Following the cue of the medical arena as a whole, the medical aesthetic and dermatology fields are inexorably turning towards progressive, all-inclusive therapies. This approach combines various integrative clinical techniques that address the patient’s complete well-being, including adjunctive skincare regimens.
The use of topical products can boost the clinical results derived from surgery, energy-based therapies and minimally invasive facial treatments (neurotoxins, dermal fillers and thread lifting). While this approach will remain in the near future, the way in which practitioners design personalized skincare solutions will be a part of what is shaping up to be a total transformation of medicine.
“Genetic, hormonal, nutritional and other medical profiles drive highly personalized integrative care,” stated Jennifer Pearlman, M.D., medical director at PearlMD Rejuvenation in Toronto, Ontario, Canada.
“We are doing mixed panels on our patients. In that setting, it is considered concierge women’s health. We refer to this approach as precision skincare that goes to a different level. Your eyes can only see so much, so we use science to deliver the ultimate in personalized skincare.”
Staying up-to-date on the latest medical and scientific approaches to anti-aging, as well as topical formulations and ingredients; and how those products interface with multi-tiered, customized therapies, is essential to navigating the evolving landscape of aesthetic medicine.
“The practice of mixing and matching therapies has been growing, but these approaches often receive very mixed reviews from both physicians and patients because we are in an age of instant gratification,” expressed Doris Day, M.D., a dermatologist in New York City, N.Y.
“Topicals, however, are for everybody,” she continued. “The use of topicals is very powerful and we give a regimen to every patient who comes through here. Also, I will combine them with facial fillers or threads, sometimes over time and sometimes during the same session.”
Professional skincare has progressed remarkably from old-style, simple moisturizers to increasingly sophisticated molecules and actives, noted William Philip Werschler, M.D., a dermatologist and assistant clinical professor of medicine / dermatology, at the University of Washington School of Medicine in Seattle, Wash.
“We’ve seen a genuine improvement in the quality of formulas over time, and there has been a definite genesis and evolution of new ingredients within skincare lines,” he said.
“If you go back to the 1990s, you had the alpha hydroxy acids and beta hydroxy / salicylic acids, which were all the rage. Then companies started working with peptides and formulations for moisturization and hydration. After some time, scientists started dabbling in growth factor formulations and more recently human growth factors, followed by plant-derived stem cell products. There are now a lot of new products based on platelet-rich plasma (PRP) and even newer approaches that are part of the emerging wave of regenerative aesthetics,” Dr. Werschler elaborated.
Subsequently, the latest breakthroughs in skincare science have little to do with introducing new molecules, Dr. Werschler added. “It is now a combination of existing technology and new technology, such as PRP and stem cells that are biologic in nature, and how those are being applied topically,” he said.
“For instance, we see more mixing of PRP and hyaluronic acid (HA), as well as with long-term fillers like Sculptra, Radiesse or Bellafill. Most commonly, we’re doing a 50-50 mix because no one really knows the best concentration. Some feel that they will obtain better stimulation of growth factors in the skin when they deliver these materials using a penetration enhancer, such as microneedling. These types of approaches are the next big thing in skincare.”
Since skincare developers are successfully integrating topicals with biologics, innovative delivery systems and newfangled medicine, the current crop of professional and OTC skincare lines are becoming more high-tech in nature.
Aside from creams and lotions that deliver protection, a handful of interesting new products have delved into innovative technologies.
For example, in the high-tech realm, in January, L’Oréal (Clichy, France) introduced a prototype of the My Skin Track pH wearable sensor and companion app that measures personal skin pH levels and creates customized product regimens. Based on the established scientific link between skin pH levels and common skin concerns, the small, thin, flexible sensor measures individual pH levels by catching tiny amounts of sweat from pores and providing a precise reading within 15 minutes.
Protection from sun damage and environmental aggressors remains at the top of the list for both physicians and scientists. As one of the more unique skincare products on the market, Drink UVO from Uvo (Irvine, Calif.), may represent a future direction for skincare products. This drinkable sunscreen contains vitamins and a proprietary blend of botanicals that reportedly protects the skin from UV rays for approximately three hours.
Allergan (Irvine, Calif.) released the SkinMedica® Lumivive™ System, an advanced skincare line that contains two corresponding serums: the Lumivive Day Damage Defense Serum, an antioxidant serum that guards skin from damaging environmental aggressors (blue light / HEV and air pollutants); and Lumivive Night Revitalize Repair Complex, which renews and detoxifies the skin while diminishing the appearance of environmental damage.
In the more traditional skincare vein, many companies continue to rework existing molecules in novel ways, such as the recently launched Retinol 0.3 from SkinCeuticals (Dallas, Texas), which provides retinol (vitamin A) at lower concentrations for people with sensitive skin. This is a prime example of a formulation that utilizes a long-standing skincare ingredient in a new and useful manner. The product’s formulation also contains a blend of bisabolol and boswellia serrata extract.
Apart from vitamin A, vitamin C is a favorite ingredient of topical product developers, and is a reliable antioxidant used in many formulations. The Professional-C™ serums by Obagi® Cosmeceuticals, LLC (Long Beach, Calif.) are available in three different concentrations of L-ascorbic acid: 10% for dry and sensitive skin types, 15% for normal skin types and 20% for oily skin types.
In the never-ending fight against acne, the recently released Epionce Purifying Spot Gel from Episciences, Inc. (Boise, Idaho), utilizes a novel combination of ingredients, including sulfur, antibacterial and anti-inflammatory resorcinol monoacetate for clearing pores and azelaic acid, which helps to increase the skin’s natural exfoliating process.
