Skin’s Layers & The Top Skin Treatments In 2019
These days there are many effective treatments for your skin like chemical peels, vampire facials and laser resurfacing but it can get very confusing as to which treatment will work for your particular skin issues. So we are going to talk about the texture, the colour and the volume of your skin. These three things are what we need to look at before we decide which treatment is going to work on work on your skin concerns.
Here is a diagram of the skin and the three main layers: epidermis, dermis and subcutaneous.
The Epidermis is the top layer where we’ve got our dead skin cells. This is also the layer where pigment lies – right below that dead cell layer, along with where the hair follicles and where the sweat glands come through.
The next layer is called the dermis and this is where we’re getting into live tissue such as blood vessels. We’ve got the base of the hair follicles here and this is also the layer where we have collagen and elastin fibres.
At the very bottom is the subcutaneous layer. This is the layer where we have fat cells that sit above the muscle and then of course we’ve got bone. The thickness of this skin really depends on the area on the body. So for example the eyelid is 0.5 millimetres thick, whereas areas like the heels or the palms can be up to 4 millimetres thick.
When looking at skin treatments, what we need to address first is : where does the problem lie. Is the problem lying in the epidermis? Is the problem in the dermis or is the problem down below?
How Texture, Color & Volume Affect Treatment Type
When we talk about texture, colour & volume, each treatment falls into a certain layer. Often if people are coming in concerned with the texture of their skin, the problem is usually within the top layer. Quite frequently there’s a build up of dead cells that need to be removed, which as a result would make it smoother. Sometimes muscle contractions such as repetitive movement like squinting or frowning doesn’t necessarily affect the depth because it’s actually the muscle that’s causing it, but it can create permanent divots in that top layer. Chemical peels, microdermabrasion, and dermaplaning are the three main treatments that focus on that dead cell layer.
Our dead skin cells stack up kind of like bricks on top of the skin and they’re held in place by this molecular glue that sticks them together. So if we’re doing something like a chemical peel for example, the chemical that’s used on the skin – and it could be a glycolic acid, lactic acid, salicylic acid, or a modified jessner’s peel – the different acids have a different effect on the skin, but basically what they’re doing is they’re breaking that bond that holds those dead skin cells in place so that the dead skin cells can come off at a faster rate.
How We Tackle Acne, Clogged Pores & Blackheads
In the case of acne, clogged pores, or black heads we have a compounding problem. We’ve got a dead skin cell layer that’s congested and congestion in the pores underneath the skin. We all have pores in our skin, but people that are prone to oiliness or acne get congestion in the pores. Their body might be producing extra oil like in the case of teenage acne or hormonal acne for women. So, they have extra oil being produced and there’s actually dead cells in the pore that also stick together. We all have bacteria on our skin called P-acne bacteria and for people who are prone to acne, they get this flare up that acne will feed off of – I call it sludge – a combination of oil and dead skin.
So an acid like salicylic acid does a beautiful job of getting into that pore and basically cleaning it out. In the clinic we do salicylic acid peels, but of course we suggest for home care to use salicylic acid as well. Salicylic also has an anti-inflammatory effect which can reduce redness.
In the case of aged skin – if we want to get the dead cell layer off then we’re going to choose a different chemical, one that’s going to be both hydrating and exfoliating, like lactic or glvcolic acid. If we are doing a treatment like microdermabrasion or dermaplaning we’re actually using a physical means of removing that dead cell layer. So it’s the scraping that actually removes it leaving the skin feeling much smoother and allowing products to absorb better. The thing that I really want to emphasize is that we are just working on that top layer.
Addressing Fine Lines, Wrinkles & Larger Pores
So regarding skin that has fine lines, wrinkles, maybe larger pores- the problem is coming from a little bit deeper down in the epidermis. So we still may do an exfoliating procedure but we’re going to be a little more aggressive and go a little bit deeper. Now we’re talking about procedures like microneedling with the vampire facial or maybe CO2 fractional resurfacing. We’re going to use either a laser or a microneedling pen to actually penetrate little tiny columns through that layer of skin, to create little tiny wounds. That process stimulates the body to shed the outer layer but produce new collagen, so we’re actually affecting a little bit deeper now. When it comes to those procedures, the deeper you go and the more heat you put in will result in an increased effect on those collagen and elastin fibres.
Quite often people can’t do much down time and that’s fine, they can do the less aggressive procedures but they may need to do more of them. It’s important to understand the difference between treating just the top layer and actually penetrating down deeper into this dermal layer. When we’re using a product like Botox or Dysport, those medications are considered neuromodulators and what that means is they affect the ability of the muscle to contract. We see the end problem on the top layer of skin. If the fine lines and wrinkles are being caused by a contraction of the muscle like the frown for example or squeezing the eyes, then we know that we can treat it with Botox or Dysport. We are actually injecting the muscle but in return, smooths the top layer of the skin.
