Physiotherapy in cosmetology

Physiotherapy (physiatry, physical therapy, physical therapy, physical medicine) is a field of medicine that studies the effect of natural or artificially obtained (preformed) physical factors on the human body and uses them to maintain, restore and strengthen people's health.

Due to the closest connection with physical sciences and technology, modern physiotherapy has a huge number of very diverse methods of application in terms of physical nature, physiological and therapeutic effect. Their use is constantly expanding, and today it is difficult to name a disease in which physical methods could not be used with benefit for patients.

The possibilities of using physiotherapy equipment have significantly expanded the range of services provided in medical centers, clinics and beauty salons. The term "hardware cosmetology" has taken root and is often used, understood as the provision of minor physiotherapy services using physical factors of influence, by cosmetologists-dermatovenerologists and (or) physiotherapists. According to the existing regulatory framework, a dermatovenerologist can prescribe physiotherapy procedures (here we mean "hardware cosmetology"), but only a specialist with a certificate in physiotherapy and balneology (a doctor or a nurse) can perform such an appointment. Unfortunately, today there is no cosmetology as an independent specialty, and the fact that most doctors working in this field are specialists in dermatovenerology who do not have special knowledge of the methods of physical influence on the human body leads not only to the lack of results after individual procedures and courses of action, but also to serious errors and complications.

The desire to attract new patients and expand the range of services rendered requires cosmetologists to use the latest technical developments and the latest technologies presented in modern equipment. Of course, the use of complex and expensive equipment increases the effectiveness of the impacts rendered, but the responsibility for performing high-tech procedures also increases. Therefore, the basic safety requirements for the use of cosmetology equipment must be strictly and impeccably met.

This applies to the following aspects:

1. correct use of equipment;
2. compliance with safety precautions required when working on physiotherapy equipment;
3. compliance with protocols for conducting procedures;
4. competent prescription of physiotherapeutic interventions, taking into account existing indications and contraindications.

It is gratifying that specialists constantly receive information from manufacturers about the protocols of work, the technique of using the equipment, the clinical trials conducted, the effectiveness of the hardware effects, which is quite reliable and impressive. Cosmetologists and patients are satisfied with the results after the procedures and the course of action using modern technologies and equipment. The effect of "fast lifting" is highly appreciated, both the result obtained immediately after the procedure and caused by an adequate vascular response and deep hydration of the epidermis and dermis, and "delayed lifting" aimed at the qualitative and quantitative of all underlying structures in the area of action.

In order for the use of physiotherapeutic equipment for hardware cosmetology to be effective and safe, in terms of not causing harm to the patient's health, it is necessary to have a clear understanding of:

• what is the patient's health status at the time of appointment of physiotherapy treatment;
• what physical factors can be used in the treatment of this patient;
• how to use them;
• what contraindications exist for this type of exposure: » how physical factors are combined with each other (if two or more physical factors are used);
• how they are combined with other procedures (cosmetics, physical activity, etc.);
• what unpleasant sensations occur during the procedure and course of action;
• what complications are possible and how to avoid them;
• What is the first aid algorithm for complications?

Impact with electric current, ultrasound therapy, vacuum and vibration, the effect of high and low temperatures, light in all its diversity - all these are well-known and long-studied physical factors of impact on the human body. Of course, technical progress makes its own adjustments to technologies and methods of their application and outlines: new technical solutions are found for using various impacts - in a more effective mode, with the least unpleasant or painful sensations and, of course, ensuring maximum safety of use.

Generalized classification of methods most frequently used in hardware cosmetology, according to the factor of physical impact

Physical factors of influence	Methods used in hardware cosmetology
Electric current
Constant;	Electrophoresis Disincrustation Electrolysis Microcurrent therapy
Variable, pulse	Lymphatic drainage Myostimulation Lipolysis Darsonvalization Bioresonance therapy
Magnetic field	Magnetic therapy
Mechanical factors	UZT Pressotherapy Vibrotherapy Brossage Microgrinding
Effect of artificially modified environment	Vacuum effect

Complex use of therapeutic physical factors

In specialized and advertising literature, the name of the method used is often commercial in nature and has a patented name that does not provide information about what physical factors are used in the operation of the equipment. This, of course, introduces a certain and sometimes dangerous confusion when using these technologies, especially when it comes to combined treatment methods. In this regard, it is necessary to dwell separately on the concepts of complex, combined and combined use of physical factors.

