Understanding the benefits of the cryotherapy in order to develop the CRYODERMIE®.

Cryothérapie

Cryotherapy is the local or general use of low temperatures for therapeutic purposes. Cold temperatures can be reached by various methods: physical, chemical or gaseous.

1/ History

Cryotherapy goes back as far as 400 years BC. Hippocrates himself described the use of ice to treat and heal wounds. Because of the difficulty to generate low temperatures, it was not widely used. Recent advances in modern technology have made possible the stabilization of freezing temperatures.

2/ Thermal shock

Experimental studies on induced hypothermia (cryotherapy) have shown the effectiveness of the thermal shock. However, it is only efficient under one strict precondition: the cooling process must be done over a very short time span. Slow and gradual cooling will significantly and negatively impact the results. Indeed, we now know that the thermal shock allows for a more controlled management of conduction and convection mechanisms as well as other medically induced “stunning” (sideration) procedures.

3/ Techniques

Production of low temperatures can be reached through various techniques:

- Ice:
It is the oldest and easiest way to use the virtues of the cold. Yet it is not the most efficient way because of poor conduction, the thermal shock is superficial and the reached hypothermia is quickly lost as soon as the ice is not in contact with the skin anymore.

- Cooling gel (ice pack):
It is simple and easy-to-use because the gel is inside a pack and stored in a freezer. Benefit: the thermal shock is effective and lasts longer. Limitation: because the frozen gel is contained in a pack, it does not always precisely fit the areas to be treated. A thin layer of air can be located between the pack and the skin, which significantly reduces thermal conduction and therefore the effectiveness of the thermal shock.

- Spray cryotherapy:
A more recent technique, spray (gaseous) cryotherapy consists of spraying micro-cristals of nitrogen on the skin which, by sublimation, generate a thermal shock. This technique is quite efficient, but requires a very strict procedure as well as potentially dangerous spray cans.

- Electronically stabilized cold
This is the most advanced technology, derived from the works of world-renowned physicist Peltier.

The Peltier Effect

The Peltier Effect

The effect of heating or cooling at the junctions of two different conductors exposed to the current was named in honor of the French physicist Jean Peltier (1785–1845) who discovered it in 1834. It was found that if a current passes through the junction (J) of two dissimilar conductors (N and P) in a circuit, a temperature differential appears between them. This briefly described phenomenon is the basis of thermoelectricity and is applied actively in thermoelectric cooling.

Thermoelectric coolers operate by the Peltier effect (which also goes by the more general name thermoelectric effect). The device has two sides, and when DC current flows through the device, it brings heat from one side to the other, so that one side gets cooler while the other gets hotter. The "hot" side is attached to a heat sink so that it remains at ambient temperature, while the cool side goes below room temperature.

Two unique semiconductors, one n-type and one p-type, are used because they need to have different electron densities. The semiconductors are placed thermally in parallel to each other and electrically in series and then joined with a thermally conducting plate on each side. When a voltage is applied to the free ends of the two semiconductors there is a flow of DC current across the junction of the semiconductors causing a temperature difference. In some applications, multiple coolers can be cascaded together for lower temperature.

The side with the cooling plate absorbs heat which is then moved to the other side of the device where the heat sink is. Thermoelectric coolers are typically connected side by side and sandwiched between two ceramic plates. The cooling ability of the total unit is then proportional to the number of thermoelectric coolers in it.

Beyond the theory, the main interest of this technology is that it allows a total control and stabilization of the temperature, to within fractions of a degree. This explains why thermoelectric cooling is now the best technique for cryotherapy, especially since it can be small and flexible.

Cryodermie®

Basic principle

The Cryodermie® is a new form of cryotherapy entirely dedicated to aesthetic treatments. Its specific action is relevant on two levels:

  • skin cooling
  • targeted treatments, from local areas to larger ones.

Skin cooling

Based on dermatological studies, the Cryodermie® was developed at an electronically stabilized temperature of -5°C, which is the optimal temperature to use this new technique. We picked this exact temperature so that it can be used on all skin types. Cryotherapy must be done very carefully, and we took into account past and current use of freezing temperatures in order to determine the optimal one for our technology:
  • Above -5°C, the generated thermal shock is too low to get any significant results. The use of gel packs or ice only have poor results, or no result at all
  • Below -5°C, the temperature becomes too cold for the skin, resulting in the crystallization of tissue water. This change from liquid to solid state may result in skin lesions and even cryothrombosis (formation of a blood clot) in blood vessels. Intense cold should only be used in dermatological procedures to treat cutaneous malignancies.

