Research Shows Climate Influences Optimal Dosage for Cosmetic Treatments

When determining treatment choices and doses a comprehensive consultation reviews clients:

• Health
• Medication
• Age
• Lifestyle issues

The traditional approach to gaining accurate insight into the skin’s health is the key deciding factor for an effective treatment plan. But a new study provides scientific evidence of another determining factor. Seasonal and climatic considerations.  

• Recent findings from a comparative cohort study published in Plastic and Reconstructive Surgery (July 2024) revealed that climate can greatly affect the dosage requirements for the cosmetic use of Botulinum Toxin A.  

• While the study specifically reviewed the impact of climate on the cosmetic dosage of Botulinum Toxin A for wrinkle improvement
• This opens up potential considerations for other cosmetic treatments, as it reveals in a scientifically validated manner how the skin behaves differently throughout seasonal changes.

Recent findings

• Researchers reported Botulinum toxin A to the glabella is a popular cosmetic intervention. 
• Functional musculature differences may arise from chronic behavioural adjustment to high sun exposure levels, requiring greater doses.
• This could affect clinical practice globally.

The study included 523 women, aged 35-60 years, who received glabellar botulinum toxin treatment between 2012 and 2019 from a single provider practising in two different centres, one in the United Kingdom and the other in Malta.

• Researchers classified the UK centres as low sun exposure (winter month treatment) and the Malta centre as high sun exposure (summer months)
• With 292 “high-sun” patients and 231 “low-sun” patients in their corresponding locations, per the study. 
• The participants attended follow-up visits every three weeks, receiving additional doses until the treatment achieved full clinical paralysis.

• The findings revealed that the “high sun” group required significantly higher total average doses (29.2 units versus 27.3 units; P = 0.0031) even when researchers corrected for age in multivariable analysis (P = 0.00574). 

“Patients subject to less sun exposure require a lower dose than patients with high sun exposure, and this was present and persisted when controlling for potential confounders,” researchers wrote.

Although robustly demonstrated, the difference in doses seen here is small, and may not necessarily change the number of vials used. However, it may be of relevance to training staff and establishing changes to treatment protocols.

The study indicated that rigid protocols about doses and distributions may lead to undertreatment if applied in sunnier climates.

In an interview with Medscape Medical News, Pooja Sodha, M.D., director of the Centre for Laser and Cosmetic Dermatology at George Washington University, Washington, DC, commented: “that the study highlights the importance of tailoring neuromodulator treatment to the individual patient based not just on gender but also on lifestyle and climate.”

“The conclusion of the study is logical, but it’s encouraging that the data supports this. The potential confounders, such as injection technique (5-point vs 3-point), nonblinding of the evaluator, history of prior treatments, and variation in treatment effect by different botulinum toxin products may be important as well in how we consider this data in practice,” said Dr Sodha.

What the study reveals for non-injectable skin treatments

While the study specifically measured how seasonal changes impacted the need for treatment doses of Botulinum Toxin A, the study highlighted the impact that climatic changes can have on the skin. 

• It stands to reason that these changes can also benefit skin treatment considerations when determining other skin support and corrective skin procedures.

Here are some additional areas to investigate during your consultation: 

Summer-focused precautionary measures

Frequent squinting and their impact on dynamic wrinkles

• Are you aware that there are bio-modulating non-injectable skin treatments to mimic wrinkles?  (See below a recommendation by Dr Tiina Meder).

Increase levels of sun exposure

• More stringent measures in the frequency and correct doses of sunscreen protection. Review client lifestyle and re-educate them appropriately.

The rise in skin inflammation due to the impact of hot weather

• As the temperatures rise, the skin will be more prone to inflammation, consider anti-inflammatory ingredients in your skincare recommendations, as well as the introduction of protocols such as skin misting with non-alcoholic toners. Increase the cooling effect with refrigeration of their toner.

Increase levels of facial perspiration

• An increase in facial perspiration can alter the balance of the skin’s microbiome, increasing certain microbes such as Staphylococcus and Corynebacterium species leading to an overgrowth.

Change in pH

• Sweat can also change the pH of the skin, creating conditions that may favour harmful bacteria and fungi over beneficial ones.

Impact on Skin Immunity

• Persistent perspiration can also compromise barrier function, and increase the permeability of allergens and irritants to enter the skin, triggering an immune response that can contribute to dermatitis.

• Introduce skin treatment and products that restore the skin’s microbiome and strengthen the skin immunity.

Talk to your supplier for appropriate formulations to strengthen barrier function or contact us for a list of skincare companies.

Read below for more insight on Winter precautionary measures

Decrease level of sebaceous gland secretion

• Due to the colder months, the body attempts to retain body temperature and in doing so, there is a decrease of the level of oil secretion to the surface of the skin. 
• This will contribute to skin dryness and dehydration.  You will need to introduce skincare formulations that improve moisture and lipid retention.

Lip dryness can be avoided with hydration

• Regularly applying a hydrating lip balm is important during the colder winter months, as the cold weather can contribute to lip chapping.

