Anti-Aging: Educating Your Patients About The Skin
By Martha Lucas, PhD, LAc
We know that cosmetic acupuncture works but what then? Education is a key part to the practice of Chinese medicine and when you practice cosmetic acupuncture, facial rejuvenation, etc., it is time talk about skin with your patients.
We often talk or hear about building the skin up, making it thicker. But, we are also told to exfoliate. Those pieces of advice sound contradictory when you think about it. They're not though; we have to remember that in a way, we have two skins. The deeper layers are the dermal layers and the superficial layers compose the epidermis. The dermis holds the foundation of our skin, the skin's circulatory system and the skin's nerve receptors.
The foundation is a web of collagen and elastin. Collagen and elastin are produced by fibroblasts and as we age we produce fewer new fibroblasts so that web wears out (slowly.) Fibroblasts also produce sugar protein molecules that act like sponges to trap and hold moisture for the skin. Thickening the dermis, or building it up, refers to building up the collagen and elastin that is accomplished by stimulating the production fibroblasts in the dermal layer. We can do that mechanically, chemically, and energetically.
The action of an acupuncture needle is a mechanical and energetic stimulation; the suction involved in micro-dermabrasion and the physical manipulation of some facial massage techniques are both physical stimulations; ingredients such as alpha hydroxy acids are chemical means of stimulation. Further, stimulating fibroblasts also stimulates the skin's immune system leading to overall healthier skin.
What About Exfoliation?
Thick skin sounds great unless that thickness is in the epidermis. Left to its own devices, environmental abuse and a little neglect, as skin ages the dermis thins and the epidermis thickens. A thickened epidermis has a rough texture, clogged pores, is dehydrated and potentially with more advanced age develops thickened plaques of keratin. The outermost layer of the epidermis is composed of keratin and that keratin sloughs off as part of the skin's regular cell renewal schedule. When those old cells don't slough off well pores get clogged. With age, the cell renewal process slows down giving the keratin a chance to build up. That keratinized surface creates a barrier that most moisturizing products cannot penetrate so your nice, expensive moisturizer is now just sitting on top of the skin doing nothing.
By exfoliating, or thinning the epidermis, we remove the potential for keratin build up. Exfoliation disrupts the skin's barrier function and the disruptive action also stimulates fibroblasts in the dermis and especially stimulates the fibroblasts to produce those hydrophylic sugar protein sponges. Now your products can penetrate more effectively, hydration and antioxidants go to the deeper layers and we can keep our pores clear up. Our skin's surface is softer, smoother and clearer with fewer fine lines. And as we accelerate cell turnover, we move sun damaged cells from below the surface of the skin to the surface and then off. Both processes really go together. The ideal skin program incorporates exfoliation, the stimulation and development of the dermis, applying hydrating and antioxidant ingredients to the skin, and nutrition that increases antioxidants and essential fatty acids.
What do we know about the skin around the eyes? It's thin, it's delicate, it gets rubbed and tugged at and it has small, easily clogged pores (milia, anyone?) Where do most people see their first wrinkle? Add in dark circles and bags and you have aging skin around the eyes. Eye cream formulations are typically lighter and absorb really well. Regular moisturizer is typically heavier and can clog the pores around the eye area. There is a wide range of cosmeceuticals designed for eye creams. The area can be targeted with those as long as they are in a nice delivery system. Such ingredients would be wasted and too expensive in a regular moisturizer. The eye area is smaller than the rest of the face therefore eye creams come in a smaller size. Every line's eye cream is smaller and more expensive than the rest of their products. Think highly specialized and highly concentrated for the area around your eyes.
A good cleanser is a desirable product. It should be gentle, but effective at removing excess oil, skin cell build up, pore debris, dirt and may also stimulate skin cell regeneration. If the cleanser is focusing on the pore clarifying aspect of skin care, but not in a way that is too drying or excessively stripping, then we can use other products to address our other goals.
Your products should have a good delivery system because the skin is designed to keep things out. If you can't get your active ingredients into the skin they aren't going to do any good. In a product you have active ingredients (actives) and functional ingredients. Functional ingredients are things like stabilizers and emulsifiers that give you a cream that is esthetically pleasing and stable. Active ingredients are the ingredients that moisturize, stimulate collagen, exfoliate, etc. They are strong and stimulating, creating change in the skin. A few examples include gou qi zi extract that is a botanical that is rich in Vitamin C and polysaccharides that help rebuild the skin's network of collagen and elastin. Tamarind seed extract is another source of polysaccharides and antioxidants and help hydrate skin. Licorice root extract is both an important Western cosmeceutical and Chinese herb. The plant's active saponins have a cortisol-like action that makes it a powerful antioxicant. Using powerful actives and effective delivery systems may lead to the potential to bring herbs down in to the skin. Bioactive or biogenic ingredients include jojoba, squalane, beta-glucans, hyaluronic acid as examples. Biogenic ingredients are either found naturally in the skin already or closely mimic something like sebum. This allows for greater penetration past the stratum corneum.
Important concept: A good skin product isn't one size fits all. While you might want a main product (like your cream) to cover many bases, it ought to have a focus, an area where it's really designed to excel. A one-size-fits-all serum might be an anti-ager, sebum balancer, and have some healing ability. But it wouldn't be appropriate for someone with active acne and probably not enough on its own for someone with really dry skin. Pearl creams can cover the bases minimally by offering antioxidant protection, some anti-aging, and light moisture, but specializes in dealing with hyperpigmention (discoloration, dark spots, age spots, melasma, sun damage, etc.).
Click here for previous articles by Martha Lucas, PhD, LAc.
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