The truth is, it is a lot to ask. Because common sense (and physics) dictates that in most cases, the faster and more dramatic the change, the more powerful or aggressive the approach needs to be.
And while that gets pleasing initial results, doctors have seen enough long-term skin damage and even treatment-induced ageing as a consequence of too much inflammation caused by procedures, to adjust their thinking on how hard, how fast and how far one should really go to achieve significant change.
As a result, we’ve seen once-popular procedures such as ablative chemical peels and CO2 lasers lose ground to more refined and delicate options such as Skin Pen needling, IPL and fractional resurfacing.
Meanwhile, ever-more sophisticated energy-based devices are being developed to boost that all-important collagen and elastin without nuking too many healthy skin cells. A radio frequency microneedling device such as Focus Dual, for example, boasts extra-fine needles to reduce swelling and bruising, while new ultrasound machine Sofwave aims to precision-deliver its energy to the dermal layer so as to achieve maximum skin density with a minimum of pain and inflammation.
But with the pathway for fresh skin cell proliferation being a controlled amount of damage in the case of heat-based devices, peels, and needling, inflammation of the skin is always going to be part of the process. “These ever more advanced treatments are brilliant as they allow us to control the inflammation we cause,” says EV Expert Julie Scott, Owner and Clinical Director of Facial Aesthetics. “But the operative word is control, and it needs to be in the hands of a professional for it to be exercised correctly.”
Taking extra careBut even skin professionals are increasingly discovering just how seriously they ought to take the off-setting of irritation and inflammation with any procedure. “’Controlled’ inflammation needs more active controlling than we may so far have realised,” says Patrick Johnson, Inventor and CEO of Celluma LED devices.
“These types of treatments need to be consistently counterbalanced by something that turns off the inflammatory cascade once they’ve induced skin repair, so the process doesn’t run wild and starts doing long-term damage.” Think dehydration, sagging, uneven skin tone, and lines and wrinkles.
Scott agrees. “If we fail to stop the inflammation before our patient leaves the clinic, our anti-ageing efforts will turn into ‘inflammaging’,” she says. Inflammaging impairs the protective barrier function, triggers pigmentation and leads to a loss of collagen, elastin, and hyaluronic acid.
It’s something that’s not always easy to explain to demanding customers expecting small miracles, says EV Expert and Cosmetic Physician Dr Emmaline Ashley, who has a background in dermatology, biology and surgery and is clinical director of Ashley Aesthetics: “We can’t cause transformations overnight because we must do things slowly and safely and build up to a final result. It means helping patients understand that their overall skin health is an ongoing process, and so should their treatment programme be. Overdoing it, pushing the skin too hard, not allowing time for healing and causing excessive inflammation will only have a negative effect.”
Patient selection is also key, says Ashley. “Some people simply aren’t suited to some treatments, no matter how keen they are to have them,” she says. “Appropriate treatments and strengths ought to be selected and performed at appropriate intervals. For example, Black and brown skin is prone to post-inflammatory hyperpigmentation. A scrupulous doctor will advise against treatments that are too invasive, or make sure the patients’ skin is properly prepped – this is as important for combating inflammation and encouraging healthy collagen regeneration as ensuring the right aftercare.”
So, what exactly do our experts do to achieve to call time on downtime?
Fortifying skin prep“Sometimes I feel like I sound like a broken record, but it’s not worth spending your money on expensive ‘tweakments’ if you’re not looking after your skin before and in-between appointments,” says Ashley. “Your skin is a reflection of overall health, so it starts with eating well, keeping hydrated, and using a good, proven skincare routine.”
Scott finds that most of her patients arrive with a compromised barrier function (which says a lot about either our aggressive approach to skincare or our stress levels), so is hot on “doctor-developed cosmeceutical skincare proven to support barrier restoration, restore hydration and calm redness” in the run-up to treatment.
Ceramides, silicones, humectants and peptides are her go-to skin strengtheners, while vitamin E, green tea extract and oat extracts are indispensable for rendering skin as calm as possible before subjecting it to a procedure.
Her go-to’s are ZO Hydrating Cleanser, Skin Health Hydrating Creme, and Daily Power Defence. She also points out that the surgeons she has worked with over the past two decades were routinely pre-occupied with quelling inflammation and strengthening patients’ skins before they took to the scalpel: “Skinceuticals CE Ferulic, arnica supplements, and a variety of anti-inflammatories were a given to prevent scarring and promote successful healing,” she remembers.
