The beauty industry has traditionally operated in the low-tech arena, utilizing the fruits of nature rather than industry to encourage a client’s best face forward. In the past decade, however, as skin care has leaned increasingly toward anti-aging and corrective treatments, our industry has been pulling some amazing technology from the medical field, allowing us to offer therapeutic treatments that deliver real, long lasting results.

Sure, you’re aware that when it comes to skin care, we’ve moved beyond the ground apricot kernels of the ‘70s. But just how “with it” are you outside the realm of product formulations? Do you run from the room at the mention of a megahertz? And if the only image that comes to mind at the mention of electrical current is the season’s last thunderstorm, then you’ve got some serious catching up to do.

Ultrasound and microcurrent technologies can both be safely incorporated into your spa’s skin care menu; they serve as adjuncts to the treatments you already offer, and let you create new services centered around the specific activities and benefits they offer. They best part? Neither technology involves a concept that’s too difficult to grasp.

Ultrasound
What defines sound as being ultrasonic is its frequency: Anything above 20,000 hertz-or 20,000 vibrations per second-which is the threshold of human hearing, is classified as ultrasound. By definition, a hertz is a "unit of frequency equal to one cycle per second," according to Webster's dictionary. And for our purposes, "frequency" refers to "vibration."

Ultrasound is used in medicine for both diagnostic and therapeutic purposes, and the frequencies utilized for each are completely different. Likewise, when we use ultrasound for esthetic purposes, the treatment being performed will dictate the frequency setting.

"Ultrasound has been used for years as an aid in medical diagnosis, in situations where things remained hidden from our human perception; undetected to the naked eye," says Dr. Christian Jurist, national education director, Cosmopro Group, Daytona Beach, Florida. "What ultrasound does, as a diagnostic tool, is hit a tissue with sound waves which bounce back and are then interpreted by advanced medical hardware and software, giving doctors and diagnosticians the data they need. Ultrasound technology is also used in the medical arena for therapeutic purposes such as the treatment a soft tissue injuries; it was from here that it made its jump into esthetics. Its abilities to raise local tissue temperature increase blood flow, stimulate cellular activity, move fluids and enhance product penetration are just a few reason why ultrasound made a natural move into skin care.

"In the esthetics arena, ultrasound can be used for a number of purposes,' adds Jurist. "The most common art skin cleansing, phonophoresis (product penetration), wound healing and cellulite reduction. Whichever treatment you are administering would determine the oscillation of the sonic vibration you would use, because to achieve these different goals you would use specific frequencies." The most important thing to know about ultrasound is that the lower the frequency, the deeper the sound waves will penetrate.

Microcurrent
An electrical current is defined as being micro if its signal is less than 1,000 micro amps, amp being short for ampere, the basic international unit by which electrical current is measured. Some perspective?

"It takes a million micro amps to light up a light bulb," offers David Suzuki, vice-president sales and marketing, Bio- Therapeutic, Seattle. "Our microcurrent machine uses no more than 200 micro amps." Any machine that emits current greater than 1,000 micro amps is considered an EMS (electrical muscle stimulation) machine, and is classified by the Food and Drug Administration as a medical device. EMS is, however, an accepted modality in esthetics in many countries.

"Microcurrent is the reproduction of your own biological current," says Danielle Tsoklis, director of education, Silhouet-Tone, St. Albans, Vermont. " As we age, this current, which sends messages from the brain to the muscles via the spinal cord, does not send those messages properly." Operating well below the threshold of pain and barely detectable in any tactile manner to the client receiving it, microcurrent can be used for a variety of esthetic goals: to tone facial muscles, increase collagen production, aid in lymphatic drainage, iontophoresis (product penetration) and skin rejuvenation.

Ultrasonic Skin Care
Ultrasound has yet to be approved by the FDA as anything other than a prescription medical device, making its purchase or use unlawful unless under the order of a physician. Like laser ultrasound equipment can be used only in day spas that have a doctor on the premises-at least on a part-time basis.

"Following regulations, ultrasound therapy is safe for use in the spa, but like anything there are, of course, some contraindications," says Jurist. "Some examples would be metallic implant of any kind, infections, unknown lesions, tumors, cancer and pregnancy (Prenatal ultrasound differs from therapeutic ultrasound.) Also, you never want to pass the transformer head over any vital organs, the thyroid gland, the eyeballs."

While ultrasound technology can be used for targeted purposes and results it should be pointed out that at basic, ultrasound is vibration. What this means is that, also on a very basic level, it’s a great tool for stimulating cellular activity- and ultimately, skin rejuvenation. "Ultrasound enhances the diffusion of cytoplasm, stimulates cells. accelerates circulation, softens tissues: and increases skin metabolism," says Sonia Boghosian, co-owner, EuroPro Camarillo, California.

"Currently, partially conclusive research is looking into the fact ultrasound may help to produce collagen especially by stimulating the fibroblast and collagen fibers directly with sonic vibration," says Jurist. "My point view is that it may also help indirectly because ultrasound generates local heat, which promotes vasodilation a thereby an increase in blood flow enhancing cellular activity, as oxygen and nutrients are delivered to the tissue to later boost physiologic collagen production. And of course, all of it together also means enhanced tissue repair."

For cleansing, Jurist says the vibrations of the ultrasound may help clear debris out of the pores as the transformer head is moved across the client's face and "microbursting" of dead cells occurs. Referred to as skin scrubbing, this is a professional treatment for skin health that can be equated to going to the dentist for a teeth cleaning.

