jurist. “Home-care products must aim to build the quantity of powerhouse antiaging ingredients as nutrients in the skin in order to continue to feed and repair our damaged cells.”
“What you do daily affects the skin more than what you do every month or two,” reminds G.M. Collins’ Asquith. “Daily protection, correction and repair is, without question, the most important thing a client can do for her wrinkles.”

Clients also need to know what not to do. Explain to them that improper skin care can, in and of itself, contribute to skin wrinkling. “Using sun block, limiting sun exposure and not smoking are the most important steps,” says surgeon Miranda. He also recommends applying topicals containing antioxidants and retinoids, and the use of mineral make-up.

Other wrinkle prevention methods: Clients should stay hydrated by drinking lots of water and eating foods rich in vitamins, especially fruits and vegetables. And as for Grandma’s advice about lifestyle practices such as sleeping on your back and not touching your face, Miranda says, “Sure, it would be ideal if you never stretched or put pressure on the tissue because over time structural changes will occur—but not at the expense of a good night’s sleep.” (No use exchanging those wrinkles for undereye circles!)
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Let’s Get Real

As a spa owner, you know how important expectation management is, and never is that more likely to be an issue than with antiaging treatment. “We are estheticians, not magicians,” says Bio Jouvance’s Boghosian. “We tell clients that with good skin care and equipment, yes, it is possible to erase several years. But the skin didn’t age overnight and therefore it is not going to be resolved overnight.” Can you produce results that clients might compare to airbrushed photos of celebrities who invest limitless amounts of time and money to not appear old? Probably not. Can we diminish and soften deep wrinkles? You bet.

April Zangl, CEO and co-formulator of the HydroPeptide collection, suggests taking before-and-after photos. “Let the client actually see the results,” she says. “Or use a digital imaging system like a Visia machine to track progress.”

Miranda estimates that one in nine of the prospective patients who walk through his door suffer from body dysmorphic disorder, a mental condition in which the person’s real or perceived flaws distress them to an excessive degree. That sort of person will never be satisfied with results, and may cause you and your staff undue difficulty. “Don’t be afraid to say no,” says surgeon Miranda. “We can’t look at everyone as a dollar sign.”

“The client’s results are dependent not only upon the science and ingredient technology of the topical products, but by the patient’s own health and dietary habits,” says BiON’s Lockhart. “‘Expectation management’ is greatly influenced by the patient’s diet, and this aspect of the health and beauty of skin needs to come into the conversation. The patient who converts to an extremely healthful diet with the bulk of his/her daily calories coming from fresh fruits and vegetables will achieve a significantly greater skin-rejuvenating result from your efforts than the person who has a less healthful and balanced diet. The body and the skin need the correct balance of nutrients to maintain optimal health and achieve optimal skin rejuvenation results.”

Finally, pairing individuals’ skin with the correct treatment may be your most important task. “When someone comes in ready to invest in their skin, it’s important they understand that not all services or treatments are suitable for everyone,” says Somerville. “The truth is, as professionals, we still can’t know everything about someone’s skin right away. There is a process of learning about a client and how their skin reacts and responds.”

“It is imperative that with each client, the skincare professional sets goals and timelines, and dispenses home-care duties,” says DermAware’s Zone. “I have yet to see the magic machine or potion that will banish wrinkles entirely, but can we achieve remarkable results with progressive professional and aggressive home care? Yes, yes we can.”

Andrea Renskoff is a Los Angeles-based writer.

Wrinkle Busters

These professional manufacturers offer solutions to treat deep wrinkles.
Topical Products:
• 5 Star Formulators, 5starformulators.com
• Aminogenesis, aminogenesis.com
• Bio Jouvance, biojouvance.com
• BiON, bion-research.com
• Botanical Science Technologies, botanicalscience.net
• DermaQuest, dermaquestinc.com
• DermAware, dermaware.com
• DermElect, dermelect.com
• Environ, dermaconcepts.com
• GloTherapeutics, gloprofessional.com
• GlyMed Plus, glymedplus.com
• G.M. Collin, gmcollin.com
• Guinot, guinotusa.com
• HydroPeptide, hydropeptide.com
• Innovative Skincare, isclinical.com
• Pevonia, pevoniapro.com
• SAIAN, saian.net
• Sothys, sothys-usa.com
• Wilma Schumann, wilmaschumann.com
Equipment:
• 7E Wellness, 7ewellness.com
• Beautiful Image, beautifulimagellc.com
• Belleza and Beauty, bandb1.com
• Dermatude, dermatude.com
• Image Microderm, imagemicroderm.com
• Myo Technologies, myoinc.com
• Onyx Medical, onyxmedical.com
• Silhouet-Tone, silhouettone.com
• Skin Care Consultants, lamskin.com