Why it matters to prevent skin ageing at any age.

Anastasia Mashkina, MD is a dermatologist and aesthetic medicine specialist in Moscow. She is a WOSIAM member. Here she discusses combining chemical peels, hyaluronic acid and sodium succinate for facial rejuvenation.

The problem: skin quality at a young age

Improving skin quality is now a common request. Early photoaging, late acne treatment and weakened local skin immunity all reduce skin quality early.

Patients most often report dull skin, reduced turgor, dryness and tightness, age spots and fine wrinkles.

The main driver is dermal inflammation. It is linked to imbalance of local immunity, raised proinflammatory cytokines and matrix metalloproteinases.

Inflammaging is chronic, mild, symptom-free inflammation. It shows raised proinflammatory cytokines (IL-1, IL-6, IL-18 and TNF-alpha). Matrix metalloproteinase (MMP) is a family of zinc-dependent enzymes. They break down the protein matrix in the dermis.

Acting early on this imbalance slows rapid ageing. Aesthetic procedures should begin by restoring that balance.

The combined approach

The technique treats the epidermis and suppresses chronic dermal inflammation. It combines superficial peels with injections of high-molecular-weight hyaluronic acid and sodium succinate in one session. The author uses Hyalual peels and Xela Rederm.

Exfoliation and peels

Exfoliation speeds up renewal of the epidermis. It evens skin relief and reduces hyperkeratosis. Acid combinations are chosen for the problem being treated.

Each acid corrects a specific concern. Most patients present with several concerns at once, so multi-functional peels help. Hyalual peels renew the epidermis, inhibit tyrosinase activity and limit excess melanin.

Redermalization

Redermalization uses intradermal injections of Xela Rederm, H&S or Electri. These contain hyaluronic acid and sodium succinate.

High and low molecular weight hyaluronic acid act differently on macrophages. Low-molecular-weight acid raises pro-inflammatory markers (nos2, TNF-alpha, IL-12, CD80). High-molecular-weight acid raises pro-resolving markers (arg-1, IL-10, Mrc-1).

High-molecular-weight hyaluronic acid binds CD-44 receptors. It forms a ligand-antagonist of pro-inflammatory cytokines. It also lowers MMP-9, which destroys the intercellular matrix. The result is less inflammaging and better dermal structure.

Sodium succinate lowers MMP-2, which breaks down structural skin proteins. It normalises microcirculation and cellular energy metabolism. It is an antioxidant, and it supports healthy metabolism and oxygenation.

During the combined procedure, the peel, Xela Rederm and controlled skin injury trigger repair. Succinate blocks tyrosinase, so melanin synthesis is inhibited. Existing melanin lightens, and facial tone becomes brighter.

Indications

The combined technique suits patients with various levels of photoaging. It can be used alone or within a wider plan to improve skin quality.

Protocol overview

  • Ageing. Advanced Resurfacing peel, 4 to 7 minutes. Three to five procedures, 2 to 3 weeks apart.
  • Pigmentation. Brightening peel, 3 to 6 minutes. Four to five procedures, 2 weeks apart.
  • Seborrhoea or post-acne, sensitive skin. Clarifying peel, 5 to 8 minutes. Three to four procedures, 2 weeks apart.
  • Dull skin. Glow Enhancing peel, 4 to 7 minutes. Two to three procedures, 2 to 3 weeks apart.

How the procedure runs

Preparation

Patients use home care with sodium succinate and sunscreen. SPF 50 is advised for six weeks after the course. This helps prevent post-traumatic hyperpigmentation. Question the patient, check contraindications and photograph the starting skin quality.

In the session

  • Prepare and clean the skin.
  • Apply the Hyalual peel solution for 4 to 7 minutes, based on skin condition and reaction.
  • Rinse with water.
  • Inject Xela Rederm, H&S or Electri intradermally in micropapules. Treat pigmentation more densely. Use 1 to 2 ml.
  • Apply Profi Deluxe spray to reduce redness and discomfort.
  • Apply SPF 50 sunscreen against UVA and UVB.

A course of three to four procedures at two-week intervals is recommended.

Results

After a course, patients reported better complexion and smoother texture. They also reported smaller pores, fewer small age spots and lighter large age spots.

Wrinkle depth reduced, elasticity improved and vascular pattern lessened.

The authors conclude that peeling with high-molecular hyaluronic acid and sodium succinate is effective. It supports younger looking skin at any age.

Originally published in Prime Journal, September and October 2018.