Combined treatment is an effect in which several physical methods are prescribed in a certain time sequence - one after another or on different days of the course of treatment. This is a traditional way of prescribing physiotherapeutic procedures in a polyclinic complex and in sanatorium-resort treatment.

Combined use of physiotherapy methods, when 2 or 3 physical factors act simultaneously and are applied to the same area of the body in a single procedure. This includes the simultaneous use of two types of electrical energy (for example, in the Futura Pro device, Ultraton, UK), mechanical vibration and vacuum (Key Modul, LPG Systems, France), ultrasound and electrical current, and other combinations.

The combination of 2-3 physical factors acting on the body in one procedure is based on the principles of their rational selection. Today, this is one of the most promising and researched areas in the development of hardware cosmetology methods. Most often, when combining physiotherapy, factors of unidirectional synergistic action are used, the similar effect of which is summed up or potentiated by each other. An example of such a combination is the lymphatic drainage effect and the effect of stimulating collagen production, obtained with the simultaneous use of mechanical kneading and vibration, in various proportions.

The result of the combined effect of several physical factors during one procedure is an increase in the therapeutic effect when smaller doses are prescribed. Thus, when conducting galvanic mud therapy or combining galvanic and alternating current in parallel in lipolytic procedures, high efficiency is achieved by using a lower mud temperature in the first case and a low galvanic current in the second.

When conducting combined physiotherapy, two physical factors are often used during one procedure, one of which is the main or leading one. It improves the reaction or increases the sensitivity of the tissue, system or the whole organism to the action of another factor. The effectiveness and safety of the procedure depend on the correctly selected dosage, first of all, of the leading factor. It is noted that a slight increase in body temperature during procedures aimed at strengthening muscles relaxes the muscles, contributing to more effective and painless development of deep structures. The leading physical factor in this combination method is thermal exposure, since the use of "high" temperatures will lead to overheating of the whole organism, the impossibility of performing direct current exposure to obtain a myostimulation effect and deterioration of the general condition of the patient.

A slight local increase in body temperature also increases by 20-30% the rate of lipolytic processes triggered by the use of low-frequency electric current (combined use of infrared radiation and electrodipolysis). And in this case, the leading factor is also heat, since overheating of tissues in the area of exposure can lead to not only a local negative reaction (tissue hypoxia reduces the rate of lipolytic processes), but also a high overall load on the cardiovascular system. The increase in local temperature in tissues during such procedures should not exceed 2-4 ° C, which allows for an effective lipolytic effect without unpleasant sensations and overload of the cardiovascular system.

In combined physiotherapy, it is possible to use factors of opposite - antagonistic - action, most often to weaken or soften certain reactions (usually unfavorable) that occur in the body under the influence of one of the factors. The simultaneous administration of galvanic current and sinusoidally modulated currents significantly weakens the irritating effect and pain sensations under the electrodes caused by the passage of direct current, which allows preventing electrical burns and not reducing the therapeutic dose of current exposure.

Thus, correctly selected and scientifically substantiated combinations of various physical factors with each other or physical therapeutic agents with drugs increase the effectiveness of treatment and lead to the absence of adverse reactions to physiotherapeutic procedures.

In practice, we often encounter the fact that adaptation to many physical factors develops after several procedures, in the middle and especially at the end of the course of treatment, due to which the effect of the procedure gradually decreases and becomes insignificant. An example of this are all current effects with constant current parameters that do not change during the procedure, which are effective only during the first 6-7 procedures. Subsequently, adaptation to the action of the factor develops and the therapeutic effect of the procedure decreases.

