Skin care has an even brighter future thanks to the newest use of light emitting diode (LED) technology that does everything from energize skin cells to stop the P.Acnes bacteria dead in its tracks. LED technology commonly lights digital clocks, car dashboards and the readouts on stereos and DVD players. Form a skincare perspective, it’s the basis for photomodulation, an elegant scientific process that sends calibrated packets of light into the dermal layer, setting off a frenzy of cellular activity to produce softer, more youthful-looking skin. Originally developed by NASA to improve wound healing and tissue growth in space, this deceptively simple science is now poised to revolutionize the skincare market.

“LED photomodulation represents an important departure from lasers and intense pulsed light systems (IPLs), which rely on the thermally injuring the skin to prompt an increase in collagen production,” says David McDaniel, M.D., dermatologic surgeon, fellow of the International and American Societies of Dermatologic Surgery, and noted clinical investigator who has played a pivotal role in the advancement of cosmetic lasers, IPSs and LED photomodulation devices. Dr. McDaniel is also the director of research and innovation for Light BioScience, Virginia Beach, Virginia, makers of the GentleWaves LED photomodulation device.

"LED photomodulation takes an entirely different approach by stimulating the cytochromes-a protein that responds to light and color- prompting the skin's fibroblasts to pro- duce collagen and elastin proteins," explains Dr. McDaniel. "It's a natural photobiochemical reaction that's similar to photosynthesis in plants, which triggers the body to convert light energy into cell energy. By using specific wavelengths and frequencies, LEDs can also treat acne scars by stimulating collagen formation and slowing the production of collagenase, an enzyme that causes collagen to break down."

Naming Lightwaves
The newest LED skincare technology is referred to by many names including photomodulation, LED photorejuvenation and biostimulation. Cosmopro in Daytona Beach, Florida, recently rolled out its sleek Rejuvalight II LED unit, with many other equipment companies following suit. Device designs range from boards with an array of LEDs for hands-free therapy to the more common handheld wand with LEDs embedded in the tip. Either way, the overall power of these machines is less than that produced by a 25-watt light bulb, making them cool enough to treat both sensitive and ethnic skin types.

An LED rejuvenation treatment simply entails exposing a client's skin to a cluster of diodes for a short time. The GentleWaves device, for instance, has two hinged panels allowing the entire face to be treated in about one minute. The time needed to treat the skin with a handheld device varies according to the size of the targeted area.

While estheticians are reporting great results with photomodulation therapy alone, they frequently enhance the overall results of their treatments by performing an LED rejuvenation treatment in conjunction with other skincare modalities.

"We've had wonderful results with our LED photorejuvenation treatments," says Caroline Weber, esthetician and owner of the Pure Essence Skin Care Clinic in Danville, California. "We normally give our clients six treatments that are done 7 to 10 days apart. We've found that we get the best results by using a mix of modalities that we perform at separate times. We often do a microdermabrasion treatment or a lactic acid exfoliation first, for instance, since LED devices can't exfoliate the skin." Weber also notes that after clients finish a series of LED photomodulation treatments, they frequently opt for a maintenance course involving an LED therapy every four to six weeks. Physicians are taking this same approach by doing a series of LED photomodulation therapies in conjunction with dermal fillers, Botox, chemical peels, lPL and laser therapies.

Specially modulated red and near-infrared LEDs are most commonly used for treating aging, photo-damaged or blotchy skin. The newest LED devices for skin rejuvenation are typically based on NASA research that has established optimal wavelengths for tissue and wound regeneration at 680, 730 and 880 nanometers (nms).

Making Miracles
Specifically calibrated blue or blue-violet LEDs are being used to treat acne. These LED devices handily control breakouts by setting off a cascade of cellular activity that creates a deadly environment for the P.acnes bacteria. The OmniLux Blue LED at 415 nms- developed by Photo Therapeutics Limited-has recently been cleared by the Food and Drug Administration for the treatment of inflammatory acne. Photo Therapeutics received official clearance after conducting clinical studies that showed a 74% improvement in 86% of all test subjects suffering from acne. While the OmniLux Blue LED is sold only to physicians, the new Acne Lift by Inner Act in Reno, Nevada, uses similar "blue" technology and is currently available to day spas.

From a medical standpoint, LED devices have been used in German clinics for many years to hasten the healing of painful bedsores. In the United States, NASA has used LED technology to improve the bone and muscle tissue of astronauts in micro- gravity, as well as to grow food in space. Because LED photomodulation influences the behavior of skin cells, studies are underway in the areas of vitiligo-a spotty loss of skin pigment-hair growth, precancerous and nonmelanoma lesions, and even brain tumors. The Department of Defense is conducting studies on 'the effective ness of using LEDs for healing eye injuries, particularly damaged retinas. Diabetes researchers are studying LED technology to improve circulation of the extremities and diminish the risk of nonhealing wounds. Because anecdotal evidence now suggests that LEDs may also play a role in the suppression of herpes breakouts, clinical trials are underway to see how effective this technology might be against this persistent virus.

"I have a client who consistently developed a cold sore once a month," says Maddie Conklin, esthetician and owner of A Personal Touch by Maddie in Walnut Creek, California. "I did a series of LED treatments around her mouth to soften the fine lines, followed by a monthly maintenance for several months. During that entire time, she never broke out with cold sore. Two months after discontinuing treatment, though, her cold sore pattern returned. I gave her two more LED therapies a few months later, and she didn't break out for another three months. I can't help but think there's some correlation between LEDs and herpes activity."

Smoothing Things Over
From a purely esthetic perspective, LED photomodulation has already proven to be a powerful skincare tool. Studies have shown that this light technology increases circulation, reduces puffiness, smooths and brightens the complexion, lessens hyperpigmentation, and improves the appearance of fine lines and wrinkles.

