The Expert: Dr Reza Mia
Patients have long sought effective methods to treat stretch marks, saggy skin, wrinkles, fine lines, pigmentation marks, scars and cellulite. However not many of the available methods have been able to fully satisfy these needs and often the solutions available came with unwanted side effects or un-natural finishes.
Redermalization is a novel concept in Anti-Aging & Aesthetic Medicine, created to describe the previously unseen effect obtained by combining an injectable product containing both Hyaluronic Acid (HA) & Sodium Succinate (Hyalual) with specific injection techniques. The term was coined as far back as 2011 but is new to South African shores and describes the targeted anti-aging effect produced by the interventional techniques mentioned above, which effectively act against three mechanisms of skin aging.
These mechanisms of aging affect mainly the dermis (the living layer of skin beneath the keratinocytes):
1. Dehydration & volume loss: ever decreasing levels of HA in the skin results in decreased water retention which contributes to a loss of volume and the exacerbation of wrinkles and other signs of aging.
2. Deceleration of metabolic processes: This leads to slower regeneration of collagen and elastin in the skin and accelerated aging.
3. Accumulation of free radicals: results in deterioration in the color and texture of facial skin, causing premature aging by damaging the cells and their DNA.
The techniques used to achieve redermalization are based on multiple intradermal injections of Hyalual, the patterns used are determined by an assessment of the patients’ skin and its needs. HA stimulates restoration of the dermis by increasing the amount of collagen, through fibroblast stimulation, in the skin; which promotes improved water retention to volumise the skin at various levels. This reduces the visible signs of aging, such as fine lines and loose skin.
The effect of the accumulation of free radicals and the inhibition of several metabolic processes must be kept in mind as these factors promote skin aging and lead to the hypo-synthesis of collagen and elastin. However, the use of “pure HA” may not reduce many of these causes of aging.
Therefore, sodium succinate acts with HA to synergistically provide a pronounced antioxidant effect, actively block free radicals and stimulate sluggish metabolic processes in the skin. The effect on the metabolic processes include strengthening cellular respiration, normalizing ion transport, increasing protein synthesis and increasing energy production through stimulation of the Krebs Cycle in Mitochondria. This all translates to the restoration of cells, an increase in skin elasticity, firmness & tightness, improved color & texture of the face as well as a reduction in the signs of aging & fatigue.
Objective studies have found increased skin tightness, reduced sagging and moisturized skin. Once treated with mono-component HA products, increased skin elasticity was observed, whereas in skin treated with an HA product which included sodium succinate, such as Hyalual, a significant improvement in overall skin quality was observed due to an increase in its turgor and elasticity, improved hydration and color correction. Results in older patients were more observable to the naked eye. In addition, accelerated healing of skin defects was seen at skin biopsy sites after treatment with Hyalual in all study patients when compared with the same biopsy areas before treatment. A recent study showed that Hyalual has a more noticeable impact in comparison with mono-component HA products. Semi-quantitative microscopic analysis of skin biopsies in all patients confirmed the greater influence of Hyalual on the structure of the dermis and capillary network of the skin. The number of fibroblasts were shown to increase by 300% versus the 200 % increase shown with products containing only HA. An increase of up to 100% above baseline amino acid levels is seen as well.
When compared to dermal rollers, Hyalual exhibits an improvement over the mechanical stimulation seen with dermal rollers, enhancing both non-scar tissue collagen as well as scar tissue collagen as opposed to dermal rollers, which primarily produce scar tissue collagen.
Patients injected by the author have reported improved results in the firmness, hydration and texture of the skin as well as a significant improvement in the appearance of stretch marks, which reportedly feel smoother to the touch. It is noteworthy that these patients confirmed the study findings mentioned above and preferred the results seen on the areas treated with Hyalual.
Specific patient issues:
Thinning or Saggy skin. This applies to skin on the face and the body. The HA increases skin density and the SA stimulates the formation of elastin in the skin to thicken the spongy living layers of the skin and to tighten and lift skin on all areas of the face and body. This allows us to lift and tighten skin on the face, neck, arms, legs, breasts, tummy, bum, knees and hands.
Much of the effect produced by these injections may be permanent. Although the new collagen & elastin produced will gradually break down over time, the lifting and tightening effect is permanent, as long as the “assault” that caused the initial stretching does not recur. That is, the down force created by the muscle in the face that creates the jowls, or in the case of the tummy, the stretch created by a pregnancy or significant weight gain.