With a combined method, which is a stronger irritant to the body as a result of the simultaneous action of two or more physical factors, the adaptation process becomes less pronounced, the force of the impact does not weaken over a long period of time.

In this regard, the therapeutic effectiveness of combined methods is usually significantly higher than the effectiveness of monotherapy. This applies only to the immediate results of treatment, but also to the long-term results. Apparently, we are talking about the prolonged period of the consequences of combined procedures, which ensures the duration of the therapeutic effect after their course application.

In addition, the possibilities of combined methods allow to reduce the number of daily applied methods, providing greater time savings for both the patient and the staff. At the same time, the therapeutic effect is achieved in a shorter period of time and is maintained for a long time.

An important nuance in the use of combined factors of influence is the need to take into account contraindications to all those physical methods that are used in treatment, which will ensure the necessary safety and the absence of complications.

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Contraindications to the use of physical factors of influence

The appointment of any physical factor must take into account the patient’s health status, age, gender, indications and contraindications, individual characteristics and preferences.

By the area of impact and by the effect on the body, contraindications are divided into general and local. The largest number of contraindications are allocated when carrying out general procedures, regardless of the active factor, since the impact is carried out on a large area (2 or more zones, for example: the back area and the back of the legs, arms and chest), reactions of all body systems are triggered (cardiovascular, respiratory, excretory, nervous, endocrine, etc.). Local contraindications are limited by the condition of the tissues in the procedure area and a possible negative segmental response to the resulting irritation.

When conducting electrotherapeutic methods, the greatest number of contraindications are distinguished, compared to other physical factors. Electrotherapy includes methods based on the impact of high and low voltage electric currents, electric, magnetic and electromagnetic fields on the body. The physicochemical essence of the action of the above factors consists in the active movement of electrically charged particles (ions, electrons, polar molecules) in tissues and intercellular fluid, accumulation of charged particles in membranes, etc., which leads to the occurrence of thermal and oscillatory (specific) effects not only in the area of impact, but also at the organismic level.

Contraindications are divided into absolute and relative. Absolute contraindications are a 100% ban on any type of impact and take into account the patient's age, phase of the disease, severity of the condition and nosological units.

Relative contraindications (general and local) take into account:

• area and zone of action (general or local: a limitation in using a method for general action may not limit the use of local therapy);
• method of influence (for example, the use of electric current has the largest number of contraindications and, under certain conditions, the presence of contraindications to electrotherapy does not prohibit the use of other physical factors);
• the condition of the superficial soft tissues in the area of impact and nearby areas (for example, a soft tissue contusion or the early postoperative period are contraindications for conducting current procedures in this area, and the appointment of vibration-vacuum therapy is indicated from the very first day);
• contact and/or cosmetic products used.

Contraindications to all physical factors of influence

1. General, absolute:
   • malignant neoplasms;
   • cardiovascular diseases in the decompensation stage (acute inflammatory processes in the myocardium, endocardium, pericardium, heart defects, myocardial infarction in the acute period, frequent attacks of angina pectoris, acute cardiovascular failure);
   • hypertension stage III;
   • severe sclerosis of the cerebral vessels:
   • systemic blood diseases;
   • bleeding or tendency to bleeding;
   • cachexia;
   • general severe condition of the patient;
   • fever (body temperature above 38 C);
   • mental illnesses (epilepsy, hysteria, psychosis);
   • varicose veins stage III;
   • active symptoms of phlebitis;
   • pronounced vascular sclerosis with a tendency to thrombosis and hemorrhage;
   • dysfunction of the kidneys, liver and thyroid gland;
   • condition after a course of radiotherapy less than 2 weeks;
   • active form of tuberculosis of the lungs and kidneys.
2. General, relative:
   • hypotension;
   • vegetative-vascular dystonia;
   • taking diuretics;
   • hypoglycemia;
   • menstruation;
   • pregnancy.
3. Local, absolute:
   • violation of the integrity of the skin in the area of impact;
   • skin diseases in the acute stage in the area where the procedure is performed;
   • purulent and fungal skin lesions;
   • stones in the kidneys, gall bladder and hepatic ducts (when working in the appropriate projections).

