The largest organ of your body is your skin. This amazing organ is a fine tuned barrier that selectively allows certain substances into the body, while keeping harmful pathogens and pollutants out. It is a sophisticated filtration systems that protects us from negative environmental factors.
Our skin is vital for preventing internal organs and tissues from being exposed to ultraviolet (UV) radiation, pollutants, toxins, temperature extremes (thermoregulation), and microorganisms such as viruses and bacteria (immunologic surveillance). Additional essential functions of our skin include sensory perception and fluid control.
The epidermis, dermis, and the hypodermis are the three main layers of skin.
The layer we see in the mirror is the epidermis. This visible outer layer is made up of approximately four to five layers of skin cells. The thickness of the epidermis is dependent on where it is located on the body. Our sturdiest and thickest layers of skin are found on the palms of our hands and the soles of our feet. These five layers of skin cells are 1.5 mm thick and regularly take a beating in daily use, so it is understandable that is where the thickest layer of skin would be found. The areas of the body with 4 layers are known as "thin skin." The thinnest layers of skin at 0.05 mm in thickness are found behind the ear and on the eyelids.
The middle layer of skin is referred to as the dermis. The dermis is the area often addressed in anti-aging treatments because it is where we find fibroblasts and collagen, factors that contribute to whether our skin looks wrinkled or more youthful in nature. The dermis contains not only collagen, and fibroblasts but hair roots, elastin, sebaceous glands, blood vessels and sensory structures. The dermis itself is further separated into two layers: the papillary above and the reticular layer on the bottom. The dermis provides cushioning and protection and gives us our sense of touch. While epidermal thickness remains fairly constant throughout life, dermal thickness will vary with age.
Underneath the dermis and epidermis is the deepest layer of skin, the hypodermis. The hypodermis is also known as the subcutaneous fat layer, or subcutaneous tissue. This layer of fat insulates us and helps regulate our temperature.
 See the image below.
Being aware of areas with thinner skin such as that around the eyes will help you in administering your plasma pen treatments. When laying down your grid on crows feet, drooping upper eyelids or undereye bags, use a much lighter intensity than you would on other parts of the face.
If you have a male client, be aware that male skin is characteristically thicker than female skin. The younger the age of a client, male or female, the thinner the skin. Our skin gradually thickens until our 40s and 50s, then a decline in its thickness and a host of other cosmetic aging issues will start to present themselves. Thinning of the skin, as mentioned before, occurs in the dermis. Collagen and elastin fibers begin to degrade and the skin's ability to repair itself wanes. The Plasma Fibroblast Skin Tightening treatment addresses the dermis and helps improve the elasticity and structure of the skin that diminishes with age.
The outermost layer of skin, the epidermis, is made up of a variety of specific types of cells. These cells are keratinocytes, melanocytes, Merkel cells and Langerhans cells. The four layers of the epidermis are divided into the stratum germinativum, stratum spinosum, stratum granulosum, and stratum corneum.
Keratinocytes compose over 90 percent of the epidermis, producing keratin that makes up the stratum corneum layer of our skin. This layer is important because it keeps water or moisture in the skin and harmful substances out. As keratinocytes divide and differentiate, they move from the deeper layers of the epidermis until they reach the most superficial outer layer. Once they reach the stratum corneum, they are fully formed keratinocytes that are eventually shed during epidermal turnover. Cells of the stratum corneum are the largest and most abundant of the epidermis.
Melanocytes produce melanin, the molecule that gives our skin pigment. Melanocytes react to UVB light, producing a tan or sunburn. Melanin is a form of natural sunscreen, absorbing radiant energy from the sun and providing a measure of protection from the harmful effects of UV rays. Melanocytes are found in the basal layer of the epidermis as well as in hair follicles where they give hair its pigment. Melanoma cancer indicates that the cancer originated within the melanocytes.
Sun exposure, melanocyte-stimulating hormone (MSH), adrenocorticotropic hormone (ACTH), estrogens, and progesterones all stimulate melanin production. This is why it is so important for a client to avoid sun exposure before their fibroblast appointment to reduce the risk of hyperpigmentation in the treatment area.
Langerhans cells are part of the immune system of the skin. They are capable of ingesting foreign antigens and breaking them down so that the immune system can be activated. An example of this type of immune system activation is contact hypersensitivity.
Merkel cells (also called Merkel-Ranvier cells) are present near nerve endings and contribute to our sense of touch. Merkel cells are specialized in the perception of light touch.
The epidermis is unique in that it contains no blood vessels. It receives nutrient delivery and disposes of waste products through a process of diffusion from the dermis layer below. Although the dermis is only 3-5 mm thick it contains a vast network of structures, including blood vessels, collagen, elastin, nerves, hair follicles, smooth muscles, glands and lymphatic tissue. While keratinocytes dominate the epidermis, the main cells of the dermis are fibroblasts. With your plasma pen, you can directly reviltalize the fibroblasts to start producing robustly again. The fibroblasts stimulate not only collagen and elastin but glycosaminoglycans. There are a variety of glycosaminoglycans, but hyaluronic acid is the most well known substance.