Fine lines & wrinkles. Regular dermal fillers are not the best choice for filling superficial, fine lines as they might look like worms or bumps in the skin. Fine lines close to the mouth or those that are caused by smiling should not be treated with botulinum toxin as this will alter the smile and if used around the mouth, the “Cupid’s Bow” shape of the upper lip will be lost. Therefore Hyalual is injected to treat individual fine lines wherever they are found on the face.
Acne scars. Each individual scar is treated with the product to break down the scar tissue and the adhesion that creates the “crater”. As for skin tightening, some of the effect is permanent, as once the body breaks down the new collagen and elastin, there is no stimulus for the adhesion to recur. This means that the scars will never look as bad as they looked before the first injection took place.
Pigmentation marks. This applies to freckles, birthmarks, patches, post-inflammatory hyperpigmentation or any other pigmentation problems. This is one of the most popular uses of Hyalual, the HA stimulates the white blood cells to consume the little molecules that house the pigment in the skin while the SA reverses the pigmentation process, blocks the formation of new pigment and both of these together produce collagen and elastin to dilute the pigment to lighten the areas. Almost like adding milk to a cup of coffee, this effect is actually visible to the naked eye at the time of injection.
Scars. Hypertrophic scars (the ones that appear raised) are better treated with a Dermapen and massage to break down the scar tissue, but hypotrophic scars (the ones that appear depressed) are best treated with a combination of therapies including Hyalual, fillers and other superficial methods of stimulation. Hyalual stimulates new collagen and elastin directly in the scar area.
Stretch Marks. The same is true for stretch marks, regardless of the age, or colour of the stretch marks.
Burns. Skin that has been burnt and even skin that has been grafted may be treated with Hyalual. Grafted skin appears uneven and resembles a chicken wire fence; this is as a result of the process used to stretch the graft to cover a greater surface area. Hyalual may be used to smoothen the skin.
Cellulite. The first option for treating cellulite is to enhance the quality of the skin overlying the cellulite. That is, by increasing the thickness, density and elasticity of the skin, whatever is happening underneath the skin in no longer that important to the appearance. If this is not sufficient, further steps are taken to treat both the fatty and the connective tissue portions of the cellulite.
Hair loss. Hyalual works by stimulating the mitochondria in target cells to increase the output of those cells. This has been used successfully on the scalp to stimulate hair growth.
In all of these areas, combination therapy is key…
Botulinum toxin: apart from the obvious use of the toxin for lines and wrinkles, this works well with hyalual in areas such as the lower face and neck to stop the downward force of the muscle on the skin to prevent deformations such as jowls and turkey necks. When used on the scalp it prevents hair loss by stopping the production of sweat, (which contribute to the hair loss).
Ultrasound: Our physiotherapists at Anti-Aging Art use ultrasound to stimulate the production of collagen has been extensively studied and when this is used shortly after the injection of Hyalual, the synergistic effect is clear. Patients have reported dramatic improvements when they have undergone the combination therapy when compared to receiving the injections alone.
Orlight: Pulsed Light has also been shown to stimulate collagen production and to tighten loose and saggy skin especially in lighter skin where it is safe to use higher energy levels.
PRP: Patients’ own blood is drawn, spun in a centrifuge and the platelet rich plasma component is injected into the skin and scalp to take advantage of the platelet derived growth factors to stimulate skin and hair. This may be used in alternating treatments as needed.
Dermapen: This device stimulates the skin through physical means as tiny needles inject into the skin creating thousands of tiny pores. This treatment is painless and is useful for all skin types but especially for dense and hypertrophic scars that need to be broken down.
Peels: Chemical peels remove the superficial layers of dead skin, stimulate the living layers to thicken & produce new cells and to temporarily remove some of the skin’s defenses to allow specific creams to penetrate deeper into the skin, for example, the Advanced Skin-Tone Corrector cream for pigmentation marks.
Injectable Lipolysis: When stubborn fat deposits are cause for concern, redermalization is used to address the surface texture of the skin and to reduce the surface area but in order to reduce the volume of the tissues, one could make use of injectable lipolytic products to break down some of the fat cells. Adults cannot make new fat cells and therefore the areas with reduced fat cell numbers will be less efficient at storing fat.
Disclaimer: this article is written for educational purposes and is not to be taken as an endorsement or advertisement for Hyalual or any other product or medical treatment. Dr Reza Mia is the Country Key Opinion Leader for Institute Hyalual.