Acupuncture Malpractice Insurance – Hyaluronic Acid: The Key to Hydrated Youthful Skin
Hyaluronic acid is a natural. Substance found in the body. It’s present in large concentrations in the skin where it helps keep complexion hydrated. And plumped, we hear about hyaluronic acid a lot in our social media and regular world today.
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Hi, my name is Dr. Shellie Goldstein. I am here today from Florida. We are going to talk about hyaluronic acid and I wanna thank the American Acupuncture Council for allowing me to give this very exciting presentation today. So let’s go to the slides. Hyaluronic acid, the KE to hydrated youthful skin.
And for those of us in Florida, this is very important, but it’s also important for everybody as you’re about to see, what is hyaluronic acid? Hyaluronic acid is a natural. Substance found in the body. It’s present in large concentrations in the skin where it helps keep complexion hydrated. And plumped, we hear about hyaluronic acid a lot in our social media and regular world today.
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What you may or may not know about hyaluronic acid is it’s a humectant. And what is a humectant hum? A humectant is a protein or a substance that actually draws moisture from the environment, whether it’s from the air or from the water or wherever you are. So it takes it in from the environment and through the skin into the deeper layers of the tissue, what we call the dermal layer and below.
And a , like I said, is a substance that has the ability to attract and retain moisture. Similar to a sponge. Just you put a sponge in water, it just soaks it up and it holds onto it, and that’s what hyaluronic acid does. As we age our body, like other substances in our body, we begin to produce less and less of it.
So what happens? We start to dry out. Our skin looks dry, our tissues get dry. We get fine lines and we can get skin wrinkles. When we think of the body, let’s start with the anatomy of the face. You have the bone, which is your solid core structure of your face, layered and horizontally. On top of that is our layer of muscles.
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Then we have fat and we have skin, and what keeps everything together, it both separates, but it also joins all of the horizontal tissues of the face and the rest of the body is connective tissue or fascia. It’s like a web, as you can see in, in the image. It’s just this woven web that holds everything together in place, but it also holds the individual tissues in place as well.
The primary components of fascia are collagen. So collagen is the integrity and the support system of this tissue. It’s like the mattress. It’s gives you the support, gives you the volume of that you need and see in your skin tissue. Whereas the next in protein is elastin. Elastin isn’t so much volume, but.
It allows that snapback. So if you take your skin and you lift it, and you drop it, elastin is what you need in order like that rubber to snap back into place once you lift and let it go. And then there are fibroblast cells, or small protein. That when stimulated is what produces collagen or what stimulates the production of collagen in the fascia.
It also affects many immune and inflammatory responses, and it’s very important for wound healing as we’re gonna learn in a few minutes. And then there’s hyaluronic acid. It’s the moisture this . Substance that bathes all of the other proteins, the collagen, the elastin, the fibroblasts, and other cells that are in this area, what we call the extracellular matrix.
Hyaluronic acid is in the image, is this a little red line and it has a surrounding it, what we call protio glycans and protio gly cancer. What attracted those water molecules to the hyaluronic acid? It is so effective that hyaluronic acid molecule can hold up to 10 a thousand times of its molecular weight and water, which makes it responsible for th up to 30% of the skin’s national natural moisture retaining ability it has.
So here’s . Hyaluronic acid strand and then attached to what are bound to the hyaluronic acid are protio, glycans, and protio. Glycans are what the water molecules attach to, and you can see it in this area. In the lower image, you can see the hyaluronic acid and green, the protio glycans are those little
Feathers that stick out from the hyaluronic acid. In red, elastin and collagen that woven matrix of different colors of blue. So all of these are in fascia and in the what we call the extra cellular. Matrix in the face, hyaluronic acid is primarily located in the dermal layer of the skin, which is the second layer of the skin.
And we’ll look at this for a minute, and it’s found throughout. This matrix is found throughout loose connective tissue of the superficial layer of the skin. Below the deep layer of fascia, and it’s generally found in places aside from the skin, in places that are moist, like the oral cavity, the cartilage of the nasal structure and blood vessels, and in the mucosa membranes of the face here, although the structure of fascia layers varies across different areas of the phase.
Here we see it where the stars are. So the very top layer of skin is the epidermis. It’s what we see when we look at someone else, when we look in the mirror. And then just below the epidermis is the derma layer, and this is the true health of the skin. So the surface is the surface layer, the epidermis, and just below it is what we call the dermis.
And this is where we see most of the hyaluronic acid, the extracellular matrix, and all of the nutrients and proteins that keep cells nice and healthy. And then underneath that we have the superficial Retin Macular Cuts fibrous. And those are not horizontal. They’re vertical structures like ligaments that hold those horizontal structures in place.
