Skincare’s role in modern aesthetic practices has evolved from an after-thought to a given. “Skincare is integral to optimizing outcomes and plays a more prominent role than in the past because we now have access to superior, scientifically proven ingredients which act synergistically with our in-office procedures to deliver amazing results,” said dermatologist Kristine Romine, MD, founder and CEO of KRMD Advanced Medical Skin Care and Camelback Dermatology & Skin Surgery in Phoenix, Ariz.
Social media and the internet have been taken over with information regarding skincare. Despite the ever-prevalent amount of information available online, patients still consider dermatologists and aesthetic medicine clinicians their most trusted source for skincare recommendations, according to Jeremy Green, MD, a board-certified dermatologist in Miami, Fla.
“Patients still love to speak with us individually regarding our beliefs and preferences surrounding different treatment options,” Dr. Green shared.
Tapping into a Growing Market
According to Dr. Romine, industry research suggested that in 2020 anti-aging skincare com-prised the vast majority of professional skincare sales, followed by anti-pigmentation products,anti-dehydration and sun protection. “The global professional skincare market size is expected to grow by almost 30% from 2020 to the end of 2026. This translates into $4.65 billion of growth over the next five years,” she explained.
NPD Group, a market research company in Port Washington, N.Y. released the 2020 Women’s Facial Skincare Consumer Report, which suggested that the COVID-19 pandemic may have helped fuel U.S. skincare sales. According to the report (at the time of release), more women in the U.S. are using facial skincare products today compared to one year ago. Furthermore, close to 40% of facial skincare users report using their products more often today. When asked specifically about the pandemic, 22% of women have changed their skincare routine because of COVID-19. Most are washing or moisturizing their face more often than pre-pandemic; one-third have expanded their routine to include more products; and the majority of those using more products intend to stick with their new routine when things normalize.”1
Straddling the line between cosmetics and pharmaceuticals, cosmeceuticals – a product category not yet subject to regulation – have undoubtedly taken over the personal care industry across the globe. Despite the wide-spread confusion about its definition and scope, it would not be an exaggeration to state that almost 30% to 40% of any dermatologist’s prescription count across the world consists of a cosmeceutical,” according to an excerpt from the journal article, Cosmeceuticals.2
How Skincare Can Enhance Your Practice
Dr. Romine shared that in her practice she routinely uses her own private-label skincare products. These products are chemist devel-oped and allow for optimal results prior to, during and after injectables, lasers or light-based treatments.
For example, injectable procedures restore volume and decrease wrinkles, but these treatments may also result in bruising, swelling and minor discomfort. “Peptides and other active ingredients can reduce bruising and healing, as well as stimulate collagen, elastin and hyaluronic acid, thus improving injectable out-comes,” Dr. Romine explained. “Antimicrobial and antibiofilm agents can also be used to reduce untoward effects and improve safety.”
There are times Dr. Romine may use hyaluronic acid or growth factors as a “glide” during procedures that break the skin’s surface, such as microneedling and immediately after fractionated resurfacing. Silicone-based non-occlusive gel applied after procedures that break the skin’s surface helps to decrease transepidermal water loss, she added.
Suneel Chilukuri, MD, a cosmetic and dermatologic surgeon, practicing at Refresh Dermatology, in Houston Texas, said his practice has incorporated at least 12 product lines to use as adjuncts to cosmetic procedures or as standalone skincare for patients. “We pick hero products from PCA Skin, DefenAge, SkinMedica, Isdin, Clarity Rx, Restorsea and others,” he said.
PCA SKIN (Scottsdale, Ariz.) stands out for its OmniSome technology which is used in its Intensive Brightening Treatment Retinol and other retinols, Dr. Chilukuri advised. “Retinol is an unstable molecule so this technology wraps around it, which allows it to penetrate past the dermal-epidermal junction,” Dr. Chilukuri explained. “In addition to allowing a slow release over ten hours, other ingredients can be combined within the same retinol to address other skin concerns.”
In June 2021, PCA SKIN introduced its innovative ExLinea Pro Peptide Serum, which is a clinically proven neuropeptide spot treatment that uses a breakthrough expression line-reducing technology called Peptide-Pro Complex. This technology helps to deliver immediate and long-term reduction of visible expression lines. It also helps lift, tighten, firm and smooth skin for a younger-looking, more defined facial contour. One clinical study reported 100% of patients showed a visible improvement in skin smoothness, lifting and tightening after four weeks.
Dr. Chilukuri uses ExLinea Pro Peptide Serum immediately after neuromodulator treatments. The product includes Argireline Amplified (Acetyl Hexapeptide-8) to minimize fine lines and wrinkles by reducing muscle contractions and improving the relaxation of muscle contractions.
“It does not have the same effect as a neuromodulator, but it is going to enhance those results,” Dr. Chilukuri shared. “Another product that I use with neuromodulators is hyaluronic acid and the HA5 Rejuvenating Hydrator from SkinMedica.”
