Use of the vibration compression massage method in aesthetic medicine

Aging is a combination of naturally occurring biological and biochemical changes in the body that are caused by genetic and epigenetic factors. As we know, this process affects different levels of structural organization - from the molecular to the systemic level. Despite the many existing hypotheses of aging (the theory of the "biological clock", "silent genes", "free radicals", "mitochondrial aging", etc.), there is no widely recognized concept explaining the cause of the emergence of involuntary changes ^[1,7].

One of the endogenous theories of the development of involutional processes in the body is the hypothesis of programmed aging, which is based on the idea of the existence of "aging genes" that can influence the functional capabilities of cells and cause programmed age-related changes^[7]. Exogenous aging is the result of exposure to environmental factors such as ultraviolet radiation, ionizing radiation, toxic products, air pollution, which contribute to the production of reactive oxygen  species and   ultimately  lead   to DNA  damage and  cellular  disfunction ^[6,7,8]. Skin exposure to negative endogenous and exogenous influences leads to accumulation of the damaged cells and their metabolic products and degradation of the extracellular matrix. The structure of collagen fibers of the dermis changes, whereby increasing their resistance to the proteolytic enzymes effect.

Meanwhile, the reticulin and elastic fibers are “collagenized” increasing their sensitivity to the action of elastase and trypsin ^[1,7]. The growth of tissue hypoxia, an increase in the number of free radicals and lipid peroxidation products, as well as a shift in the pro- and antioxidant balance to the acidic side leads to a disruption of interstitial transportation, deterioration of lymph formation and lymph flow ^[2,3,4]. It is a vicious circle boosting involuntary changes in tissues. As such, therapeutic measures aimed at improving interstitial transport by stimulating lymph flow, as well as at increasing tissue oxygenation by improving local blood circulation, can slow down the aging processes of individual organs and the body as a whole. ^[5,6,8]

Aging of the face, neck and décolleté area is caused not only by progressing involutional processes in the skin and its appendages, but also by structural changes in the muscles, fatty tissue, ligamentous apparatus, and bones of the facial skeleton ^[8,10].

Age-related changes in the epidermis are manifested by its thinning, emerging foci of hyperpigmentation and neoplasms. Aging of the dermis is manifested by a gradual change in the structure of its collagen and elastic fibers, depletion of the intercellular matrix, and desolation of the vessels of the microcirculatory bed. A decrease in the secretion of sweat and sebaceous glands causes xerosis and itchy skin disorder. In addition, involutional changes in tissues of the facial area include redistribution of subcutaneous fat - hypertrophy and subsequent migration of superficial fat packets, atrophy of deep fat packets, stretching of ligaments, changes in the tone of facial muscles, bone resorption^[11,13]. These processes lead to changes in the configuration and deformation of the soft tissues of the face, neck and décolleté - wrinkles and folds, decreased volume of the face’s middle, and sagging of the face’s lower third^[12].In 1974, based on the prevalence of certain visual signs of aging, I. I. Kolgunenko identified general patterns of age-related changes, which allowed to identify six morphotypes of aging - muscular, fine-wrinkled, tired, deformational, combined, as well as senile face deformation [9]. Currently this classification is still widely used for development of an individual plan for cosmetology correction of age-related changes in face, neck and décolleté areas. For instance, in patients with tired, deformation, mixed morphotypes of aging, as well as with senile face deformation, cosmetology correction should begin with improvement of the lymph flow, facial and skeletal muscles tone, tissue microcirculation, which leads not only to their blood filling, but also to the forced removal of tissue metabolites^[14,15,16].

Consequently, lymphatic drainage of tissues promotes neutralization and accelerated removal of harmful substances existing in the interstitium, and also improves the regenerative potential of tissues due to better blood circulation and oxygenation of the treated area. Consequently, these procedure can be used not only for tissues preparation for subsequent cosmetic procedures, but for purposes of rehabilitation after apparatus-supported, injection and other aesthetic corrections ^[9,17,18].

One of the most advanced and effective methods that are currently used to improve the lymph flow and microcirculation in tissues, normalize the tone of facial and skeletal muscles, as well as trigger synthetic processes in the dermis is the STT-sculpting with a Beautylizer apparatus (Beautyliner Group, Russia). This method is based on vibration and compression effects on tissues using special rotating spheres. In addition, the apparatus has a SMART-TOUCH skin pressure control sensor system. The sensor pressure control system amplifies the effect by correctly and safely distributing the load on the patient's body, which makes the procedure using the Beautylizer apparatus comfortable for both patient and operator.

The objective of this study was to investigate the effectiveness of vibration compression massage using the Beautylizer apparatus in patients with involutional changes in facial skin.

The study covered 20 patients from 25 to 59 y.o. (mean age 46±5.7 years) with involutional changes in facial skin and was conducted in an outpatient setting. Each patient received 10 procedures, twice a week.

