Why aesthetics is embracing the cool side

New device-based innovations are providing good news for the treatment of all skin tones, especially Black skin. Reporter Becki Murray investigates the potential for both safer and more efficacious methods for face and body rejuvenation.

While it might be a stretch to say that traditional energy-based treatments left Black skin totally out in the cold, it’s certainly true that safety and efficacy concerns have somewhat restricted the treatment of melanin-rich skin.

Now a colder approach is promising an innovation-led solution. New devices, focusing on reducing the effect of thermal energy, may better allow the treatment of all skin tones, including up to Fitzpatrick skin tone VI. The result: decreased safety profiles and better results across the board.

WHAT’S BEEN THE PROBLEM TRADITIONALLY?

“Energy-based treatments involve throwing energy at the skin and typically that means creating heat in the process,” outlines Dr Dev Patel. “Often, we’re using that heat for the best clinical outcome, however, as we know, it also causes inflammation. And the darker the skin tone, the higher the risk of that inflammation causing a disturbance of pigment, leading to post-inflammatory hyperpigmentation or post-inflammatory hypopigmentation.” Hyperpigmentation will usually resolve within 3-12 months but the latter, which is more prolific in darker skin, is notoriously difficult to treat, and the risk of PIH increases the more heat is applied.

Thus, some energy-based devices, such as traditional ablative lasers, simply carry too high a risk for darker skin tones, both for pigment disturbance and possibly other side effects, such as keloid scarring.

“Ultimately, we have to always think about patient safety first,” says Dr Patel. “So, we’d either restrict those devices for individuals with darker skin or use modified low-energy protocols. That means, to get the same result as a lighter-skinned person, you probably have to do more treatments resulting in greater patient investment.” Dr Patel also reports a significant drop in patient-reported prolonged healing when using CellDerma’s GF5 Growth Factor Serum post-procedure.

Yet, technology is advancing, which allows companies to make devices that are, in general, safer for all skin types. So, with the right research, you can discover machines that can be used more easily for skin tone type IV, or even V and VI, giving practitioners more options in-clinic.

THE COLD SOLUTION

Perhaps most excitingly, UltraClear is the newest ablative laser on the block. Specifically, it’s a cold ablative laser – meaning it doesn’t generate the same amount of heat as traditional devices.

“The UltraClear laser delivers ‘cold fractional ablation and dialled-in coagulation’ at the same time and the same location,” says Dr Amiee Vyas. “This means less heat is put into the skin, therefore minimising the complications and risks associated with normal resurfacing lasers, including PIH.”

For comparison, “with CO2 laser emission, 40% of the energy ablates and 60% is thermal energy. With UltraClear, 95% is ablating and just 5% is thermal energy, therefore allowing skin of colour to be treated safely with a fractional laser perhaps for the first time.”

What’s more, by reducing the amount of heat applied to the skin, there’s said to be faster healing and less pain for patients of all skin colours. “The frequency that it works on, 2910nm, means it operates at peak water absorption,” says Dr Patel. “So, when the energy from the laser is being absorbed, you’re effectively getting a global effect on all the skin. It is having an ablative effect, but it’s creating much finer channels of ablation. It’s also doing it in multiple hits, rather than all in one go, but it’s super quick, meaning you can do a full face in 15 minutes. Plus, you don’t even need to use numbing cream for lower energy treatments.”

Elsewhere, body treatments are taking advantage of cold energy-based technology too. Emerald, from Erchonia, is the only device FDA-approved for full-body fat loss and it has zero thermal effects as a non-thermal low-level laser (NTLL). That provides an eye-catching safety profile for a fat reduction device across all skin tones. What’s more, its body toning results are supported by multicentred double-blind randomised control trials, which is the industry gold standard. Its anti-inflammatory effect on cells and its ability to trigger the release of ATP energy also makes this new-age well-being laser perfectly aligned with the growing client demand for mood-boosting treatments.

THE COLD-ER SOLUTION

Not all new treatments are bidding a complete goodbye to heat. Yet, many are controlling thermal energy with increased precision and speed, to minimise its impact. Cynosure’s Picosure, for example, is a ‘picosecond’ laser that utilises super short bursts of energy, aka trillionths of a second, to reduce thermal damage and target precise areas without harming the surrounding skin. The fractionated lens redistributes picosecond energy into high and low intensities to create intra-epidermal laser-induced optical breakdowns (LIOBs). This creates a pressure wave that expands into the dermis, activating the body’s natural healing response to increase collagen and elastin production without thermal side effects. It’s not only effective for tattoo removal, but tackles pigmented lesions, scarring and wrinkles in all skin types, with little patient downtime.

Likewise, while micro-needling radiofrequency has allowed the treatment of scarring in darker skin for some time now, newer devices are offering greater precision, such as the SkinPen Precision system. It has been proven to reduce the appearance of facial acne scars for all Fitzpatrick skin types.

Other devices are focusing on protecting the surface of the skin from thermal damage for better post-treatment results. “With the newer plasma technology like Neogen, when the laser hits the skin, it doesn’t significantly disturb the surface, it passes through. So, it doesn’t actually ablate in the way that we see from Plexr (which I still love) or even most lasers. You just see a little shiny hue to the skin,” explains Dr Patel. “There’s certainly heat involved, as the patient feels it, and about four or five days later, they’ll have some shedding like they’ve had a chemical peel. But you can get equivalent results to a CO2 laser, but with a fraction of the downtime and inflammation. That means your risk profile is a lot better which is good news for darker skin. It’s FDA approved only up to skin type III, but the company does approve its use in darker skin types under medical discretion and in trained hands. We have been getting some super results.”

Finally, there’s SofWave. This non-invasive ultrasound technology generates heat in the dermal layer of the skin to stimulate collagen and elastin production, but, importantly, it’s designed not to trigger a thermal effect at the skin surface. It’s certainly not pain-free for patients, with numbing cream required and a patented cooling plate system hard at work, but it’s a machine you can use on every inch of the face, no matter the skin type or, significantly, skin colour. “You can absolutely use it on the darkest of skins without any problems and you are getting skin tightening, dermo-remodelling and improvement in wrinkles,” says Dr Patel. “It is actually one of only two devices FDA approved for lifting, specifically around the neck. It ticks every box - patient safety, holistic treatment and negligible downtime.”

Proof then that focusing on taking some of the heat out of your approach might just be the hottest thing in aesthetics right now.