I. Below that, we have a fat layer, which gives our skin plumpness. And then below that we have the superficial fascial membrane. And this membrane actually attaches the above layers to the below layers, another layer of ligaments. And then we have another layer of fascial membranes, which don’t have as much hyaluronic acid, but because of that, underneath it as an entire layer of hyaluronic acid or extracellular matrix.
And then we have the lining of the muscles epimysium and then the muscles themselves. So this is lining, you can see multiple layers of hyaluronic acid, which keeps this entire tissue layering nice and hydrated, nice and wet, so that things slip around and slide more effectively. So in acids, the benefits of hyaluronic acid are that keeps skin nice and plump.
When skin is nice and plump and hydrated, it minimizes wrinkles and fine lines. There are many different types of wrinkles. I’m talking about wrinkles at this. Moment that are related to skin dehydration, it increases skin elasticity and slide remembering that the elasticity is the elastin or the snap back in our skin tissue, and that all of those, that proteins need to stay wet.
In order to work effectively. And then also remembering that wetness allows those horizontal planes to slide back and forth. When we don’t have enough hyaluronic acid in our skin, we get dry. It gets irritated and then you start to see facial redness, irritation, even to the point where you have skin breakouts and dryness.
Like eczema and psoriasis. And then also remembering that we have fibroblasts in that extracellular matrix. And so without that wetness or moisture we have difficulty having our wounds heal. So hyaluronic acid and providing that moist environment helps the fibroblasts development and assisting assist in wound healing.
And here’s an example of this. So in terms of the integrity of hyaluronic acid, you see the image on top. You have tissues that need hyaluronic acid to lubricate and enhance the movement of those adjacent cells. That slide that we were talking about and then without. Hyaluronic acids are changes in that production from either age or other trauma, that type of thing.
We start to lose the production of hyaluronic acid, which leads to skin dehydration, loss of firmness and elasticity, wrinkling, and then again those horizontal planes. What happens if . You don’t have moisture. They get sticky and tight and so things, the lows, layers just can’t move independently of one another.
And that’s when you start to get fascial binding. And there are many ways to improve hyaluronic acid. One is acupuncture. When we are needling to improve the skin layer, so it’s very superficial layers of the tissue we’re not gonna place the needle perpendicular. Why? Because then you go towards the bone area.
We need to go into that superficial tissue. So we’re gonna angle the needles at a 15 to 20 degrees. Relative to the surface of the skin. So for us as facial acupuncturists, we tend to use intramurals more because you can slide them at an angle as opposed to going deeper in, into the tissue and missing it heading into the muscle layers.
So we will use very superficial needling to stimulate the skin to produce more collagen, in which case the, and the hyaluronic acid elastin all of the proteins that are found in that extracellular matrix in order to improve skin elasticity, plumpness, and texture. And then also we use needling.
Anytime you roll or create a, an, and a little channel by puncturing the skin. It allows product or whatever it is on top of the skin to move into those deeper layers of the skin. So we use it. Same microneedling is a very popular treatment that we use. And facial acupuncture. So it’s a number, like a plum blossom, a lot of superficial needles in one small area, and then you rub product into the surface of the skin.
So by superficial needling, we’re creating tiny little channels in the skin that make it easier for topical products, including hyaluronic acid, serums, or creams. To penetrate into the deeper layers through the epidermis, into the germal layer and below, and this will enhance the absorption and the effectiveness of whatever product we’re using.
And then that combination of superficial needling and hyaluronic acid, whether it’s in the form of a serum or a cream, can enhance the skin, make nice and plumb, make it smoother, more even toned with reduced fine lines, wrinkles, and even scarring it at ate layers. When we think about hyaluronic acid and topical products we think of it either as a serum or a cream or a mask. Another conversation, at another time, which I promise I will deliver here. And so we’ll use these products that contain dosages of hyaluronic acid and they go into the surface of the skin and directly moisturize the, those deeper layers and superficial layers.
Their job is to retain water. So again, the protio glycans on the hyaluronic acid proteins bring water into the tissue or wherever the hyaluronic acid sits to improve the skin plumpness and reduce the appearance of fine line and wrinkles. So it’s immediate hydration. You put the product on the moisture, it attracts the moisture and plumps the surface of the skin.
Depending upon the product and depending upon the depth of penetration, if it’s sitting on the surface of the skin, this product, then it’s gonna bring moisture to the surface of the skin, and if you can press it through the deeper layers. Say with the addition of superficial needling, then it actually goes into the tissue below the germal layer, and then it has longer lasting results.