Inclusion / Non-inclusion / Exclusion criteria

Inclusion criteria:

• young and middle-aged patients (25 to 68 y.o.);
• signs of involutional changes in facial skin;
• absence of contraindications for performing vibration compression massage procedures;
• informed consent signing;
• willingness to follow doctor's recommendations.

Non-inclusion criteria:

• patient participation in another study;
• decompensation of somatic disorders;
• mental disorders in past medical history;
• any correction of involutional skin changes within the last 6 months;
• pregnancy and breastfeeding.

Criteria of exclusion from the study:

• emergence of non-inclusion criteria in patient during the study;
• progression of adverse events or complications requiring discontinuation of therapy;
• the patient's desire to withdraw from the study.

Clinical study methods

Efficacy was assessed at the end of the study (5 weeks after the start of therapy).

Global Aesthetic Improvement Scale. The treatment effect was assessed using the Global Aesthetic Improvement Scale (GAIS). The effect was scored on a scale from 1 to 5.

Special study methods

Study of qualitative skin characteristics. The qualitative skin characteristics before and after treatment were studied using the Aramo Smart Wizard (ASW) (Aram Huvis Co., Ltd) skin diagnostic device (dermatoscopy) under magnification, RZN 2018/6812.

The level of moisture, elasticity and severity of wrinkles were measured. Measurements were taken on the skin surface under standard conditions within the right cheek area.

The X30 lens and the "Wizard" software were used. Pixels in the matrix: 1600x1200 pixels. WIFI image resolution: VGA (640x480), USBVGA (640x480) / 2M (1600x1200). Frame rate of VCA (640x480) - 30 (frames per second), 2M (1600x1200) - 15 (frames per second).

To make sure the measurement results are accurate and credible, it is recommended to conduct diagnostics on the skin of the face after removing makeup. Sweat or oil may affect the results of facial skin diagnostics. It is recommended to remove sweat from the skin surface with a special tissue before taking measurements. If the measurements are to be taken with a makeup on, lightly wipe the face with a tissue. The measurement results may be influenced by temperature, environment and seasonal changes.  If sensors are used for measurement, the results may be influenced by a sensor angle and applied pressure. It is necessary to maintain the correct angle when taking measurements. Please note that temperatures above 28°C or humidity above 80% may have an impact on the condition of the skin and, therefore, measurement results.

Table 1. Global Aesthetic Improvement Scale (GAIS).

Statistical methods

Statistical analysis was performed using StatTechv software. 4.0.4 (developer - Stattekh LLC, Russia).

Quantitative indicators were assessed for compliance with normal distribution using the Shapiro-Wilk test (with less than 50 subjects) or the Kolmogorov-Smirnov test (with more than 50 subjects).

Quantitative indicators with a normal distribution were described using arithmetic means (M) and standard deviations (SD), and the boundaries of the 95% confidence interval (95% CI).

In the absence of normal distribution, quantitative data were described using the median (Me) and the lower and upper quartiles (Q1 - Q3).

The normally distributed quantitative indicators calculated for two related samples were compared using the paired Student's t-criterion was used.

The quantitative indicators with abnormal distribution in two related groups were compared using the Wilcoxon criterion.

Results

The study included the post-therapy GAIS score analysis.

Figure 1. Dynamics of GAIS scale data in patients with involutional skin changes after using Beautylizer

According to the GAIS scale, 10% showed exceptional improvement, 40% showed significant improvement, 35% showed improvement, and 15% showed no change.

Table 2. Skin quality parameters before and after using Beautylizer. Changes in skin hydration before and after therapy were analyzed.

Table 3. The skin hydration before and after therapy
 * - differences in indicators are statistically significant (p< 0.05)

The analysis showed that the statistically significant changes (p< 0.001) were observed for the “hydration” indicator (method used: paired Student’s t-test).

Figure 2. The skin hydration before and after therapy. Changes in the skin elasticity before and after therapy were analyzed.

Figure 3. The skin elasticity before and after therapy.

Table 4. Changes in skin elasticity before and after therapy.
 * - differences in indicators are statistically significant (p< 0.05) The analysis showed that the statistically significant changes (p< 0.001) were observed for the “elasticity” indicator (method used: paired Student’s t-test)

Table 5. Changes in severity of wrinkles before and after therapy * – differences in indicators are statistically significant (p< 0,05). The analysis showed that the statistically significant changes (p< 0.001) were observed for the “severity of wrinkles” group (method used: Wilcoxon test).

Figure 4. Skin hydration and elasticity before and after therapy. Changes in severity of wrinkles before and after therapy were analyzed.

Figure 5. Severity of wrinkles before and after therapy

Figure 6. Severity of wrinkles before and after therapy