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Skin boosters using micro-injections with predominantly non-crosslinked hyaluron filler gels like Restylane® Vital, Juvéderm® VOLITE or Belotero® Revive are gaining popularity for very good reasons. Unlike traditional dermal fillers, they are not injected beneath the skin to volumise or shape the face. Instead, they are very fine dermal easily integrated "fillers" that are injected into the skin to hydrate, improve skin quality and give very natural results. They are also gently bio-stimulating, meaning they "stretch" the fibroblasts in the injected area and as a result this cell is producing more collagen. An effective bio-remodeling skin booster using 2 times 5 injection points (bio-aesthetic points - BAP) for a full-face treatment is Profhilo®. However, the recent K-beauty treatment via topical application or micro-injections with bio-remodeling exosomes is gaining popularity.
Exosomes are nano-sized cargos with a lipid bilayer structure carrying diverse biomolecules including lipids, proteins, and nucleic acids. These small extra cellular vesicles are secreted by most types of cells (skin relevant are the keratinocytes and fibroblasts) to communicate with each other. Exosomes circulate through bodily fluids and can transfer information. They can be either good or bad, however taken from a healthy young cell they will be sending the best messages. Studies have shown the efficacy of exosomes in skin ageing. They can facilitate skin remodeling (increasing collagen and decreasing senescent cells) leading to skin rejuvenation.
Cells sleep because they don't get enough bio-stimulation: messages. Better messages is better skin architecture. This is why exosomes are so important. At the World Stem Cell Summit it used to be 90% about stem cells (they only life 28 days) and 10% about exosomes, now it is 50/50. The reason is called heterochronic parabiosis. 1. One of the most robust methods of improving the function of ageing tissues is that of heterochronic parabiosis,. The effect was shown in a study with a surgical procedure whereby a young and old mouse are joined together so the share one circulatory system. 2 This study according to dr Kate Goldie AMWC 2023 Monaco is proof that it is not the cells, but the messages they give that is transforming lots of different tissues, which has the ability to profoundly regenerate tissues. That is why people are so interested in exosomes. Exosomes taken from a very young cell give potentially the best messages as they "send the message" of youth. EV (Extra-cellular Vesicle) is the actual correct term as messages come as micro-vesicles and exosomes and form 2 different messages from the cell. 3 We start to understand active ingredients. In exosomes one of the most important ingredients is RNA and is part of the future of regenerative aesthetics. Messenger RNAs up-regulate and Micro-RNAs down-regulate. They physically go into the cell and change how the cells works. So we have to be cautious. In this study "The therapeutic and commercial landscape of stem cell vesicles in regenerative dermatology" dr Kate Goldie et al. assessed all available exosomes in the (UK) market.
Most exosomes used in-office are extracted from human stem cells and frozen to keep them as stable. Unlike actual stem cells, exosomes don't have a nucleus and therefore they are safe to use. Exosome therapy is the application of topical exosomes after in-office treatments which disrupt the skin barrier, like laser resurfacing, chemical peelings or microneedling. Exosomes are also used in micro-injections as a stand-alone skin boosting treatment and in a few skin care products. Be aware that as usual, not all products are alike. The way exosomes are sourced (origin), size, their content (can be growth factors) and function determine largely their efficacy and the price of the product.
One of the challenges is that we do not really know what is in the exosomes. They are like small packages with a lot of messengers. The use of exosomes looks promising for several indications: regenerative aesthetic medicine, healing, scar treatment, burns and atopic dermatitis, however their safety is not yet fully established and no official registration for their use granted.
1. Cell Cycle. 2012 Jun 15; 11(12): 2260–2267. Heterochronic parabiosis for the study of the effects of aging on stem cells and their niches
Irina M. Conboy
2. Heterochronic parabiosis reprograms the mouse brain transcriptome by shifting aging signatures in multiple cell types Methodios Ximerakis
3. J Cell Biol. 2013 Feb 18; 200(4): 373–383. Extracellular vesicles: Exosomes, microvesicles, and friends Graça Raposo et al
Skin flooding is the latest TikTok trend to counteract dry or dehydrated skin. It is basically layering hydrating mists, serums or creams to boost hydration in the skin. The idea is to start with a humectant-rich, lightweight products first and then add a thicker emollient to seal in the moisture on the skin. This is a trend which is suitable for all genders at all ages if products are chosen wisely.
DRY OR DEHYDRATED SKIN
There is a difference between dry and dehydrated skin. Dehydrated skin is water-lacking skin, considered a skin condition and can be temporary, while dry skin is lipid-lacking skin and seen as a skin-type. All skin types (yes including oily skin) can be dehydrated. Picture yourself in an environment like airplane without any humidity. Our skin will react to this "dehydration condition" by either (over)production of oils and lipids to "protect" itself fro drying out or get very dehydrated. When the skin is producing a fierce amount of oils and lipids as compensation, you do not have lipid-lacking or dry skin, however your skin might be dehydrated. Lipid-lacking or dry skin has less ability to produce those oils or lipids and often has an impaired skin barrier. Lipids are the "mortar" between the bricks and when they are lacking, more water will evaporate from the skin and thus it loses hydration.
