AM Upskills: Incorporating LED into your facial treatments
LEDs (light emitting diodes) are semiconductors that convert electrical current into narrow spectrum light. These diodes have been around since the 1960s, and now their presence is ubiquitous all down to the manufacture of a blue light LED in 1993 by Nichia Chemical of Japan.1 This allowed the blend with red, green and yellow lights to create white light.
The subsequent evolution and relatively cheap cost of LED lights, has surged interest in their clinical application for a variety of medical and cosmetic uses.
Understanding the mechanism of action of LED light is slightly more complex, however. In the same way that plants use chlorophyll to convert sunlight into plant tissue, LEDs can trigger natural intracellular photo-biochemical reactions. To have any effect on a living biological system, LED-emitted photons must be absorbed by a molecular chromophore or photoacceptor. Light, at appropriate doses and wavelengths, is absorbed by chromophores such as porphyrins, flavins, and other light-absorbing entities within the mitochondria and cell membranes of cells.
The action of a chromophore can then modulate the respiratory pathway, and there are many theories about how this actually occurs. The photodissociation theory2 is possibly one of the most widely accepted, though the respiratory chain is complex and beyond the remit of this article. However, the latter stages are under the control of cytochrome c oxidase.
This enzyme is the main chromophore for red and near infrared (NIR) light. Activation of the respiratory pathway produces free radicals, which are essential to the feedback and regulation of all respiratory pathways. Carbon monoxide (CO) and nitrous oxide (NO) are two such free radicals, and in the ambient state they allow cross talk and feedback between mitochondria and various protein gene transcription pathways.
THE PHOTODISSOCIATION THEORY
The photodissociation theory implies that NO and CO “clog up” the cytochrome c oxidase. By applying LED therapy, this then dissociates NO or CO off this enzyme to allow oxygen to bind instead and continue cell respiration. So, when a cell like a fibroblast is exposed to LED, there is a resultant increase in ATP production, which modulates free radicals, reduces apoptosis (programmed cell death) and increases blood flow and angiogenesis as well as up regulating transcription factors.
These pathways lead to increased cell proliferation and migration, modulation in levels of cytokines (interleukins, tumour necrosis factor) and inflammatory mediators and it also increases anti-apoptotic proteins. So how does this actually manifest? Well, when LED is applied to skin with various aesthetic conditions, we are able to lift and tighten lax skin and reduce fine lines and wrinkles.3,4
Depending on the target chromophore, different wavelengths of light can be used. Three wavelengths of light that have demonstrated several therapeutic applications are blue (415nm), red (633nm), and near-infrared (830nm).
INCORPORATING IN CLINIC
There are several interesting studies that have been released recently looking at LED light and its role in augmenting clinic treatments. One split-face study, where Lightstim LED was used following micro-needling, demonstrated a subjective improvement in the appearance of the skin, and patients also observed less swelling, erythema and pain on the LED-treated side. Visia skin analyses also demonstrated objective improvements in pigmentation, bacterial load and pore size. The study also included a surgical arm of those who had undergone a SMAS-facelift who reported similar improvements.
A further study was designed to evaluate the tolerability and compatibility of various Exuviance alpha hydroxyl acid peels, Lightstim and three days’ home-use of Exuviance skincare. This used self-assessment questionnaires to determine how patients felt their skin was post-treatment. 94% rated their results as excellent (75%) or very good (12.5%). 100% felt that there was a significant improvement in their skin condition, and 93.8% of participants found the LED light relaxing.5
We offer an abbreviated treatment as an adjunct to all skin-based rejuvenation treatments at The Clinic by Dr Mayoni. So, anything that involves skin resurfacing (non-laser) will be followed by an abbreviated session of LED light. This is provided by handheld devices such as Lightstim or the panel treatment Dermalux. This will not include any thermal energy based skin treatments we offer, as the combined heat levels may be too high.
We also use the full protocol as a stand-alone treatment for rejuvenation and in the treatment of rosacea, acne, pigmentation and inflammatory conditions such as eczema and psoriasis. You can really add value to all your treatments with LED, with minimal outlay and improved downtime while allowing the patient a little bit of relaxation time during treatment.
Looking specifically at treating acne, propionibacterium acnes is a gram+ve bacteria involved in the pathogenesis of acne vulgaris. Traditionally blue light has been used to reduced bacterial load by strongly activating endogenous porphyrins. This then results in free radical production, which then damages the p. acnes cell wall and treatment of acne. Recent evidence shows that a combination of blue and red light6,7 benefits non-inflammatory and inflammatory lesions with minimal to no side effects.
Improved results were seen in these patients where a superficial removal of the stratum corneum was performed to allow better penetration of LED.6 This finding is applied in practice with our patients who suffer with mild to moderate acne. We will resurface with a dermal infusion device or a peel immediately prior to delivering phototherapy.
AT-HOME OPTIONS
Many homecare devices are not able to provide the right wavelengths or frequencies in order to deliver results. Generally, these will require more frequent application than an in-clinic treatment – usually six to eight times a week. They come in the form of face masks or wands, although the wands do tend to be more practical.
A mains-powered device will provide a more consistent level of energy in every treatment compared to a battery powered one. Not all devices are made the same, so you do have to be careful about what claims are made. Always ask for evidence of how the devices work in the form of clinical studies. Of course, FDA approval, which Lightstim carries, helps to ensure you are offering a medical standard of treatment.
With proper use, my patients have reported some immediate results including plumping, increased local blood circulation and calming of redness. They also report it to be a soothing and calming treatment. Of course, the longer-term resolution of fine lines and wrinkles will take slightly longer. Results of radiance and tightening are reported after two to four treatments and the full results are seen at six to eight weeks following the protocol
REFERENCES
1. Calderhead RG. The photobiological basics behind light-emitting diode (LED) phototherapy. Laser Ther. 2007;16:97–108.
2. Hamblin MR, Demidova TN: Mechanisms for Low-Light Therapy, in Hamblin MR, Waynant R, Anders J (eds): Proceedings of the SPIE, 6140:1-12, 2006
3. Kim JW. Clinical trial of nonthermal 633nm Omnilux LED array for renewal of photoaging: clinical surface profilometric results. J Korean Soc Laser Med Surg. 2005;9:69–76.
4. Nestor M, Andriessen A, Berman B, et al. J Cosmet Laser Ther. 2017. Photobiomodulation with non-thermal lasers: mechanisms of action and therapeutic uses in dermatology and aesthetic medicine; pp. 1–9. Feb 17
5. McDonnell Bowes. Combining Light and professional skincare. Consulting Rooms Vol 3:1 Jan-Mar 2020
6. Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415nm) and red (660nm) light in the treatment of acne vulgaris. Br J Dermatol. 2000;142:973–978.
7. Lee SY, You CE, Park MY. Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV. Lasers Surg Med. 2007;39:180–188.
Dr Mayoni Gooneratne (MBBS, BSc, MRCS) is founder of The Clinic by Dr Mayoni. She is a London-based general surgeon with over 18 years of medical and surgical experience. As a graduate of St George’s Hospital Medical School, she has been a member of the Royal College of Surgeons since 2002. Dr Mayoni has also undertaken extensive training with Cosmetic Courses at Aurora Clinics. Alongside her team of carefully chosen and highly trained individuals, she offers clients the best in results-driven treatments and customer service.