Dr Martin Godfrey explains how effectively using nutraceuticals can improve aesthetic treatments and wound healing
Medical practitioners of all specialties have long understood the importance of good nutrition in determining optimal treatment outcomes. Ensuring patients receive a healthy balance of protein and carbohydrates in particular, together with boosting levels of vitamins and minerals if needed, has been widely suggested to be almost as important as the treatments themselves. This is particularly the case for skin health and wound healing1 – two central issues in the practice of aesthetics. Now, many practitioners are looking closely at going one step further: boosting and focusing the positive effects of good nutrition with the use of nutraceuticals (often referred to as ‘nutricosmeceutials’ in the aesthetic world). These terms are used to describe any product derived from food sources with extra health benefits in addition to the basic nutritional value found in foods.13
Collagen levels and the presence of free radicals in the skin are critical factors in determining skin health. For the skin to function normally and appear young the structure of the dermal layer must be maintained, as the dermis, which provides structural support to the epidermis, carries the blood vessels and supplies the skin with important nutrients for its functioning.2
The dermis is home to fibroblasts, which generate the collagen as well as elastin and hyaluronic acid. Natural ageing, usually accelerated by the presence of free radicals, will affect this structural integrity, plus sun-exposed areas of the body will develop signs of photoageing – the result of the breakdown of collagen fibres.2 It is estimated that we lose about 1.5% of our collagen from our skin every year as we age.3
Both these types of ageing can be exacerbated by unbalanced diets, for example, containing too much sugar, and/or poor diets, which lack essential nutrients such as essential fatty acids.4 High sugar levels lead to the development of Advanced Glycation End products (AGEs), due to a chemical reaction between glucose and the free amino groups in proteins. AGEs remain in the skin and other tissues because they cannot be degraded normally by enzymes. These affect the fibroblasts in the dermis, causing a reduction in the amount and quality of elastin and type I collagen fibre production.2
Moreover, aged fibroblasts synthesise lower levels of collagen, both in vitro and in vivo, compared to young adult fibroblasts.5 This results in visible signs of ageing (development of fine lines and wrinkles, sagging and loss of tone), which are usually most prominent on the face, and also have a negative effect on wound healing – although this latter effect remains to be conclusively clinically proven.
Few studies have been carried out to confirm the effects of supplemental oral collagen peptides in conjunction with aesthetic procedures, but initial published results are promising
One approach to supporting the skin as it undergoes the necessary trauma of aesthetic procedures is to boost the collagen production within the dermis. Since collagen cannot penetrate the tight junctions of the epidermis, doctors are increasingly looking at oral collagen supplements to support collagen synthesis from within, rather than using only topical treatments externally. The addition of oral antioxidants may also reduce the harmful effects of free radicals, allowing collagen to remain in the skin for longer.6
It is worth noting that the amount of transport across the intestinal barrier is a rate-limiting step that will affect the efficacy of these compounds in the skin. In order to be active in the deeper layer of the skin, native collagen has to be hydrolysed to cross the intestinal barrier and reach the blood stream. Second, given that the dermal tissue contains fibroblasts, the bioactive collagen peptides that arrive in the blood stream must bind to fibroblast membrane receptors and stimulate these cells to produce new collagen, elastin and hyaluronic acid.2 Few studies have been carried out to confirm the effects of supplemental oral collagen peptides in conjunction with aesthetic procedures, but initial published results are promising. One such study published last year in Clinical Interventions in Ageing,7 indicates an improvement in the depth of nasolabial folds in patients undergoing an aesthetic procedure, with and without a nutricosmeceutical. Interestingly, the results were similar in both the patients that had filler injections and a collagen supplement, and those that received the collagen supplement alone – suggesting the nutricosemeceutical had a true effect of its own. On the strength of both this clinical and observational/anecdotal evidence, aesthetic practitioners, particularly in the UK, Italy and the US, are increasingly turning to nutricosmeceuticals to support improved outcomes and longer lasting effects for their procedures.8
Various other oral (and topical) treatments for wrinkled and photoaged skin are sometimes used to augment aesthetic procedures, with products containing retinoids recognised as a benchmark. Retinoids are a family of compounds made up of various mixtures of vitamin A and its derivatives, and follow the vitamin A pathway when ingested or applied. Retinoid treatments gained popularity in the 1980s partly because of the work of Kligman et al.9 Studies have indicated that the end process may be similar and that collagen content can be increased in the upper papillary dermis by retinoids. This process is carried out by inhibiting collagen degradation, thereby leading to an increase in collagen synthesis.10
The use of retinoid creams in aesthetic procedures is becoming more common today since the benefits have been indicated to be positive, for example in patients where these products were used before they were subjected to chemical peels and dermabrasion.11 However, adverse effects such as skin irritation, dryness, burning, and erythema are common and well documented.12
Larger studies of nutricosmeceuticals containing both collagen peptides and antioxidants are underway both in pre-treatment and during aesthetic procedures, but until results are published, hard proof of their efficacy is frustratingly still a year or so away. Ultimately, the decision to recommend nutricosmeceuticals to patients belongs to the aesthetic practitioner. Intuitively it would seem sensible to recommend that patients eat healthily both before and after their procedures, including a high intake of fruit and vegetables (particularly those high in antioxidants). Reducing intake of foods with high sugar content may also be sensible. Tantalisingly, the scientific jury is still out on nutricosmeceutical use. I believe, however, the prospects look very promising.