The primary function of the dermis is to nourish the epidermis. The dermis is composed of 2 layers, the more superficial papillary dermis and the deeper reticular dermis. The papillary dermis is thinner and composed of loose connective tissue, capillaries, elastin, reticular fibers, and collagen. The reticular dermis contains dense connective tissue with larger blood vessels, closely packed elastin and collagen fibers. The reticular layer is where you will find the all-important fibroblasts as well as mast cells, nerves and other structures suspended in a gel-like substance. This gel-like substance is made of hyaluronic acid, chondroitin sulfates, and glycoproteins.
When your skin endures the controlled injury of the plasma arc, it forces your skin and your immune system into activating its wound repair response. This makes your skin's fibroblasts produce the collagen, elastin and glycosaminoglycans that it needs to sufficiently repair its structure.
The fibroblast is the major cell type of the dermis. These cells produce and secrete procollagen and elastin fibers. Procollagen is cleaved by proteolytic enzymes into collagen that aggregates and becomes cross-linked. These tightly cross-linked collagen fibers provide tensile strength and resistance to mechanical forces. Collagen makes up 70 percent of the weight of the dermis. Of this collagen Type I is about 85 percent of the total collagen and Type III collagen is the remaining 15 percent. Although elastin only accounts for less than 1 percent of the dermis' weight, it gives skin its cushiony, "bounce back" feel that's so prevalent when we are young. Elastin's ability to return the skin to its resting shape is crucial for maintaining a youthful glow. The plasma pen treatment is fantastic for kick-starting your skin's natural processes to create more of these skin components. These types of cells will form during the healing process to create glowing, healthier skin.
Not all wrinkles are created equal. Understanding the different forms of wrinkling will help you assess the best treatment plan for your client. As we age lines and creases become more prominent over major and minor joints. Dynamic wrinkles, the type targeted by Botox are formed when contraction of the skin produces wrinkles and creases that lie perpendicular to the underlying muscle force. Relaxed skin tension lines (RSTL), are formed during relaxation and often follow a different direction than age and dynamic wrinkles. (See the image below.) Relaxed skin tension lines are created by the natural tension on the skin from underlying structures.
Knowing your client's Fitzpatrick skin type is the most important information you will need to learn during the consultation. This treatment is not appropriate for Fitzpatrick skin types V and VI. The amount of melanin pigment in the skin determines an individual's skin color and skin phototype. Skin pigment is a genetic trait, but certain diseases can affect melanin pigment. Hormones like estrogen and progesterone can stimulate melanin production. The hormonal fluctuations of pregnancy can cause melasma, where dark patches of skin appear on the face. The Fitzpatrick Scale is based on a complexion type's typical response to being exposed to UV rays. (See table 1, below.) This classification is based on your client's personal history of sunburns and tanning. This simple clinical tool can evaluate whether a particular cosmetic treatment is more likely to produce a positive outcome or more adverse effects like hypertrophic scarring and hyperpigmentation.
African Americans, Hispanics, Latinos, Asians, Native Americans, Pacific Islanders, and individuals of Middle Eastern descent are more likely to have issues with hyperpigmentation and hypopigmentation. Hypopigmentation is a condition where the skin loses pigment in response to trauma. Hyperpigmentation is an increase in melanin output due to skin injury or inflammation. Clients in Fitzpatrick skin types III and up are at risk for this response. This procedure is not recommended for Fitzpatrick skin types V and VI because of a tendency to scar white or pink in these skin types.
You may TEST for hyperpigmentation by administering a small amount of fibroblasts to a low visibility area.
If you have a client that may be at risk for pigmentation issues it is recommended that they apply a tyrosinase inhibitor or melanin-balancing product a week before their appointment and after their procedure once the scabs have fallen off. Tyrosinase is the enzyme involved in the skin's production of melanin. They should choose a non-irritating product before the procedure so as not to increase skin sensitivity. This would include niacinamide, arbutin and alpha arbutin. Once they have healed and can resume their normal skin care routine, they can utilize more aggressive tyrosinase inhibitors like hydroquinone, vitamin C, azelaic acid, lactic acid and kojic acid to ensure that they don't experience any long term post-inflammatory hyperpigmentation. These ingredients should not be used a week prior to the procedure because they can cause increased sensitivity.
BLU Technology | Blue Light Irradiation
Your Fibroblast Pen is equipped with blue light irradiation. Visible light with low intensity is used in clinical trials to promote the healing of wounds and to reduce inflammation. Blue light irradiation is a potential approach in treatment of keloids, hypertrophic scars and fibrotic skin diseases. This is great to use during the procedure to promote healing as you work on skin types that you think may be prone to scarring. To access the light features - double click the power button to toggle lighting options.
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