Hyaluronic acid, because it’s naturally produced in the body, in its pure form, it’s very safe to use. Sometimes people will get a reaction to a product and any product which could result in irritation or redness or itching. In most cases, it’s not the hyaluronic acid that’s actually causing the irritation.
I. But it’s other ingredients in the product. Products are made of multiple ingredients. Sometimes an ingredient doesn’t agree with your skin, particularly if you have very sensitive or sensitized skin, and so you may develop some redness. It’s usually not the hyaluronic acid, although if you discontinue it and try a different product with a different formation, it may or not.
When we think of derivatives of hyaluronic acid, we think of them in terms of molecular weight. So all proteins, all ingredients, particularly in the skincare world, are have a certain weight and that’s measured in dass. So a compound. So in its raw form, say hyaluronic acid in its raw form, because it’s raw, it has a very high molecular weight.
Which means that it has difficulty pressing into the surface of the skin. So it remains on the surface to pre and remembering that the hyaluronic acid is, and the proteoglycans are actually gonna pull the water to the place of the hyaluronic acid. So if it’s a high molecular weight, it’s just gonna sit on top of the skin.
It can’t get through the skin, so it’s gonna remain on the surface. And where does the water go on the surface? So it’s going to create a protective film that prevents water from actually evaporating. So it’s gonna keep the moisture that’s in the skin in, and it’s going to put water on the top. So it’s actually going to give you a tightening effect because it’s a locking moisture in.
So it’s gonna look plump, but it’s gonna feel a little tight. For deeper penetration, particularly in skincare world, we look at different forms, say the hydrolyzed, which actually breaks it down a little bit and allows the hyaluronic acid to split into smaller fragments, and that’s usually less than a thousand to 1800.
Das. And so this allows that product to penetrate a little bit deeper into the surface of the skin. So again, drawing that water a little deeper through those tissues. There’s another form, sodium hyaluronic, and this is the salt of the hyaluronic acid that’s used and it’s good for stability when you think of cells.
And molecules that penetrate through the cell wall. Salt is one that actually go, is small enough to go back and forth and back and forth through the cell walls, which is where you want the moisture. And so another form the form of the alkaline foreign sodium hyaluronate is oftentimes used in cosmetic formulas, allowing it to penetrate a little bit deeper into and through the epidermis into this.
Skin area, the deeper layers. And this is actually a, gives you a visible effect of plumpness from underneath the skin surface as opposed to on top of the surface. There are two new forms of hyaluronic acid that are being used right now, sodium hyaluronic cross polymer, and this is even a lower molecular weight than the salt version, and it’s crosslinked to form.
A molecule that is a little bit higher molecular weight, but passes through that barrier quickly. And it’s it’s very interesting because it’s gives you the stability of a hyaluronic salt acid but also the humectant properties of a more superficial, so it’s covering both the surface and a little bit deeper and then to go most deeply or the deepest into the skin.
Is the the new sodium ated Hyaluronate and acetyl hyaluronate is it’s new. And what’s fascinating about this form is that this ingredient or this formulation of hyaluronic acid actually can penetrate into the skin three times. Much deeper, which allows for three times more water and absorption than ordinary hyaluronic acid.
And it keeps it in, it locks it in so that it stays longer. So it’s great for aging skin, dehydrated skin, or people say who live in the desert or in dry climates or even in the winter when you tend to lose a lot of moisture on the surface over your skin from cold. It also inhibits the release of MMP one, which is a degradation of collagen, immature skin.
Skin and it’s also used to help protect the skin from the UV rays and environmental pollution. So it’s lookout for that one. It’s new. It’s coming up and I think it’s gonna. Be really popular. It’s used to reduce crows free and the nasal labial fold of the skin, the wrinkles that run from the corner of the nose to the corner of the mouth.
And keep an eye out. I think it’s gonna be very popular in upcoming formulations of skincare. What’s interesting is this research study, it’s a randomized control trial of the efficacy of cream-based hyaluronic acid at different molecular weights. And this. They’re using water bound hyaluronic acid at a weight, a molecular weight.
So three different weights, 51, 3300, 802,000. That’s more than three, isn’t it? It’s five. And so they applied it around the eyes. 76 female patients between the ages of 30 and 60 years for 60 days. So they measured at 30 and 60 days. And what they, so one eye, they used this cream and then the other at different molecular weights.
And they used placebo on the other side. And then they were taking objective measurements. So they used a semi-automatic morph photometry meter in order to demonstrate the changes, the objective changes. What they did is the measurements were wrinkled depth. They, and then they also compared the size or the amount of change that occurred at 360 days.