"One of the biggest challenges with LED photomodulation is that it almost seems too good to be true," says Robert Weiss, M.D., dermatologist, assistant professor of dermatology at Johns Hopkins University School of Medicine, and founder of the Maryland Laser, Skin and Vein Institute in Baltimore. "To a physician, LED photomodulation seems counterintuitive. I was skeptical that a low-energy source could actually stimulate cells and improve the texture, color and firm- ness of the skin. Even so, we agreed to enroll 30 people in a clinical study for the GentleWaves Photomodulation device, and then send the data to the FDA. We also opted to study an additional 30 test subjects.

"For accuracy, we did digital photography using a clamp-like device to ensure that every test subject's face was in exactly the same position for each photograph, and the results were impressive. By the fourth treatment there was improvement in the skin, including a reduction of fine lines, and less blotchiness or background pigmentation. We did skin biopsies on five patients after two months and four months, and found a very uniform deposit of collagen in the papillary dermis. After doing eight sessions over a four-week period, we ceased treatment. We've now been following up with this test group for nine months, with 12 months being our goal. Surprisingly, their skin continue to improve even though it has been months since their last LED photomodulation treatment."
LED photorejuvenation has even been shown to reduce pore size. In a recent study conducted by Drs. McDaniel, Geronemus and Weiss, 90 subjects with photodamaged skin showed documented improvements ranging from:

*62% global improvement of the periorbital region.
*36% improvement on the upper lip.
*27% reduction in skin roughness.
*25% reduction in redness.
*30% improvement in the elasticity of the skin.

"I've personally found that LED therapy takes care of many skin conditions," says Oanielle Oepert, esthetician for Body & Soul Spa by Slender Elegance in Scottsdale, Arizona; "I use our PhotoActif LED machine to reduce signs of rosacea and acne scarring. I often do an LED therapy by itself or use it during hydrating and lifting facials. Softening the appearance of fine lines and wrinkles requires several treatments, but improved skin texture can usually be seen after one treatment. Another benefit for clients receiving an LED therapy is that they never leave the spa with any skin redness."

LED devices are also gaining favor with body therapists who are faced with the daunting task of treating the appearance of cellulite. In addition to homecare regimens that include a healthy lifestyle, daily dry brushing and using anticellulite products, Veronica Stetson, massage therapist for Body & Soul Spa by Slender Elegance, reports seeing improved results when she includes LED photo- modulation in her cellulite therapies.
"I've always been quite aggressive when treating cellulite by doing a deep-tissue massage technique that can be painful to clients, especially if they have hard cellulite," she says. "Since getting our LED device last November, I find that I only have to do a light massage in conjunction with an LED photomodulation session to get significantly better results. There's less swelling in the lymph nodes, for instance, and better circulation.

"I've also noticed a visual improvement in engorged capillaries and veins. 'My spider veins are fading,' is a typical comment I hear after clients have had a few LED treatments. I've even noticed an improvement in the bruising of one client who suffers from lupus and has to take blood-thinning medication. After doing a series of light therapies for cellulite, I was surprised to see that her legs hardly looked bruised at all."

Taking a Cautionary Stance
As good as all this information may sound, there are some strong cautions for day spa owners who are contemplating buying one of these devices. It's still very much a "buyer beware" market, making it imperative to deal only with reputable manufacturers. Naturally, there's the efficacy of the device to consider and the somewhat hefty price tag: LED units for the medical field are averaging about $30,000, with esthetic models ranging from $6,500 to $9,500. One exception is the new Max7 by Flip4 in Montreal, Quebec, Canada, that's ringing up at $25,000 to $30,000. This unusual LED machine uses seven different colors and 10 different programs to provide photorejuvenation treatments for a variety of skin conditions.

"Manufacturers are definitely racing to market with LED devices, although many may be no more effective than shining a flashlight on the skin," says Mitch Goldman, M.D., dermatologist, founder and medical director of both La Jolla SPA MD and Dermatology/ Cosmetic Laser Associates of La Jolla, La Jolla, California. "You need to see hard evidence that a particular machine can perform as promised. Ask: What is the basis for this device and how has it been proven to work?"

Buying the right machine "is essential to the efficacy of your treatments, as well as the reputation of your business," says Dr. McDaniel. "We've clearly demonstrated many times that not all LEDs are created equal. Depending on how the parameter codes are modulated (precise color or wavelength, pulsation of light, optics and other factors), the results can vary from great to having no effect at all."

Lighting the Future LED photo modulation is in its infancy, with the first devices on the market using only a fraction of what's possible with this fascinating technology. Companies are currently pursuing the physical therapy market with new wraparound" LED pads that encircle areas that are prone to soft tissue injury. Larger units are being planned for full-body LED therapies to improve sun-damaged skin. These designs, by the way, are ranging from a substantial array of LEDs mounted on panels, to an LED booth-modeled after a tanning booth-to treat full body sun damage in minutes.

When it comes to the future of LED photomodulation, I envision great things," says Dr. McDaniel. I believe it's going to affect many, if not all, areas of medicine, as well as basic light science and healthcare research. Our newest research with solar simulators, for instance, indicates that LED photomodulation can be used to reverse some of the negative effects of UV A radiation at a genetic level. Photomodulation of the gene and DNA activity in living cells may even afford scientists a glimpse into some of the mysteries of life itself. There are so many potential applications for LED photomodulation that, given enough funding and qualified manpower, a new research project could be started every month." .

J. Elaine Spear is a former salon owner a DAYSPA contributing editor and spa/salon consultant to major corporations. She's based in Santa Fe, NM.