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Combination Therapy for Optimal Results

By: Jennifer Linder, MD
Posted: June 24, 2010, from the July 2010 issue of
Woman receiving LED treatment

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Cavitation—the formation of gaseous bubbles in a liquid—is thought to be responsible for phonophoresis in the skin. Research shows cavitation of the lipid bilayer in the skin leads to increased permeability of keratinocytes,9 and the resulting enhanced penetration of corrective products contributes to faster results. Multiple ultrasound studies also have demonstrated an increase in human fibroblasts following treatments. This is important in wound healing and in the treatment of visible aging, as fibroblast cells stimulate the production of matrix proteins such as collagen and elastin.10

Light therapy treatments

LED, IPL and laser use light to trigger change in the skin, and, like other rejuvenation procedures, light therapy can be enhanced with the use of topical skin care products. The most important consideration when combining light therapy treatments with topical therapies is how they will impact the absorbance of the light into the tissue. The light’s electromagnetic energy must be attracted to and absorbed by a specific cellular component or target chromophore in the skin. Therefore, any colored product on the surface of the skin at the time of treatment has the potential to interrupt light absorption. The reflective nature of topical products could also interfere with treatment outcomes. For this reason, light therapy treatments should be administered on clean, dry skin.

LED devices offer a photobiochemical reaction or photomodulation. During photomodulation, a cell’s mitochondria is thought to be turned on, or illuminated, by the light. By illuminating mitochondria, the light is able to up regulate or down regulate the activity of these cells. The wavelength emitted by the diodes interacts with specific cellular components in the skin.11 LED is purported to have positive effects on acne, visible aging and wound healing. LEDs do not create any thermal damage in the skin, and treatments can be combined with virtually any topical products and treatments.

IPL devices deliver a broad-spectrum of visible light, ranging from 515–1,200 nanometers. Cut-off filters are used to determine the specific wavelengths of energy that are emitted from the handpiece, thus targeting a broad-spectrum of chromophores. IPL is a versatile treatment that allows for the reduction of hair, telangiectasias and solar lentigos, and IPL devices utilize heat and light to induce changes in the skin.12

Laser strengthens electromagnetic energy and focuses it as a monochromatic, coherent beam of light. Unlike IPL, laser devices emit only one wavelength. Lasers can be either selective, meaning the energy is absorbed by a specific chromophore within the skin and do not ablate the surface, or non-selective, when the target chromophore is water and all water-containing tissues are affected, leading to ablation. Regardless of whether skin is removed during treatment, all lasers create a significant amount of heat in the skin.13