Collagen-poppingWhether taking collagen supplements is a red herring (literally!) or an essential step towards getting amazing results from your tweakments is a hotly debated issue, but that doesn’t stop increasing numbers of practitioners recommending them. The idea is that the collagen peptides in the many drinks, powders and capsules available provide the building blocks for this essential skin-supporting protein.
But they also, say some medics, stimulate a healing response in your skin and help to slow down the rate of ‘collagen burn’, which is when you burn through your collagen stores faster than normal at times of stress, illness, intense exercise or accelerated ageing (think menopause).
Pupinder Ghatora, the pharmacist behind the award-winning collagen supplement Ingenious Beauty Ultimate Collagen, would add tweakments as a cause of high collagen ‘burn rate’. “The collagen-boosting effect of this type of treatment is very short-lived if you don’t make sure the body is replete with collagen peptides to not only repair the damage you’ve just inflicted but lay down additional collagen as well,” he says. “Only then will you emerge with skin that looks more youthful than it did before.”
Scott prefers the marine collagen peptide drink Skinade, which has “700mg of collagen peptides per serving but is mainly a health drink based on pro-collagen factors, which is what makes the difference for me,” she says.
“Nutrients like vitamin C, MSM, L-lysine, omegas and a B complex are the key to collagen-boosting, more so than collagen peptides.” She doesn’t believe this type of supplementation is a magic bullet (certainly not if it’s not accompanied by a well-balanced diet), but they “certainly can provide the building blocks for collagen growth and ensure the patient doesn’t ‘run on empty’ when they submit to a procedure.”
Ashley is more circumspect. “The research and clinical data on collagen supplementation is still lacking. That’s not to say that supplements couldn’t theoretically have some benefit and may improve skin elasticity, but studies are small, have funding bias and use very different methodologies and outcome measurements,” she cautions.
The light fantasticCalming, balancing LED therapy is becoming a staple in most cosmetic clinics, with doctors beginning to regard it as an essential add-on to ‘controlled damage’ treatments. Even the doctor who invented microneedling, says Johnson, advises not to have that treatment if you can’t follow it up immediately with low-level light therapy.
As an inventor of the Celluma LED device, Johnson would bring that up, but Scott, for one, wholeheartedly agrees. “I go in with the anti-inflammatory and collagen-boosting red and near-infared Dermalux Flex LED after anything invasive, perforative or aggressive,” she says. “It’s the calming blanket that stops that inflammatory process and prevents patients from going outside with vulnerable skin, and I’ve seen it calm and prevent flushing and redness.”
Ashley agrees that the technology has been shown to have anti-inflammatory effects. “The exact method of action is still something we’re exploring, but using LED light is a lovely way to help reduce inflammation post-treatment,” she says.
Post-inflammatory potionsLastly, aftercare with the right topicals is as important as the skin prep you need to do. “My go-to product post (and pre-)-procedure is Clinisept,” says Ashley. The water-like lotion hydrates, calms, disinfects and re-sets the skin’s pH, thereby helping to restore the barrier, so it’s ideal both to prep the skin and provide aftercare.
“I also always recommend Clinisoothe, the consumer version of the product, to my patients to use at home,” she adds. Ashley is also a fan of Epionce products, “which really focus on skin barrier repair and protection.”
Those who want to protect and fortify their barrier on a budget are in luck, as there are many good and often dermatologist-recommended brands being launched that are all about barrier repair. CeraVe, La Roche Posay, Curél, Cultured Biomecare and new Dove DermaSeries are all great buys.
In addition, “growth factor creams are definitely an up-and-coming and exciting area,” says Ashley. “The wound-healing process is extremely complex and growth factors play an important signalling role in it. They have been used outside of cosmetic medicine to aid with wound healing and management.”
Calecim is one brand that specialises in these creams and serums; don’t be surprised to find them being smoothed on by your doctor the next time you have a microneedling or laser procedure.
In short, a scrupulous inflammation-balancing protocol can mean the difference between a spectacular, long-lasting result with little to no downtime, no result at all, or worse, a negative one.
Julie Scott, Owner & Clinical Director
Julie Scott has over 25 years experience in the field of plastics and skin rejuvenation and is a member of the BACN and RGN, having qualified as a Plastic...Book with Julie Scott
Emmaline Ashley, Aesthetic Doctor
I'm Dr Emmaline Ashley, the founder of Ashley Aesthetics. I'm passionate about beauty, wellness and science. I wanted to combine all of my loves into creating...Book with Emmaline Ashley