For patients concerned about pigmentation, Dr. Chilukurioften recommends PCA Skin’s Intensive Brightening Treatment Retinol. “It has Hexylresorcinol,a brightening agent that decreases melanogenesis. Other ingredients include retinol, resveratrol and niacinamide, an anti-inflammatory that also decreases the amount of redness,” Dr. Chilukuri explained. “If we are treating somebody who has acne, I might use Intensive Clarity Treatment. Again, the retinol is “wrapped”, allowing the addition of salicylic acid to decrease the number of acne papules. There is nothing out there like that.”
When it comes to UV protection the only sunscreen Dr. Chilukuri uses for patients with melasma is SkinMedica’s Total Defense and Repair. The product combines broad-spectrum UV protection with a unique blend of antioxidants (SOL-IR Advanced Antioxidant Complex) that provide protection from infra-red radiation while also promoting skin repair.3
To help decrease activation of melanocytes, Dr. Chilukuri has melasma patients apply the product in the morning and at night. “It contains physalis angulata, a unique ingredient that decreases heat-induced melanocyte activity.”
Barry DiBernardo, MD, a plastic surgeon based in Montclair, N.J., is impressed with the results he sees from the U.SK Under Skin (San Diego, Calif.) line of skincare products. “Under Skin is the cosmeceutical division of one of the largest pharmaceutical companies in Sao Paolo, Brazil with 8,000 employees,500 of which are scientists,” he emphasized. “This product line is different than other skincare lines in that it is epigenetic skincare. The products penetrate into the cells, rather than sitting up near the surface – the cause of redness, flaking, etc.,” he explained. “The goal of the whole line is that the products go into the cells and repair DNA changes, allowing the cell to function optimally. Over time the cells get younger and younger.
“Yes, most medical skincare will work on the cellular level, but Under Skin goes one step beyond that, working through biomolecular and epigenetic pathways. That’s why this line is in a class by itself,” Dr. DiBernardo continued.
Dr. DiBernardo uses Under Skin during the neck lift procedure with MyEllevate. “Patients have tape on their necks for a few days. As soon as the tape comes off, we have them apply the Desire Sculpt Serum in the morning and evening. They are then instructed to continue to apply the product afterward to enhance and maintain the procedure results,” he shared.
Desire Sculpt Serum’s proprietary combination of complex peptides, TensylTech and DensylRepair, work synergistically to control signs of aging, such as volume loss and firmness, fine lines and wrinkles. This new class of biomolecular and epigenetic skincare features a speedy cosmetic effect and delivers a lasting improvement. It provides an immediate tightening action and a plumping effect with continuous use. A specific red algae extract addresses one of the nine hallmarks of aging to prevent telomere shortening and delay skin aging. Desire Sculpt Serum is recommended for patients looking to tighten, restore volume and smooth wrinkles, lines and folds on the face and neck, according to U.SK.
U.SK has clinical research results showing Desire Sculpt Serum increases epidermal moisture by 27% and elasticity up to 11.7%, with a 61% improvement in firmness after 60 days, according to Dr. DiBernardo.
The Importance of Barrier Boosting Skincare
As Carl Thornfeldt, MD, a dermatologist in Fruitland, Idaho, and founder of Epionce (Boise,Idaho) explained, better aesthetic results can be achieved when performed on a healthy, intact skin barrier. In 2002, Dr. Thornfeldt led the team that developed Epionce Renewal Facial products, which help support the natural healing process pre-and post-procedure by boosting the barrier and calming irritation.
“There are two types of inflammation: acute and chronic. The goal of aesthetic treatments is acute inflammation so that the skin bar-rier can heal itself and thus stimulate collagen production. The best outcomes happen when acute inflammation is allowed to occur, but not left untreated to turn into chronic inflammation,” Dr. Thornfeldt advised. “By using a consistent daily skincare regimen that enhances the healthy protective barrier, like Epionce Renewal Facial Cream, downtime post-procedure is markedly decreased, and unanticipated reactions are reduced as the skin is in a better state to naturally heal.”
In posters presented at the American Academy of Dermatology annual meetings in 2016 and 2018, Dr. Thornfeldt shared results from two split-face, double-blind, prospective, controlled clinical studies. The studies compared the Epionce Essential Recovery Kit (inclusive of a priming oil, firming mask and medical barrier cream) to Aquaphor following acetic acid soaks. In the first trial, patients had fractionated erbium laser therapy. In the second, patients were treated with a deep chemical peel – the Epionce Peel System. Investigators evaluated erythema and transepidermal water loss at baseline and after the procedures and found the Epionce Essential Recovery Kit produced superior results to Aquaphor.
