Medesthetics

NOV-DEC 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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"Healthy cells exist in an anabolic state, which is the 'building' condition of the cell that allows it to maintain physiologic functioning; dehydrated cells, on the other hand, revert to a functioning; dehydrated cells, on the other hand, revert to a catabolic state, resulting in cellular hypoxia, cellular damage and toxin buildup," explains Huntington, New York-based and toxin buildup," explains Huntington, New York-based plastic surgeon Elliot B. Duboys, MD. "From an aesthetic standpoint, dehydration compromises cellular functioning resulting in a dull appearance, increased sensitivity and signs of aging." More specifi cally, enzymatic reactions necessitate hydrated skin, says Leslie Baumann, MD, founder of the Skin Type Solutions Franchise System, which independently tests skincare products for effi cacy and helps doctors choose products to sell. "Skin hydration is crucial because enzymes that make things happen require water," she explains. "Water helps the enzymes fold correctly so that they are properly activated. Most cellular processes have particular 3D shape requirements for the molecules, which particular 3D shape requirements for the molecules, which are infl uenced by the presence of water. Put simply, water makes the cells work better, whether it is repairing damage, producing important structures or breaking down toxins." producing important structures or breaking down toxins." In addition to aging and environmental concerns, such as sun exposure and harsh cleansers, certain topical skincare sun exposure and harsh cleansers, certain topical skincare ingredients—including alphahydroxy acids (AHAs) and astrin- g ents like benzyl peroxide—can lead to irritation and dryness. Common medications, such as statins used to lower serum cholesterol, can also deplete the cholesterol essential for synthesizing the stratum corneum's lipid membrane. What's more, popular aesthetic treatments such as peels and laser resurfacing, as well as antiaging topicals, can actually exacer- resurfacing, as well as antiaging topicals, can actually exacer- bate skin dryness. "Any good age management product must contain a reti- noid, and since retinoids down-regulate sebum production, they can lead to dry skin, especially in climates with a drying combination of low temperatures and low humidity," says John Kulesza, president of skincare formulator Young Pharma- ceuticals. "That means an effective moisturizer is essential for ceuticals. "That means an effective moisturizer is essential for those using age management products." Balancing Ingredients Most skincare professionals would agree that steering patients toward effective moisturizers is necessary. The patients toward effective moisturizers is necessary. The challenge is choosing among the myriad products now avail- able. Early moisturizers contained a mixture of ingredients able. Early moisturizers contained a mixture of ingredients classifi ed as occlusives, emollients or humectants. "Occlusive agents, such as squalane, one of my favorite ingredients, and silicone—which is especially useful in preparations for sensitive skin because it is nonreactive—seal in moisture, as do emollient esters such as isopropyl palmitate," says Kulesza. "Petrolatum (Vaseline), one of the most effective Kulesza. "Petrolatum (Vaseline), one of the most effective occlusive agents, has been in use for 150 years. It is still the main ingredient in ointments used to protect the skin after main ingredient in ointments used to protect the skin after treatments like peels and laser resurfacing where the skin treatments like peels and laser resurfacing where the skin barrier is compromised." Rather than seal in moisture from the skin, humectants, such as ammonium lactate, glycerin, sodium PCA and sodium lactate, attract water from the environment and bond with it lactate, attract water from the environment and bond with it to hold it in the stratum corneum. "Humectants, such as medium and low molecular weight hyaluronic acid (HA), can absorb moisture throughout the day and night, and hold a thousand times their weight in water to continually supply moisture to skin cells," says Dr. Duboys. Today's moisturizing products often include a mix of occlu- Today's moisturizing products often include a mix of occlu- sives or emollients to seal in moisture as well as humectants to attract extra hydration. But they don't stop there. Many to attract extra hydration. But they don't stop there. Many to attract extra hydration. But they don't stop there. Many also contain ingredients shown to help synthesize skin lipids and other naturally occurring components needed to maintain the health and function of the skin barrier. Formulators like Tatiana Kononov, director of research and development at Revision Skincare, use the terms hydrophilic (water loving) and lipophilic (oil loving) to talk about skin hydrating ingredients. "Examples of commonly used hydro- philic moisturizers include sodium hyaluronate and glycerin," she says. "Commonly used lipophilic components include squalane and jojoba esters. Emulsions—mixtures of lipids and squalane and jojoba esters. Emulsions—mixtures of lipids and water-based ingredients—can be made with different proper- water-based ingredients—can be made with different proper- ties depending on skin type, climate and moisture needs of the skin." Biomimetic is a term used in skin care to describe ingredi- ents that mimic components found naturally in healthy skin. "State-of-the-art moisturizers are employing biomimetic "State-of-the-art moisturizers are employing biomimetic lipids—fatty acids, ceramides and cholesterol, for instance," lipids—fatty acids, ceramides and cholesterol, for instance," says Kulesza. "They are not really occlusives or humectants. Rather, they support the natural skin barrier, helping it to Rather, they support the natural skin barrier, helping it to retain moisture more effectively. The best formulations, in my retain moisture more effectively. The best formulations, in my opinion, contain a combination of humectants, such as HA, occlusives and biomimetic lipids." "At NeoStrata we address hydration from multiple path- ways with formulations containing traditional humectants that hydrate the surface of the skin and our patented Maltobionic hydrate the surface of the skin and our patented Maltobionic medestheticsmagazine.com | NOVEMBER/DECEMBER 2016 25 "The best formulations, in my opinion, contain a combination of humectants, such as HA, occlusives and biomimetic lipids. " BACKGROUND: ANTHONY BRADSHAW © GETTY IMAGES; WOMAN: VICTOR HABBICK VISIONS © GETTY IMAGES

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