Treatments For Different Skin Colours
Now let’s talk about colour of the skin. Procedures that treat the colour of skin are going to be treatments such as photofacials for those with lighter skin, and chemical peels for those with darker skin tones. Typically pigment is in the epidermis of the skin so when you think of pigment, it’s important to note that a tan is the body producing extra colour; extra melanin from the melanocytes which is actually a protective mechanism. We all look so healthy with a tan but it’s actually sun damage, your body’s way of trying to protect itself.
Now when we start to see darker spots on the face which typically appear later in your 30’s, 40’s or 50’s your skin is trying to protect itself from the sun and it’s producing these clusters of pigment. The Vectra camera is great at showing these extra pigmented spots. One of the best ways to treat these is with a photofacial which uses Intense Pulsed Light or IPL. IPL penetrates through the top layer of skin and is absorbed by the extra melanin. From here the dark spots actually darken temporarily and then come to the surface and slough off.
“Sometimes people get a ‘wow’ result with one treatment, sometimes two or three treatments is required, then annual treatments are required if you’re continuing to go out in the sun to get the sun damage.”
The other thing that a photofacial can treat is broken blood vessels which again can be from sun damage but can also just be part of the aging process. Once women reach menopause their bodies get dilated blood vessels everywhere, so the photofacial works beautifully on that as well. Chemical peels can also be used to treat pigment but it requires multiple treatments, so we usually reserve that treatment for somebody who has naturally darker skin, making them a poor candidate for the photofacial.
Photofacial’s use light energy that’s attracted to colour so if a person has a naturally darker skin tone and darker pigment, the laser is going to heat them up too much making it an unsafe treatment. Instead we can do a series of chemical peels for the clients with the darker skin tones, forcing the skin to exfoliate more which will gradually pull up some of that pigment to get a nice more even colour.
Now if somebody has pigmented spots or a raised bump on the skin we can zap those off with a procedure called electrocautery. We do want to make sure that any little lumps or bumps are not precancerous so we always have someone from our medical team check that out prior to burning those off.
Correcting Facial Volume Loss
What brings so many clients into the clinic is concerns about volume loss ( or as they call it…drooping!) Volume loss in the skin can start as early as your 20’s. Let’s think of your skin like a mattress where the epidermis is your sheets, the dermis is memory foam and then your subcutaneous layer; where the fat is, is the actual mattress. What happens first is the epidermis gets thicker and the dermis gets thinner. As we lose volume in this area, it affects the texture of the epidermis. The subcutaneous layer loses fat as we age and the fat pads drop along with muscle loss. To top things off our bone starts to shrink, so as we get older we’ve got multiple things happening in the skin.
“One of the best ways to correct volume loss is with hyaluronic acid fillers.”
Products like Restylane, Juvederm, Belotero – there’s multiple products available in Canada but they are all hyaluronic acid molecules. Hyaluronic acid is already made naturally in our bodies, it’s in our eyes, it’s in our skin, it’s in our joints but the way our bodies make it is very watery, we metabolize buckets of it every day. When hyaluronic acid products are used for cosmetic injections they are altered in the manufacturing process and they add cross linkers to turn them into a gel, so when they’re injected into the dermal layer they actually provide volume and attract water molecules. HA fillers will stay put anywhere from 6 to 18 months depending on the area. So that’s how we correct volume loss in the dermal layer.
There are other products on the market like Sculptra. Sculptra is a good example of a poly-L-lactic acid molecule that stimulates your own collagen. It can also be injected into this layer and it will stimulate those collagen fibres. We see results with that product for as long as 2-3 years. It’s a very soft, natural look that’s especially good for our patients who have an overall thinning and maybe filler isn’t the best choice for them. Our clients who are extremely athletic and have a very low body fat- runners, soccer players, those types of clients do very well with Sculptra.
Another product on the market is called Radiesse which is made from Calcium Hydroxylapatite which stimulates collagen build up underneath the skin adding volume over the course of a few months. We typically use Radiesse in areas where we want a little bit more contoured look, most popular being the jaw line.
The Power Of Ultherapy
So when we’re talking about skin treatments for volume, one of the only treatments that is available out there to actually stimulate these deeper layers is Ultherapy. Ultherapy is an ultrasound device that goes through the skin, heating it up to a point where it causes a thermal injury, stimulating new collagen. So with the ultrasound device in Ultherapy the technicians can actually see the layers of the skin and the target layer where the collagen fibres are lying. That tissue will get heated up to between 60-70 degrees Celsius and over the course of the next 3-6 months we’re going to see a slight volumizing. In our clinic we typically do it in combination with either HA fillers or Radiesse just so that we can speed the process up but Ultherapy is a great treatment for getting down really deep, but safely.
How EA Beauty Can Help
EA Beauty is our method of really helping our clients first of all identify their concerns and then match that with the correct treatments. We have our new EA Beauty Workbooks, you can download it and start to identify for yourself where your areas of concern are. Then when you come into the clinic you’ve already got that established and our technicians can take over and help you identify which treatments would be the best for you.