Microneedling is another procedure during which skincare products can help to improve the treatment and outcomes, Dr. Thornfeldt shared. “I have found that using a serum during microneedling has a twofold benefit, and I prefer to use Epionce Intense Defense Serum. First, it provides a slick surface for a smoother technique during the treatment. Secondly, the multivitamin formulation absorbs into the skin, supporting the protective barrier and providing all 24 vitamins used for epidermal function,” Dr. Thornfeldt stated.
Epionce products incorporate hyaluronic acid to encourage hydration, as well as barrier boosting cholesterol, ceramides and linoleic acid. The ingredients are formulated in a specific ratio required for normal skin barrier function, to help restore skin and improve the barrier’s natural healing process.
Dr. Thornfeldt also uses the barrier repair product line for patients with chronic skin conditions such as melasma, acne and extrinsic Revox Line Relaxer is an advanced, targeted serum formulated to work synergistically with a neuromodulator. But it also works alone to visibly improve the appearance of under-eye lines and crow’s feet wrinkles.
“One of the things about this product that was most compelling to me was the data on it,” Dr. Green said. Researchers found that when a neuromodulator was paired with Revox Line Relaxer versus a serum with no performance ingredients, Revox Line Relaxer visibly reduced the appearance of horizontal and vertical expression lines. The product worked to target under-eye lines, visibly improve skin texture and hydrate skin. The appearance of fine lines and wrinkles caused by dry skin also improved, and it helped maximize overall neuromodulator benefits, in addition to visibly increasing skin radiance.
Neuromodulators might fall short in addressing infraorbital skin aging in patients that have excess skin laxity. Suffice to say that not everyone is willing to undergo a procedure with ablative lasers to achieve a more dramatic effect, Dr. Green noted. So, if there is something we can offer patients to achieve meaningful results with no downtime, that is backed by robust data, that’s a good thing.”
Pre- and Post-Treatment Considerations
Top physicians nationwide agree that ALASTIN’s (Carlsbad, Calif.) periprocedural products powered by TriHex Technology® can make all the difference when it comes to patient outcomes and downtime. For Arisa Ortiz, MD, a dermatologist in San Diego, Calif.,“ALASTIN really brought to life the importance of priming the skin to get the best results and reduce downtime from a procedure, which has been really important to my practice.”
Clinically proven to optimize the outcomes of rejuvenation procedures when used pre-and post-treatment, TriHex Technology is a proprietary blend of peptides and active ingredients that improve the function of the Extracellular Matrix (ECM) and upregulate neocollagenesis and elastin production.
Ilanit Samuels, PA-C, medical director for The Baumann Cosmetic and Research Institute in Miami, Fla., almost refuses to do laser resurfacing if patients haven’t pre-treated with Regenerating Skin Nectar with TriHex Technology,“because it has been such a game-changer.”
Dr. Romine avoids using topical retinoids or retinols after procedures that break the skin’s surface until re-epithelialization is complete. “Acidic products such as benzoic acid, hydroxy acids and ascorbic acid should also be avoided until the skin barrier is healed,” she emphasized.
Other ingredients that Dr. Romine tends to avoid recommending are organic products with essential oils that may cause a higher risk of contact dermatitis, chemical sunscreens due to the risk of contact dermatitis and acne; and petrolatum-based products, which can increase acne risk due to their occlusive properties.
Dr. Thornfeldt cautioned that aesthetic clinicians should think twice about recommending products that trigger inflammation. “That means topical creams that cause photosensitivity or redness, or products with exfoliating beads or granules. These are intended to have a quick effect and get down deep into skin, but what they are actually doing is tearing and weakening the protective skin barrier and putting it into a state of chronic inflammatory response, which leads to redness, barrier disruption and the skin becoming more vulnerable,” he noted.
1. More U.S. women are using facial skincare products Today, reports The NPD Group. NPD Group. (2021, June 16). Retrieved September 14, 2021, from https://www.npd.com/news/press-releases/2020/more-u-s-women-are-using-facial-skincare-products-today-reports-the-npd-group/.
2. S;P. A.J.G.K. S. (n.d.).Cosmeceuticals. National Center for Biotechnology Information. Retrieved September 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/31334943/.
3. McDaniel DH; Hamzavi IH; Zeichner JA; Fabi SG; Bucay VW; Harper JC; Comstock JA; Makino ET; Mehta RC; Vega VL; (n.d.). Total defense + repair: A novel concept in solar protection and skin rejuvenation. Journal of drugs in dermatology (JDD). Retrieved September 14, 2021, from https://pubmed.ncbi.nlm.nih.gov/26151795/.4. Shao Y; He T; Fisher GJ; Voorhees JJ; Quan T; (n.d.). Molecular basis of retinol anti-ageing properties in naturally aged human skin in vivo. International Journal of cosmetic science. Retrieved September 14, 2021, from https://pubmed.ncbi.nlm.nih.g o v/ 272 61203 /.