On the pulse

How aesthetic therapist and clinic owner Hollie Bawden cleared a client’s cystic acne with pulse–triggered laser

HOLLIE BAWDEN

Hollie Bawden has been in the aesthetics industry for 14 years and established Hollie’s Skincare in Leamington Spa to focus on skin improvements for various concerns. Along with a level 4 Diploma in Advanced Skin Science, Hollie also specialises in needling and peeling services.

CONSULTATION

The patient came to the clinic suffering with acneic breakouts that covered her cheeks, jawline and were presenting down on to her neck. Some were small pimples and others were cystic. Where previous breakouts had been, she was left with post-inflammatory erythema (PIE). There were no signs of any pitted scar tissue or uneven texture. The rest of her skin was in relatively good condition – no major dehydration concerns aside from some very gentle fine lines around her eyes and forehead, no signs of pigmentation or premature ageing and in general for her age, the skin was in a very good state. Her oily skin tendencies may be a contributing factor to her lack of ageing signs as well as good genetics.

Her collagen and elastin abundance showed no signs of major degradation, but she is in her early 30s now so prevention of dermo-epidermal junction (DEJ) slip and slide and collagen and elastin degradation can also be considered to ensure we “future proof” her skin. Across her nose and nose creases there was some gentle telangiectasia but the patient has had children so these may be from birth and are of no concern to the acne issues she was presenting.

As the patient’s skin type is oily, she did present with enlarged pores on her nose, forehead, across the inner cheeks and chin. She has always felt she excretes excessive oil, but this has never led to the level of breakouts before; her skin looks young and healthy. The skin was sallow and dull at this time and was clearly showing signs of low immunity and an imbalance of the skin’s homeostasis and bacteria levels, so an in-depth consultation was required to try and determine the causes of her acne. The patient had become extremely down about her current skin condition and asked me, “Give me my skin back.”

After assessing the patient’s skin, it was very apparent that we needed to delve into her lifestyle and look at what may be causing this internal issue as her skin topically was in good condition apart from the acne presentations. The acne was widespread so didn’t indicate they were solely hormonal, although the cystic presentations heading from her jawline to her neck indicated to me that there may be some level of hormonal investigation to do during the consultation. I asked about her diet, stress levels, sleep patterns, environment, occupation, current homecare routine and past treatment plans. The consultation led us to discuss the patient coming off the contraceptive pill about 12 months ago and as she thought back, she said her skin had started to become challenging around that time but not to the degree it was presenting as now, and not that she became concerned by.

We talked about her diet and she told me that she had recently begun a new fitness and nutrition programme. She had cut out a lot of sweet foods despite having a major sweet tooth. She had also upped her water intake to 1 litre per day and increased her intake of fruits and vegetables. The patient had also introduced a protein/whey powder to ensure her muscles were getting enough protein for tissue building post-workouts. The patient eats carbs, favouring white bread over brown or seeded, but not to excess. She doesn’t have many natural fat food sources in her diet. The patient also drinks a lot of tea and coffee at work, averaging four to six cups per day.

She was already using a medical-grade skincare brand which answered why the rest of her skin, below the acne breakouts, was in a healthy, hydrated condition, but what she was using wasn’t specific to aiding problematic skin. She also hadn’t introduced any skin-specific internal supplementation to support the dermal layer of her skin from within. The patient uses a pure mineral make-up brand which contains physical SPF (titanium dioxide and zinc oxide) and uses an SPF daily. She is customer facing in her job and now has to wear PPE and face masks daily, which will not be helping the skin, though her acne presentations were spreading further up on her face than where a face mask sits, so it wasn’t typical “maskne”.

The patient admitted to picking at the skin a lot and really digging deep at some of the deeper cysts. I have advised her of the implications of doing this when it comes to marking the skin, leaving scars and aiding the spread of bacteria from both her hands touching her face and the bacteria within the pustule. She had already tried salicylic and azelaic acid superficial chemical peels. There was a short-term reduction of the skin condition, but nothing cleared up long-term, and new breakouts occurred in between appointments. Her PIE was improving but the breakouts continued to reoccur. I wanted to ensure we weren’t over-treating the skin and causing a compromised barrier function, so I didn’t want to keep repeating treatment with BHAs.

TREATMENT PLAN

As mentioned, I didn’t want to try more chemical peeling as the patient found minimal results were achieved. Collagen induction needling could be necessary towards the end of a programme but while her skin was verging towards acne grade 3-4, we needed to reduce the inflammation first and control the bacteria before we effectively pierce the skin. This left me to consider a course of Byonik treatments. Byonik is a pulse-triggered laser that adapts its frequency to your pulse, releasing its energy into the skin every time the heart beats. Byonik laser treatments can be performed in short succession to one another without causing trauma to the skin or compromising the barrier function. We discussed seeing how stable the skin was as time went on to determine how often we would perform the treatments, with the option of using the laser on its own in between appointments without the complementary gels if necessary, for its anti-microbial and bacteria-controlling capabilities.

