Ablative procedures—e.g., chemical peels, laser resurfacing and microdermabrasion—are effective options for patients who want to reduce photodamage and restore the youthful health of their skin. But stimulating the skin is only half the equation. Patients also require post-procedure care aimed at reducing inflammation, repairing barrier function and protecting a damaged epidermis from irritants in order to reap the full benefits of your services.
“Beginning immediately after any destructive cosmetic procedure that involves controlled wounding to improve aging skin, patients must apply topicals to slam the damaged skin barrier shut,” says Carl Thornfeldt, MD, CEO and founder of Episciences Skin Care. “If they do not, environmental pollutants and ultraviolet radiation enter the skin at much higher concentrations and penetrate much deeper. These insults activate destructive pathways that reduce or negate the cosmetic benefit of the procedure. The clinical results of the procedure will absolutely be diminished and adverse reactions will be enhanced if no postprocedure care is provided.”
Restoring the Barrier
Because resurfacing procedures strip away the top layers of the epidermis, the skin barrier becomes damaged leading to redness, irritation and transepidermal water loss (TEWL). Occlusive topicals, such as petrolatum and silicone, help prevent moisture loss and keep environmental pollutants from entering the skin. Additional ingredients used to protect damaged skin and restore proper barrier function include lipids, ceramides and polyhydroxy acids (PHAs).
“Lipid-rich oils, such as squalane, are reparative lipids. They seal the moisture barrier and protect it from losing water,” says Jeannette Graf, MD, assistant clinical professor of dermatology at Mount Sinai Medical Center in New York City and partner at Omni Aesthetics MD. “Barrier repair ingredients are typically rich in lipids similar to the intercellular lipids found in skin,” agrees Mostafa Omar, PhD, formulator and president of Phytoceuticals Skin Care. “Plant oils are popular for skin care because they are good sources of fatty acid lipids. Other barrier repair ingredients—such as silicone and petrolatum—work by providing a temporary thin coating over the epidermis that reduces the evaporation of water and protects impaired skin.”
Dr. Thornfeldt notes that there are about 20 herbal extracts including safflower, sunflower, mallow and avocado that have been proven to repair a damaged skin barrier and return its function to normal. He finds the most effective barrier repair ingredients are those that mimic the natural composition of healthy skin. “Cholesterol, 11 ceramides and linoleic acid (an essential fatty acid), as well as lauric, palmitic and stearic acids make up the protective stratum corneum permeability barrier. They are arranged in a brick-and-mortar pattern with layers of lipids compromising the mortar between corneocytes,” he says. The goal of formulators is to combine those ingredients in ratios that mimic healthy skin.
Photo copyright Getty Images.