Therefore, the Cryodermie® by Osé Group was carefully designed to both protect the skin and provide the best results thanks to an optimal thermal shock

Targeted treatments

Depending on the selected treatment (which should always be personalized to one’s skin), the Cryodermie® works on several anatomical areas:

  • Epidermis,
  • Papillary dermis,
  • Reticular dermis,
  • The upper layers of the hypodermis (subcutaneous tissue),
  • Microcirculation,
  • Free nerve endings,

given that these different targeted areas can be treated analytically and selectively or through a more global approach depending on the desired result. Therefore, the Cryodermie® is unique technique designed for targeted issues. Prior to a rigorous application of the Cryodermie®, the objectives of the treatment have to be determined and the skin itself should be analyzed precisely.

Objectives of the Cryodermie®

During the application of the Cryo probe on the skin, a transfer of cold takes place on two different levels: at the surface and in-depth. And on top of that, two mechanisms occur:

  • Conduction which, by direct contact, transfers the cold from the surface to the deep tissues, cooling the various layers of the skin.
  • Convection which uses arterial and venous microcirculation to help carry the coolness in-depth.

The combination of conduction and convection allows the Cryodermie® to reach its three main objectives.

Controlled analgesia

The use of the Cryodermie® allows a quick inhibition of nerve conduction thanks to the Gate Control Theory: the suppression of the nociceptive influx at the medullary level by stimulating the Aa et Aß fibers, and the decrease in the conduction speed of the Aδ and C fibers. Also, it creates a sideration of the free nerve endings’ nociceptors in the sensory system. This quickly obtained analgesia allows for certain treatments to be painless, such as the in-depth exfoliation of the corneous layer. This skin rejuvenating treatment would be much more painful without the thermal shock.

Intermittent vasomotion

The application of low temperature on the skin generates an instant vasoconstriction of the blood vessels as a thermoregulation reflex. This vasoconstriction by itself has no benefit in aesthetics. However, this vasoconstriction is immediately followed by a vasodilation due to the release of chemical mediators. This phenomenon is extremely interesting and is called the "hunting reaction". Cycles of vasoconstrictions and vasodilations repeat themselves, resulting in a so-called "paradoxical vasomotion" (similar to a pumping effect). The initial vasoconstriction ends up triggering the vasodilation, which is particularly interesting in aesthetics.

Cryophorèse®

Precisely, this intermittent vasomotion, and especially the vasodilation allows for a better penetration of our carefully selected active ingredients. Consequently, just like iontophoresis for electricity or sonophoresis for ultrasounds, the application of a cryogenic agent on the skin at the appropriate temperature initiates the Cryophorèse® (cryophoresis), our unique (patented) technique which perfectly describes this process (cryo: cold and phoresis: migration). Therefore, the in-depth penetration of active ingredients is an intricate part of the Cryodermie®.

Methodology

The Cryodermie® requires a precise and rigorous work ethic. The results will depend on the careful respect of the following process.

Classification (face)

  • Skin type (analog scale)
  • Fitzpatrick scale (Fitzpatrick skin typing test)
  • Additional information if necessary

Evaluation

  • Review of the structural data (imperfections, etc.)
  • Review of actual skin issues (wrinkles, etc.)
  • Review of the specific clients’ requests
  • Psychological evaluation (if necessary)

Personalized Cryodermie® plan

  • Schedule of treatments
  • Choice of the care protocol
  • Choice of the products

Performing the treatment

  • According to the chosen protocol

Practical application of the Cryodermie®

Why do we age?

First of all, skin-aging is only one of the symptoms of aging in general. It is very present in society for two main reasons:

  • It is the first symptom of aging.
  • It also represents, at least in the beginning, the most socially visible aspect of aging.

However, the question remains: why do we age?

Different theories have emerged over time, which can be classified under three categories:

Deterministic theory
All biological phenomena (including aging) necessarily find their source in genetics: skin senescence is written in the human genome.
Stochastic theory
Aging is linked to epigenic factors, which means that it is caused by molecular and cellular alterations: it would then be a progressive “wear” of the body.
Evolutionary theory
Aging would be the result of a permanent interaction between genetic and epigenic mechanisms: therefore, aging for each individual would be the result of both the genome as well as other environmental factors. Even though the latter theory seems to prevail in the scientific community, it is clear that cutaneous aging still has two main characteristics:
  • it is inevitable
  • it is irreversible
Therefore aging cannot be stopped. However, advances in science and technology have allowed us the following possibilities:
  • to slow down the process.
  • to control its development.
  • to repair its consequences.
This requires a detailed knowledge of the different mechanisms of this very complex biological phenomenon.