And the 60 day measurement, what they concluded was the application of a 0.1% hyaluronic formulation was made significant changes in both skin hydration and elasticity, but they also found that the lower the molecular weight. The more effective it was. So again, going back to those cross pollinations or breakdowns of combined hyaluronic acid products that are coming up, they’re designed to both break down the acid, the hyaluronic acid, into very small, low molecular weights in order for it to penetrate through the skin more effect effectively and efficiently.
The other, another very important way to get hyaluronic acid into your skin is through your diet. So a diet rich in nutrients that support hyaluronic acid production can help improve the health and appearance of your skin. Key factors related to improving hyaluronic acid or getting hyaluronic acid through your food and diet.
A water. Drink as much water as you can. And that will help keep hyaluronic acid functioning properly. And then nutrients to consume are foods high in vitamin c, e, and magnesium to help produce and support the synthesis of hyaluronic acid. So these vitamins help synthesize it, water helps to keep it functioning.
And then antioxidants, such as fruits and vegetables. They actually protect that hyaluronic acid from breaking down. And then collagen rich foods and supplements can support hyaluronic acid by promoting skin elasticity and hydration. So you will need to have nutrients like vitamins C and magnesium to build or synthesize it.
You need antioxidants to help it from breaking down. And then drink plenty of water in order to support or maintain the functioning properties of hyaluronic acid. And then you want to promote, help, promote and support that hyaluronic acid by promoting skin elasticity and hydration by taking collagen rich foods or supplements.
And then here’s a research study. This is a 12 week double blinded placebo study, and 12 weeks is about right because when we talked about the epidermis and the dermis, skin cells start at the base of the dermis and make their way up to the epidermis so that you, what you visibly see. It takes about 30 days to, to migrate up from the cells, from the base of the dermis all the way up to the surface.
So 12 weeks is three rounds of improved production of hyaluronic acid in that germal layer in order to visibly see a difference in the epidermis. After 12. So in this study, this double-blind placebo controlled study, they were using daily hyaluronic acid, 120 milligrams, and it was from High Best.
It’s a company in Tokyo. Taken daily for 12 weeks in 40 healthy Asian men and women ranging in the age of 35 to 64, and they evaluated objective measurements of wrinkles and the stratum cornea water content. That’s the surface of the skin. The amount of transepidermal water loss, that’s through the tissues.
Elasticity and they looked at imaging analysis so that they were objective measurements rather than just asking the people. How do you feel? So this was actually a measurable controlled study. I. After 12 weeks, they noted that skin condition was significantly improved in terms of wrinkle assessment, stratum, cornium, water contact, transepidermal, water loss, and elasticity.
So they concluded that. It makes a difference. What’s very interesting is remembering that when you were applying hyaluronic acid to the surface of the skin, you wanted a low molecular weight. In this one, what’s interesting is another 12 week period they were looking at the benefits of hyaluronic acid.
Applied orally. They did a similar study, 60 Japanese male and females aging, 22 to 59 years old, presenting with crows free and wrinkles. And then they were assigned hyaluronic acid at a me molecular weight of two 300 and 300. Again, 120 milligrams of hyaluronic acid. Now what was so interesting about this.
Is again measuring the skin wrinkling by imaging analysis and skin condition, and that was from a questionnaire survey. Here’s what they found is during that study period, what they found is that the higher molecular weight at 300 K group showed significant, a higher significant. Change in terms of diminishing wrinkles and compared with the placebo group.
So both worked at two and at 300, but the conclusion is that the 300, the higher molecular weight. Worked better. Why? Now? This is a good question. So think about this. If you are applying it to your skin, then those molecular, then the hyaluronic acid molecules have to get through the skin. However, if you’re eating them or ingesting them orally, it has to get through the digestive tract and get absorbed in the digestive.
To track. So when you break them down, a higher molecular weight has more of it. So you actually get a higher delivery of the product as opposed to topically when you can’t a higher molecular weight, it’s not gonna get through. So it’s just gonna sit on the top. So situation, you want a lower one. So I hyaluronic acid is great and.
It just depends how you do it. Whether you stimulate it with acupuncture, you ingest it, or you apply it topically. And so the benefits are really not just the hyaluronic acid but the delivery system. Low molecular weight for application on the surface of the skin topical application, and a higher molecular weight.
When you ingest it, so read your ingredients, read the package you want around a 300 molecular weight of 300 k if you’re gonna consume it, and you’re gonna want a smaller, safe five to 50 if you are going to apply it topically. So if you want more information about hyaluronic acid, I actually will be giving a presentation about tissue and DA fascia at the upcoming Pacific Symposium.
Here’s more information about it, and that’s it. So thank you very much. I appreciate your time here, and I hope you enjoyed this and learned a lot. Again. Thank you American Acupuncture Council for allowing me to present today. .
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