I wanted to ensure that to whatever level I could get her skin to results-wise, it could be maintained well with appropriate homecare both internally and externally, so the results were supported for long-term benefits. Because Byonik doesn’t utilise the body’s healing capacity, the patient’s sleep deprivation and stress levels wouldn’t impede results, unlike with chemical peeling and microneedling – if a client is sleep deprived and highly stressed, these factors can inhibit the body’s healing response to treatment and therefore impact the results. As Byonik works with high-grade hyaluronic acid, upping her water intake was important so the skin’s natural water retention can be accelerated and the dermal layer of the skin is replenished, benefiting as much as possible from the hyaluronic acid used in treatment and maximising the water content of her extracellular matrix (ECM).

Prior to beginning treatment, I asked the patient to remove the whey protein from her diet, as I believe this to be a major trigger to her inflammatory acne. I also asked her to try to swap to brown bread and make an effort to improve her sleep and rest where she can. Together, we looked at introducing more natural fats into her diet like avocados, nuts, seeds and oily fish, which the patient did take on board. She has also made a conscious effort to drink more water and have less caffeine per day.

Before

After two appointments 

Before 

After five appointments

I planned to perform the Byonik Intensive Rejuvenation Treatment to the whole face and neck. First, we introduced her new skincare routine which consisted of swapping her current vitamin A moisturiser for an oil-based version and a gentle lactic acid lotion to be used together to help reduce the appearance of her breakouts and start the topical healing process. She also started internal skin supplementation – vitamins A, E, C and a phytonutrient called DIM – to help protect her sebaceous gland from overactive hormones that affect sebocyte activity with a specific cocktail of ingredients. She is to take four of these a day and I planned to review as her skin improves.

Before treatment one,

After treatment two 

Before treatment one,

After treatment two

The Byonik Intensive Repair Treatment combines three rounds of Byonik Laser with two applications of Byonik HA Gels. Byonik has three different gels that can be used with the laser, starting with the Byonik HA-Gel PLUS that contains 29% hyaluronic acid and is encased in wakame algae, which helps the HA dwell in the skin for as long as possible and is rich in B vitamins. It also helps delay the natural process of HA degradation in the skin, as well as being an antioxidant. The patient’s first treatment used 6ml of this gel, 3ml at each application. She also took away Byonik Supreme Seal which is essential during a Byonik course. It is extremely high in ceramides (2%) and helps retain the high-grade hyaluronic acid used in treatment by locking it in to the skin for up to four weeks after just one treatment, preventing trans-epidermal water loss (TEWL).

Treatment two was performed a month on from treatment one due to unforeseen reasons, yet we were both completely blown away by how the patient’s skin looked as we prepared to perform the second treatment. Although there were some obvious new breakouts, PIE was persistent in appearance and skin immunity still wasn’t balanced, it wasn’t as widespread as the month before. The breakouts higher on her cheek area had all but gone but there were areas on her lower face and neck that still looked aggravated. As her skin was improving but she hadn’t had a treatment for a month, I again used 6ml of HA PLUS on her face and neck, with three rounds of the Byonik laser.

A week on, I performed treatment three using 3ml of PLUS gel for the first application, introducing 3ml of the next gel for the second application. HA-Gel MAX contains 39% hyaluronic acid and BasicHyal 300 which is anti-microbial and inhibits bacterial growth as well as supporting wound healing and stimulating the immunity of the skin, which this patient requires. She had a slight reoccurrence of some breakouts, but her PIE was disappearing and ahead of treatment three the comparable difference over the last week was amazing to both myself and the patient.

Treatment four was performed two weeks later and this time, we had seen a wonderful stabilisation of her breakouts. She was nearly breakout free and her PIE was extremely faded and barely noticeable. I used the MAX gel for both applications to her face and neck – 6ml altogether – with three rounds of Byonik laser.

We planned treatment five for two weeks later but in between the patient had seen a slight breakout on one side of her face so we used the Byonik laser on its own for the interim. When I saw the patient for treatment five, we continued to be wowed as her overall skin condition was glowing. The PIE was still there but fading and under control.

RESULTS

The patient feels she has her skin back and with no new breakouts and we are seeing a great stabilisation of her skin condition with the added benefits of an overall improvement of areas we were not concerned with – her pores have refined; her gentle dehydration lines have shown improvement and the skin at her orbital rim is smooth, plump and fresh, as is her forehead. Going forward, we will continue to treat her skin for a further two Byonik treatments every four to six weeks and reassess. After the fifth treatment her skin texture was flawless and so there is no need to add in other treatment modalities such as microneedling.

The Byonik has zero downtime so the patient was completely comfortable and relaxed throughout her treatments. The results were apparent very quickly, so she was also very confident of the process and my treatment plan from very early on. She was astounded by her treatment results – she now gets compliments on her skin and has her confidence back.