How do we age?

Cutaneous aging affects the skin on all levels at the same time.

  • the cornea layer of the epidermis (stratum corneum) with:
    • chronic dehydration.
    • a damaged hydrolipidic film.
    • an increase of the transepidermal water loss (TEWL).
  • The dermis, with:
    • damages to the extracellular matrix, resulting in its volumetric loss.
    • a quantitative and qualitative deficiency of the fibroblasts in their synthesis of collagen and elastin.
  • The microcirculation, with:
    • a decrease in capillary blood flow.
    • a serious hemodynamic deterioration.

The main issue in the etiological analysis of skin aging is that it is multimodal. Its causes can be either endogenous or exogenous. Therefore, this physiological process can be divided into four distinct types, although they are combined very often.

Chronological skin aging and its three key aspects:

  • the genetic programming.
  • the oxygenated free radicals.
  • the non-enzymatic glycation of proteins.

Skin photo-aging (heliodermy) with:

  • damaging effects caused by UV rays on both the epidermis and the dermis.
  • potentially serious diseases (skin cancer and melanoma).

Menopausal skin aging:

  • decrease in the quality of life because of climacteric symptoms.
  • specific cutaneous changes (flush, dehydration, atony, etc.).
  • importance of hormone replacement therapy.

Environmental skin aging caused by:

  • smoking.
  • air pollution.
  • ozone.

What are the treatments?

All skin aging treatments use one of the following four strategies, although they can be associated:

Treatments by "addition"
The purpose of this method is to treat only the visible consequences of skin aging (wrinkles, as well as the collapse of the extracellular matrix of the dermis), but not its causes. Two types of transcutaneous injections are used to ensure:
  • a filling of the wrinkles and lines with biological (collagen), non-biological (catgut) or mixed (polymethacrylate/collagen) substances.
  • a filling of the reticular dermis with a synthetic hyaluronic acid developed through biotechnology in order to restore its original volume.
Treatments by "subtraction"
It can either be done by accelerating natural exfoliation (desquamation) of the corneous layer of the epidermis, or by simply “destroying” (removing) the upper layers of the skin. There are various methods: mechanical, chemical or cosmetic. In any case, they all have the same two objectives:
  • to free the skin surface from desquamating corneocytes (dead skin cells),
  • to enhance and stimulate the migration of the keratinocytes so that the skin surface is renewed and replaced by younger skin cells, restoring an overall radiance to the skin.
Although the first objective has a more immediate and spectacular effect on the skin, the latter one is a more in-depth and lasting approach.
Treatments by "stimulation"
As indicated, this type of treatments aims at stimulating the various phenomena occurring in skin physiology. This stimulation can be achieved through physiotherapy or chemical cosmetology, or by combining both. The various techniques based on those methods have become more and more popular, thanks to the emergence of a modern theory: instead of bringing the necessary substances via external ways, it seems more relevant to stimulate cellular metabolisms which naturally synthesize these substances.
Treatments by "reconstruction"
This last option includes all the anti-aging techniques found in cosmetic and plastic surgery. It is not totally independent from the previous types of treatments because "addition", "subtraction" and "stimulation" treatments are also recommended during the post-operative period.

Why the Cryodermie® ?

The four abovementioned strategies do not result in the same therapeutic approach:

  • Treatments by "addition" are exclusive to dermatology.
  • Treatments by "reconstruction" are exclusive to cosmetic and plastic surgery.
  • Treatments by "subtraction" and "stimulation" are exclusive to aesthetics, which explains why all the major brands have chosen either one of those strategies.

What makes the Cryodermie® so unique in the treatment of skin aging?

Cryodermie® = subtraction + stimulation

"subtraction"
Why?
  • to actively exfoliate the skin surface as to dissociate the stratum disjunctum from the stratum compactum in order to eliminate the desquamating corneocytes
How?
  • by manual scrubbing using a specially-formulated exfoliating active ingredient
  • Cryodermie®: the analgesic effect makes this intensive desquamation (exfoliation) possible
"stimulation"
Why?
  • to stimulate the main cutaneous cellular metabolisms
  • to stimulate all levels of cutaneous blood microcirculation
How?
  • Cryodermie®: targeted Cryophorèse® (cryophoresis) using our specifically formulated products
  • Cryodermie®: paradoxical vasodilation