Roger Ignon, president, Edge Systems, Signal hill, California, says the ultrasonic waves work to emulsify and break up debris in the skin's pores. "For skin scrubbing, the frequency used is 28,000 vibrations per second; this has a trampoline effect on the skin that pulls debris up and out of the pores to 'help unclog them," he says. When using ultrasound for phonophoresis-which means using sound waves to deliver particles into the skin-the main mechanism at work is that molecules of the substance are being broken down for easier penetration into the stratum corneum. Jurist, however, says that the ultrasound is also making the skin more permeable so that there's at least a dual action involved.

Ultrasound is effective in treating cellulite because of its influence on the lymph and its overall ability to stimulate cellular activity in tissues of all depths, assisting in drainage of cellular debris and accumulated toxins.

Another issue to know about sound waves is that they're absorbed and reflected differently by different tissues and substances in the body, so the therapist needs to learn the science behind the device and be trained to use it properly. Ultrasonic devices usually feature switchable "continuous" and "pulsed" settings for the emission of sound waves, for use according to the purpose sought. "When you work with low frequencies, in continuous mode you need to really move the transducer head around because the sound because the sound waves go to a depth where they can actually reach the bone tissue and do them damage," warns Jurist. Incidental bone is an excellent absorber of ultrasound energy, which is important to remember when working on facial areas like the forehead, chin and mandible. Alan Bunting and Laura Root in their book Ultrasound Electrotherapy, Applications, Tech & Technology for Medical Esthetics (Esthetics Education Resource 2002)

"Muscle is capable of absorbing twice as much ultrasound as fat, while bone absorbs 10 times more ultrasound than any soft tissue. Therefore, an inversely proportional situation exists, in that the more absorption that occurs, the less intensity is required for the treatment. "

Ultrasound transducers will offer different ranges of output, and some ballpark figures are as follows:

5 megahertz will help sonic waves to reach very superficially
3 megahertz will help sonic waves to reach the adipose tissue, or muscle
1 megahertz will help sonic waves to reach deep muscle and bone.

The most commonly used transducers in skin care will offer between 1 and 3 megahertz. It's possible to purchase a machine that carries one transducer set to a specific frequency of about 2 megahertz, which is very suitable for skin care, but there are plenty of models available that are designed for two transformers so that a spa owner needn't invest in more than one piece of equipment to offer a full range of services.

Electric Esthetics
Microcurrent is most widely used in esthetics for its ability to tone facial muscles, offering clients a sort of non-surgical alternative to a face lift. What makes it a great menu offering for spas is that, just as people must exercise regularly to keep their muscles toned, so too must they have regular, microcurrent treatments to maintain the tone of their facial muscles.

"Microcurrent is a good tool for the esthetician because it has a definite toning effect on the facial muscles. There is no product in the world that will tighten your muscles," says Tsoklis. "Microcurrent, which originated in the medical field in the United States in the 1960s at UCLA from work on stroke victims, reproduces the electrical signals from your brain to the message center of your muscle, which is the tendon. The Russian doctor who discovered this is named Golgi, so it is called the Golgi tendon organ. The microcurrent stimulates this tendon, thereby restoring proper muscle tension." If your brain blacks out, your biological electrical current stops, all your muscles go limp and you fall on the floor; this is evidence of the system at work, Tsoklis further explains.

To keep a client's face in shape, Tsoklis recommends a series of 10 treatments once or twice a week to start, and then once a month thereafter, indefinitely, for maintenance. "For a client who does not smoke and leads a healthy lifestyle, it's reasonable to expect to look five years younger," she says.

Suzuki adds further scientific back-up to microcurrent's positive effect on muscle tone. " ATP [adenosine tri-phosphate] levels are known to increase 500% with the use of microcurrent; this was discovered in a research study by Dr. Cheng in 1982. ATP fuels the cell, and is often referred to as the 'energy of life.' Microcurrent is often used in esthetics for muscle toning, or 'muscle re-education,' and its long-term effects are well-noted. I believe that the buildup in ATP explains the lasting effects of microcurrent on muscle re- education."

Other esthetic uses for microcurrent include iontophoresis. Using electrical current to drive corrective ingredients, such as vitamin C deeper into the skin, has been clinically shown to offer increased efficacy over simply applying vitamin C manually. [See "Lightening Strikes," in the October issue.]

Because of its wound healing ability, microcurrent is also a wonderful adjunct in any acne program.

"Clinical studies indicate; that wounds treated by microcurrent typically heal upwards of five times faster than wounds not treated by microcurrent," says Suzuki. "Dr. Emil Chi, director, University of Washington School of Medicine Histopathology Department, notes that the mechanisms of action contributing to this are increased blood circulation, increased gluconeogenesis and increased ATP levels. Additionally, it was noted that microcurrent treatments reduced redness and inflammation, causing wounds to accumulate three to five times less scar tissue than wounds not treated. Lastly, Dr. Chi notes that all of these findings are applicable for certain skin disorders- namely, acne and cold sores." The main areas of medical research regarding microcurrent include Bell's palsy, stroke paralysis, muscle healing, wound healing, pain control and even bone healing, says Tsoklis. Because of the scope of research that has been undertaken, the applications for microcurrent are understandably immense. In the esthetic arena, it can be used to help refine enlarged pores, reduce stretch marks and cellulite, and improve lymphatic drainage to alleviate puffiness and fluid retention around the eyes and other areas.

Suzuki says a new microcurrent programming technology called Sequencing, which is proprietary to Bio-Therapeutic, raises the result potential of any given treatment. "Normally, when you turn on a microcurrent machine the current output remains at a steady amperage. Sequencing pre-programs the output frequency to change from 300 to 500 times during a 20 minute treatment. The significance of this is that different people respond to different frequencies, so the more options you’re able to deliver the better results you’re likely to get.

Keeping up with our industry may seem daunting from a distance. Make it a point to familiarize yourself with the basics; chances are, you'll find that a lot of what we've mined from the medical field is no more than fundamental science that can safely serve as an invaluable adjunct to your skin care service menu.