Therefore "flooding" without "suffocating" the skin, can be a good approach for dehydrated skin and all skin types at all ages. If you want to start your flooding regimen on damp skin, you start immediately after cleansing and toning or use a light mist containing hyaluronic acid and glycerin. Both ingredients are powerful humectants and attract and bind water to the skin surface. Afterwards you might want to first apply a hyaluronic acid containing serum and then a cream to "seal the deal". The difference between flooding and slugging is that flooding is focusing on maximising skin hydration or moisture, while slugging is focusing on prevention of trans-epidermal water loss by (semi)occlusion. Read more about slugging.
Be aware not all hyaluronans are the same. There are different sizes. A macro-hyaluron (about 2000 kDa or larger) will lay on the surface of the skin and bind water there where the skin is losing the most water. A biologicaly active size hyaluron is the 52 kDa micro-hyaluron. This particular size molecule has proven to penetrate into the metabolic active layer of the epidermis, where is actually stimulates the keratinocytes (a certain skin cell) to produce +209% more hyaluron. This can be enough when you are young as the decline of hyaluron in the skin starts first in the epidermis.
Be aware it is NOT recommended to use a hyalruon size below 30 kDa in skin care. Hyaluronic acid has the ability to bind and attract water up to 10.000 times is molecular weight, are great to plump up the skin, however the smaller sizes have a different function and can actually harm the skin by for example causing inflammation.
LINES AND WRINKLES
If you get a bit older, also the dermis will lose it's most important filling substance (hyaluron). There is another skin cell type which can be stimulated to produce more called the fibroblast. This cell is a key cell in the junction of the epidermis and dermis and the dermis, so deeper layer. The powerful anti-oxidant and bio-active Glycine Saponin or abbreviated Saponin can bio-stimulate this cell to produce +256% more skin's own hyaluron and +49% more collagen. Moreover, there are products on the market which contain all of the above PLUS Enoxolone. Enoxolone has the ability to inhibit the activity of an enzyme called HYAL1 >50%. HYAL1 is one of 6 different hyaluronidase enzymes which degrate skin's own hyaluron, hence eliminate it from our skin. These enzymes get more active in sun-exposed or mature skin and are partially responsible why our skin will lose hyaluron as we age. Together with the anti-oxidant Saponin, Enoxolone can slow down the elimination of skin's own hyaluron via 2 complimentary pathways: physical and enzymatic degradation. With other words, products containing 2 different sizes of hyaluron, Glycine Saponin and Enoxolone will fill, stimulate and defend skin's own hyaluron in both the epidermis (top layer) and the dermis (middle layer) of the skin. Great for dehydrated and early or visible signs of ageing, like fine lines and (even deepest) wrinkles.
DAY AND NIGHT
For daytime I would highly recommend a cream with protective SPF and for nighttime a product containing regenerative and barrier repairing Dexpanthenol or Pro-Vitamin B5. Anti-oxidants are good in every day and night time routine. If you want to use a refreshing hydrating mist, there is only one product with hyaluronic acid I recommend and it is Eucerin Hyaluron-Filler Mist Spray. The reason for this is that it has a skin friendly pH unlike (thermal) water. Water has a pH of 7-8 which is like a slight "insult" to the skin's healthy pH every time you spray. With the Hyaluron-Filler Mist Spray, you rebalance the skin's healthy pH level and use it as much as you like. pH to me is the foundation of good skin health. I have written a few pH related blog-posts and if you are interested simply click on the "read more" button below.
One of the current trends in skin care which I don't recommend for most skin types is "slugging". It means that a thick layer of an occlusive or semi-occlusive petrolatum-based product is applied most often shortly prior to bedtime.
One of the benefits of slugging is that this thick layer is acting like an extra barrier for the skin, hence reducing trans-epidermal water loss and penetration of particle matter or irritants.
However, for a normal, combination or oily skin with an intact barrier slugging doesn't make any sense and will increase the risk of the development of milia (milk spots) are small, white cysts on your skin especially seen in the under-eye area, comedones (white - or blackheads) and worse papules (inflamed bumps) or pusteles ( a papule with a white or yellow tip). Moreover, a thick layer of product will rub off on your pillow case during the night.
Slugging might make sense if your skin barrier is compromised (not intact), for example after a chemical peeling, more invasive laser treatment, over-exfoliation, or when you have extreme dry (lipid lacking) or dehydrated (water lacking) skin. It might also help to prevent irritants or allergens to enter the skin, hence decrease barrier related skin (hyper)sensitivity. However, I would "slug" very consciously and on recommendation of the dermatologist or plastic surgeon after a procedure as there are fantastic products available in the pharmacy or drugstore for (hyper)sensitive, (extreme) dry or dehydrated skin without risking slugging-related skin problems.
Instead of a 100% petrolatum-based product, Aquaphor might be a better option at all times (also extreme cold weather), as it doesn't contain water (no risk of freezing), does contain humectants (they can bind and attract water), is semi-occlusive (protects but still "breaths"), is dermatologist recommended, affordable, available in a spray (no touch), tube, or tub and very well researched (evidence based) for a large variety of purposes.
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