In addition, the company’s Intense Defense Serum hydrates by increasing free fatty acid levels in the skin and reducing water loss, but also helps encourage the production of collagen and lightens skin. Ingredients include niacinamide, sodium hyaluronate and oil-soluable tetrahexyldecyl ascorbate.
A novel formulation that has gained traction among many practitioners is DefenAge’s Clinical Power Trio from Progenitor Biologics, LLC (Carlsbad, Calif.). These products utilize defensins, a unique peptide technology that stimulates LGR6 stem cells to signal production of new basal stem cells and new keratinocytes, improving the appearance of aging skin. This skincare system provides the advantages of retinols combined with growth factors that are commonly found in cosmeceuticals, but without irritation or inflammation.
Cosmeceuticals are topical products that claim to rejuvenate the skin, and imitate the effects of facial peels, injectables and other mostly aesthetic treatments. While the word cosmeceutical is nothing more than a marketing term, some products encompassed by this category can impart beneficial effects, according to Jason Emer, M.D., a dermatologic surgeon in Beverly Hills, Calif.
“There are a ton of cosmeceutical companies out there, but no real clinical trials backing them up,” he began. “However, there is a lot of anecdotal information on how some products can decrease inflammation, which could be very good for addressing acne, eczema and rosacea. They might also be advantageous for people with sensitive skin that want alternatives to retinol and actives like glycolic or salicylic acid.”
Among the cutting-edge skincare products that could benefit from additional commercialization and clinical studies, one that holds a vast amount of potential is cannabis oil, or hemp seed oil, which contains cannabidiol (CBD) and acts as an emollient to smooth rough cells on the skin’s surface and offers moisturizing benefits. Unlike marijuana, which has psychoactive side effects, hemp seed oil is a common source of naturally anti-inflammatory cannabinoids.
“Consumers are using these products and loving them,” Dr. Emer reported. “In my practice, we put some people to the test. They used it for a few nights in a row just around the face and they noticed softer skin, fewer fine lines, less puffiness and fewer dark circles. If consumers are saying that after just a few applications, then it is probably something that people are going to want.”
Although several CBD-based topicals are on the market (mostly online), Dr. Emer stressed that patients have to be careful when they initially start using them because there is a high risk of allergic reaction, even if it is a good, high-quality product.
“A lot of the CBD is mixed with botanicals and even though people say it is organic and natural, there are a lot of people that contract allergies from botanical products,” Dr. Emer elaborated. “Other inactive ingredients could cause problems, too.”
Another area of commercial development revolves around the use of probiotics in skincare, which has flourished as scientists perform research on the skin’s microbiome. Although research is in early phases, some products appear to act as antibiotics, while others claim to instigate healing processes without the need to create injury to the skin.
“Applying probiotics topically is still something of a mystery,” noted Dr. Werschler. “The average person has a skin flora that is well established; that is your staph and strep and pityrosporum, plus all those bacteria that live under your skin, but basically provide a first line of defense. I don’t think there is much noise in the market regarding what these topical probiotics do at this time. We don’t really know much about them, yet.”
Coming full circle back to personalized skincare, an emerging trend in precision bespoke treatments involves skincare therapies based in part on genetic information. While the commercialization of gene (or DNA)-based skincare seems fairly unorthodox, even in the world of aesthetics, genetic testing can be integrated into a physician’s all-inclusive evaluation of patients, in order to derive the best overall solution to many conditions – medical, aesthetic and otherwise.
Dr. Pearlman is one of the most prominent developers of this brand of truly holistic assessment and therapy, in which she conducts genetic screenings of patients. “We look at vitamin A and metabolism, which can demonstrate or suggest deficiencies in a patient’s ability to manage things like sun exposure, his or her increased risk of skin cancer and advanced aging of the skin,” she reported.
Dr. Pearlman’s evaluation looks at cellulose membranes and the skin barrier’s effectiveness, among other things. “Your genetics are the first chapter in a very long book of life, but it is only one driver. Interpreting genetics and other factors is important for me when shaping a health plan for the skin,” she said.
In addition, hormonal therapy (HT), which has been controversial in the past, is re-emerging as an important aspect of the personalized skincare trend. For instance, estrogen plays a large role in female skin health, with decreased estrogen levels resulting in reduced capillary blood flow to the skin.
“For women, hormones are a major determining factor regardless of genetics, nutritional status or their skin’s aging,” Dr. Pearlman pointed out. “The telltale sign of hormonal aging and estrogen loss in women is the occurrence of advanced perioral lines – a hallmark of low estrogen and other aspects of hormonal status.”
With customized solutions emerging as the future of skincare science, it is important to determine what kind of combined aesthetic therapies will work well with procedures like facial fillers and energy-based treatments.
“Treatment approaches would vary with each patient, which could be a very different concept for many physicians,” Dr. Emer maintained. “These are inventive combinations of modalities to quickly and effectively treat skin problems – holistic treatments that mix modalities, not one-off procedures.”
There is not one combination treatment that works for everyone, Dr. Emer continued. “In general, with skincare what people need – and this is based on clinical studies – is an antioxidant, typically vitamin C; a glycolic or alpha hydroxy acid; then at night, some sort of growth factor-based cream. With those you are hitting all levels of anti-aging. You want products that increase collagen production, and growth factors that basically reverse sun damage.”
This type of customization is also internal, he added. “You can’t really see it, but think of customized oral supplements designed to help people that are prone to diseases like diabetes, arthritis or skin cancer. These approaches are transforming medicine as we know it. It is time to get on the train to a better future in skincare and aesthetics.”