Your clients should avoid hot showers

• Hot showers are often a welcoming experience during cold weather; however, this can further contribute to skin dehydration. 
• This is the perfect time to introduce body butters for all-over body care.

Skin might be prone to irritation

• Ensure you promote fragrance-free and use hypoallergenic skin care products to minimise irritation.

Go gentle on exfoliation

• Introduce gentle cleansers and limit exfoliation, but rather focus on building the skin’s barrier function.

Don’t neglect sun protection

• Use sunscreen even in winter, as UV rays can still damage the skin. Choose a broad-spectrum sunscreen with at least SPF 30.

Energising skin treatments

•  Introduce skin rejuvenating treatments that improve blood flow and activate cell renewal.  Winter is the perfect season for laser skin rejuvenation and other heat-based or light-based technologies for clients.

Effective treatment with a focus on dynamic wrinkles

• Personality is mirrored in facial expressions more and more with age

Our emotions create a mimic mask of sorts. Strong summer light can also contribute to squinting more frequently.

• Anxiety, stress, and other negative emotions are most often reflected in the wrinkles on one’s forehead and the bridge of the nose, drooping corners of the mouth and narrowed unhappy eyes. These are called mimic wrinkles.

• While neurotoxins can address these concerns, there are also specific peptides that can help these wrinkles for both preventative and corrective purposes.

We spoke with dermatologist Dr Tiina Meder and formulator of Meder Beauty Science about her topical treatment solution.

• Dr Meder is a renowned dermatologist with a strong ethos in not just treatment efficacy, but also safety when it comes to her formulations. 
• Dr Meder has produced an excellent treatment known as Myo-Fix, which is designed to address these specific concerns.

Find out how the Meder Myo-Fix treatment can help your clients

• Utilising a unique blend of peptides the Myo-Fix mask reduces the skin’s mobility by limiting the contraction of the mimic muscles’ ends intertwined with the skin.
• The muscles themselves remain mobile, but their ends stretch the skin less, reducing the depth of wrinkles and leaving the face looking calmer.

All the mask’s peptides are minute small molecules that easily penetrate the skin. Studies show that the first application reduces the mobility of mimic muscles by 20–30 per cent and with regular use the muscles of the upper third of the face may become 50–60 per cent less active in their surface parts.

The neuromuscular blocking (myorelaxant) peptide-based cosmetics are commonly nicknamed serene face solutions. 

What ingredients should I be aware of?

Acetyl Hexapeptide-3

• A neuro-myorelaxing peptide, reduces the mobility of the facial muscles and decreases the contractions of the mimic muscles in the part that is intertwined with the skin.
• It is the most thoroughly researched neuromuscular blocking peptide; its effect has been confirmed by numerous scientific research studies.
• It affects the upper and upper-medium thirds of the face the most, working on the forehead, bridge of the nose, eye area and upper cheeks.

 
Palmitoyl Tripeptide-1: Helps restore the thickness of the dermis, hydrates the skin and enhances the syntheses of collagen, elastin and hyaluronic acid quickly filling in the wrinkles.

It is one of the most potent rejuvenating ingredients in the beauty industry today.

Palmitoyl Tetrapeptide-7: A cell messenger, Palmitoyl Tetrapeptide-7 restores the communication and metabolic processes in the mature skin. It stimulates the syntheses of collagen and elastin, tones up and moisturises the skin, restoring its elasticity and resilience, and helps fill in the wrinkles.

 
SH Oligopeptide-1: Biopeptide nonapeptide 1, Human Epidermis Growth Factor earned its creators, neurobiologists Rita Levi-Montalcini and Stanley Cohen, the 1986 Nobel Prize in Physiology. Epidermis Growth Factor is a peptide able to restart the decelerated or stopped-with-age processes of collagen, elastin, and hyaluronic acid’s syntheses in the skin.

• Growth factor enhances the healing of injuries, tones up the skin and slows down the ageing process.
• The growth factor is such a powerful ingredient, that the recommended dose should be applied no more than twice a week to allow the skin to fulfil its stimulating potential.

Dr Meder advises aesthetic professionals to recommend the masks to their clients both during a course of treatment and before and after any traumatic procedures including facial surgery, as well as for the clients’ regular use at home to maintain the skin’s health.

In the winter issue of APJ Journal, we will be conducting a comprehensive interview with Dr Meder on this important topic as well as the recent regulatory changes in Europe relating to ingredient safety and consider how this will also potentially impact Australian TGA regulations on specific ingredients. 

In the meantime, you can contact Meder Beauty Science for more information

Reference to the Botulinum Toxin A Study:

Borsky, Kim L. MBBS, MD1; Rodrigues, Jeremy N. MBA, PhD, FRCS1,2; Rodrigues, Raina MBA, PhD, FRCS3,4. The Effect of Climate on the Dose Requirements of Botulinum Toxin A in Cosmetic Interventions. Plastic and Reconstructive Surgery 154(1):p 57e-62e, July 2024. | DOI: 10.1097/PRS.0000000000010913