Contrary to popular belief, age-related changes are not the main cause of skin aging. The most important factor is skin damage, primarily damage from ultraviolet rays of type B.
UV irradiation leads to a decrease in the synthesis of hyaluronic acid by fibroblasts and at the same time enhances the processes of HA degradation, while the degradation products accumulate in the skin and are removed from it rather slowly.
In fact, this process is a protective reaction, since ultraviolet irradiation is an important factor in carcinogenesis, and hyaluronic acid is involved in the migration and screening of tumor cells.
What leads to a decrease in hyaluronic acid in the skin
A local increase in the amount of hyaluronic acid is a marker of some types of tumors, and enzymes that destroy hyaluronic acid often act as tumor suppressors.
Today, seven types of different hyaluronidase-like enzymes are known that are involved in the degradation of polysaccharides, and hyaluronic acid in particular.
Hyaluronidases belong to metalloproteinases, the mechanism of their activation is not yet fully understood, but it can be said with confidence that the activation of metalloproteinase synthesis is controlled by complex neuroendocrine-immune mechanisms.
Impaired synthesis of metalloproteinases can lead to the development of severe systemic diseases, such as rheumatoid arthritis.
When hyaluronic acid is destroyed, small fragments of it can induce an inflammatory response in macrophages and dendritic cells, resulting in permanent tissue damage: this is a serious problem in skin grafting.
If we take cosmetology, then here such physiological reactions, developing, in particular, after the introduction of fillers based on hyaluronic acid, can lead to excessive granulation of tissues and the development of granulomas, which is interpreted as a complication after injection.
Unfortunately, it is very difficult to predict such reactions, and therefore, it is almost impossible to prevent them. The only way to completely avoid granulomas after a filler is to avoid using fillers (as in the old joke about the ideal method of contraception: "Tea is not before or after, but instead").
So, what can we expect when using hyaluronic acid in cosmetic practice?
In order to understand when and how it makes sense to use hyaluronan, it is necessary to consider the various routes of its administration.
Ways of administration of hyaluronic acid
First of all, the effect of superficial moistening of the stratum corneum when applying hyaluronic acid is interesting. HA belongs to a class of humectants, moisturizing ingredients that attract and hold large numbers of water molecules hundreds of times their own molecular weight. HA is easily combined with other humectants such as glycerin and marine polysaccharides.
How does hyaluronic acid work in the body?
OUTDOOR APPLICATIONS
1. The main point to be considered when applying products based on hyaluronic acid is the humidity of the air.
When the air humidity is low, hyaluronic acid has the opposite effect, drying out the upper layers of the skin and tightening them, which quickly creates a feeling of tightness and stiffness of the face.
This can be avoided by immediately applying a nourishing or moisturizing cream in the form of an emulsion after applying the HA-based preparation, which will prevent the moisture from being "pulled" out of the skin.
In humid climates, hyaluronic acid preparations can be used in isolation, without any additions.
2. Low molecular weight forms of hyaluronic acid have been actively used in topical forms of anti-aging drugs in recent years.
The small size of the molecule (from five thousand to 20 thousand daltons) allows HA to penetrate into the deep layers of the epidermis, which creates the effect of stimulating the basal layer of the epidermis and affects the dermal matrix.
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In addition, some low molecular weight forms of HA act on fibroblast receptors, in particular on receptors of the CD44 type, which slows down the degradation of its own HA and somewhat enhances its synthesis. In general, low molecular weight forms of HA help to improve skin tone and even create the effect of partially filling formed wrinkles with regular use.
3. However, there is a catch here: low molecular weight fragments of HA are irritating and can increase inflammation in the skin, leveling the beneficial effect.
4. Relatively large HA molecules, having a size of about 500 thousand daltons, do not penetrate into the deeper layers, but at the same time they have an anti-inflammatory and calming effect.
This is especially pronounced when using large molecule HA preparations after laser resurfacing, chemical peels or other skin lesions. You can also recommend such drugs during the course of therapy with retinol and its derivatives, to reduce the severity of the inflammatory effect.
5. Preparations containing several forms of hyaluronic acid at the same time have a fairly universal effect. They can be used to correct wrinkles, improve skin tone, moisturize and soothe, and rehabilitate after traumatic procedures.
