THIS is the real meaning of skin rejuvenation

Skin rejuvenation is one of the most misunderstood terms in medical aesthetics. So, Nandan Gijare, Founder Director, Indian Institute of Cosmetology Aesthetics and Nutrition shares with us the real meaning of skin rejuvenation what should be our goal as an aesthetician from skin rejuvenation treatments. 

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Before we can understand skin rejuvenation, we should see what are the features of healthy skin. We can always turn to babies to see what healthy skin looks like. A healthy skin should: 
 

• Stratum corneum should be soft with intact skin barrier function 
• Stratum spinosum layer should be dense and should have strong cell-to-cell adhesion 
• Melanocytes should be evenly placed with consistent melanin production to give even tone to skin 
• Dermis should be rich in collagen and elastin fibres. This makes skin taught and elastic 
• Extra cellular matrix should have abundant GAG’s (Glycosaminoglycans) 
• Both epidermis and dermis should have good hydration levels 
   

So, when we are performing skin rejuvenation treatments, our goal should be to get a skin with these properties. This gives us few goals of skin rejuvenation procedure as follows: 
 

• Optimize cell functions. This includes regulating keratinocyte, melanocyte and fibroblast functions. 
• Preserve the integrity of epidermis while performing skin rejuvenation procedures. If the integrity of epidermis gets compromised, then it results into weaker barrier function and more chances of TEWL and damage due to external pathogens, UVR and pollution. 
• Strengthen dermal – epidermal junction. By strengthening DE junction, we can ensure more seamless flow of nutrients from dermis into epidermis and hence better keratinocyte and melanocyte function. 
• Break down scar tissues. This ensures that scar tissue revascularisation can happen. 
• Release growth factors. This can be done by micro injuries, which results into release of various growth factors like Platelet derived growth factors (PDGF), transforming growth factors (TGF), epidermal growth factors (EGF), keratinocyte growth factors (KGF), macrophage derived growth factors (MDGF) and more. 
• Increase collagen, elastin and GAG synthesis. Enhanced production of elastin and collagen can take care of fine lines and wrinkles and give more elasticity and suppleness to the skin. 

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These goals look quite straight forward. So how many skin rejuvenation regimes follow all of them? A lot of them actually incorporate none of them. Most of the rejuvenation treatments are so focussed on collagen, elastin and GAG’s that they do not pay any attention to other goals, which are critical to having healthy skin. 
 
Most of the aggressive treatments result into adverse impact on keratinocyte and melanocyte functions. Treatments like chemical peels, ablative Laser treatments and microdermabrasion damage epidermis and impact keratinocyte function adversely. They can also result into weaker barrier function. They can also damage melanocyte cells, making melanin production irregular. This is what patients usually see as PIH (post inflammatory hyperpigmentation). 
 
Hence, it is advised that aestheticians start having a more holistic and comprehensive approach towards skin rejuvenation and come up with combination therapies, which can take care of all skin rejuvenation goals. Some of the less aggressive treatments like LED therapy, Micro needling and PRP can be combined to produce a more desirable and long-lasting result for the patients. Aestheticians need to come out of the cookie-cutter business models of Chemical peels, Microdermabrasion, Botox, Fillers, IPL and d Fraxel and need to realize that only a healthy combination of treatments can give better satisfaction to their patients and can also reduce the overall cost of the treatment.