INJECTION
Injection correction of wrinkles, contouring, reshaping of the face, as well as the introduction of HA preparations by mesotherapy for general hydration and revitalization of the skin, are probably the most popular aesthetic medicine procedures in recent years. Many drugs on the market provide similar results to one degree or another.
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It is important for practitioners to understand that the quality of the drug always determines the nature of the effect of the procedure, but side effects and complications are possible even when using the highest quality and proven drugs.
Hyaluronic acid is present in the connective tissue, dermis and epidermis, and its amount is regulated by natural mechanisms.
Any introduction of HA from the outside activates the mechanisms of regulation, therefore, contouring, etc. cannot be considered a completely controlled process: after the drug enters the skin, the rate of its degradation and probable changes in tissues will be determined by the state of health and the individual characteristics of the body as a whole.
The effect of external rejuvenation, reduction of wrinkles and improvement of skin tone may last for a different time.
It is important to understand that any introduction of significant amounts of HA locally leads to activation of the synthesis of metalloproteinases, which also include collagenases and elastase, the synthesis of which is closely related to the synthesis of hyaluronidases.
Therefore, the degradation of the injected hyaluronic acid can occur with a simultaneous increase in the degradation of its own collagen and elastin, which does not contribute to maintaining the elasticity of the skin.
In general, I would like to once again warn specialists against excessive enthusiasm for injecting HA, primarily against using this method too often.
Local administration of HA preparations to compensate for the deficiency of one's own HA has a therapeutic and aesthetic effect, but the use of HA for "prophylactic injections" is highly debatable.
Oral use of hyaluronic acid
In recent years, a fairly large number of nutritional supplements based on hyaluronic acid have appeared on the market. It is proposed to use them for the purpose of rejuvenating and moisturizing the skin, preventing aging, protecting the skin from damage from ultraviolet radiation, etc.: in general, reading the labels of such drugs gives the impression that a panacea for all diseases and old age has finally been found.
Experiments with the introduction of hyaluronic acid labeled with radioactive isotopes through the digestive tract of rats have shown that about 90 percent of HA is completely digested in the gastrointestinal tract and is subsequently used as an energy substrate in the structural processes of the rat body.
Actually, any kind of food is digested in this way, and polysaccharides ("long carbohydrates") in particular. Within 96 hours of ingestion of labeled HA, the amount of radioactive isotopes in the skin was quite high and exceeded the number of isotopes in the blood.
Thus, it can be assumed that the consumption of hyaluronic acid in food or nutritional supplements can have a beneficial effect on skin condition.
Unfortunately, despite the popularity of these dietary supplements, reliable studies on the effectiveness of the use of HA preparations to prevent skin aging are extremely difficult to find. However, we can say with a high degree of certainty that it is quite safe.
Recommendations for the use of hyaluronic acid preparations by cosmetologists
In conclusion, we will formulate a number of recommendations for cosmetologists on the use of hyaluronic acid preparations. It is recommended to prescribe external forms of preparations based on hyaluronic acid deliberately, taking into account the characteristics of the preparation and some external factors.
Rules for the use of hyaluronic acid:
• To moisturize and soothe the skin, it is optimal to use preparations based on large-molecular HA: in the form of lotions, gels or masks. It is possible to use them for the correction of dryness and irritability of the skin, rehabilitation after traumatic effects or for certain diseases (xerosis, actinic keratosis).
• Low molecular weight forms of HA are recommended for the correction of wrinkles and age-related changes in the skin, for a limited time and, possibly, in combination with soothing drugs. Complex (high-molecular-low molecular weight) preparations can be considered as universal cosmetic products with anti-aging, soothing and moisturizing effect.
Peculiarities of removing hyaluronic acid from the body: recommendations for specialists!
• At high air humidity, it is possible to prescribe HA preparations in isolation, at low humidity it is recommended to use them in combination with lipid-based nourishing creams.
• Injection correction with HA preparations must be justified, taking into account indications and contraindications. Injection procedures should be carried out with sufficiently long breaks.
• Combined use of external and injectable forms of preparations based on HA is possible.
• HA supplements are generally safe, but their effectiveness is currently debatable, so prescriptions of this kind can hardly be considered therapeutic.
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