Additional contraindications to the appointment of certain treatment methods:

Contraindications to vaporization:

1. General:
   • hypertension;
   • IHD;
   • angina pectoris;
   • asthma, allergic rhinitis.
2. Local:
   • rosacea, rosacea;
   • multiple telangiectasias.

Contraindications to brossage:

1. General:
   • violation of the integrity of the skin;
   • blood clotting disorder
2. Local:
   • sensitive skin;
   • rosacea, rosacea;
   • vascular fragility;
   • atonic, weakened, “tired” skin;
   • chronic dermatoses in the acute stage

Contraindications to desincrustation:

1. General:
   • pregnancy;
   • active thrombophlebitis;
   • metal prostheses;
   • violation of the integrity of the skin;
   • intolerance to electric current;
   • endocrinopathies.
2. Local:
   • sensitive skin;
   • dehydrated skin;
   • rosacea, rosacea.

Contraindications to ultrasonic peeling:

1. General:
   • severe hypotension
2. Local:
   • metal prostheses;
   • violation of the integrity of the skin;
   • sensitive skin (individual intolerance).

Contraindications to vacuum cleaning (peeling):

1. General:
   • blood clotting disorder.
2. Local:
   • violation of the integrity of the skin;
   • sensitive skin;
   • rosacea, rosacea,
   • vascular fragility;
   • atonic, weakened, "tired" skin:
   • fine-wrinkle type of aging;
   • photoaging.

Contraindications to microcurrent therapy, microcurrent desincrustation and bioresonance therapy:

1. General, relative:
   • pacemaker;
   • pregnancy;
   • intolerance to electric current.
2. Local, relative:
   • tooth sensitivity (when performing procedures in the facial area);
   • chronic dermatoses in the acute stage.

Contraindications to galvanization (electrophoresis), pulsed and alternating currents (myostimulation, electrolipolysis, electrolymphatic drainage, ridolysis):

1. General:
   • presence of a pacemaker;
   • individual intolerance to current;
   • individual intolerance to the drug;
   • pregnancy;
   • high blood pressure;
   • generalized eczema;
   • active thrombophlebitis.
2. Local:
   • tooth sensitivity (when performing procedures in the facial area);
   • dental cysts (when performing procedures in the facial area);
   • thyroid diseases (when performing procedures in the face, neck, and décolleté area);
   • sinusitis, frontal sinusitis in the acute stage (when the process is carried out in the facial area);
   • gold and platinum reinforcement (when performing procedures in the facial area);
   • severe skin irritation after the procedure;
   • the presence of metal structures in the area where the procedure is being performed (large pins, plates, prostheses, etc.);
   • acute intra-articular injuries;
   • acute form of herpes infection;
   • chronic dermatoses in the acute stage (neurodermatitis, psoriasis, etc.);
   • urolithiasis and cholelithiasis (when applied to the abdominal and lumbar regions);
   • violation of the integrity of the skin;
   • acute purulent inflammatory processes.

Contraindications to magnetic therapy:

1. General:
   • individual hypersensitivity to the factor;
   • ischemic heart disease;
   • angina pectoris III FC;
   • severe hypotension;
   • thrombophlebitis in the active phase;
   • threat of miscarriage;
   • presence of a pacemaker
2. Local:
   • metal structures in the impact area (large pins, plates, prostheses, etc.);
   • chronic dermatoses in the acute stage.

Contraindications to ultrasound therapy:

1. General:
   • absolute: early pregnancy, paralysis, acute stage of eczema, thrombophlebitis, acute infectious diseases;
   • relative: vegetative-vascular dystonia, hypotension.
2. Local
   • metal structures in the impact zone (large pins, metal structures, plates, prostheses, etc.);
   • when working on the face: facial nerve paralysis, trigeminal and oculomotor neuralgia, sinusitis and sinusitis in the acute stage, the early period after deep chemical peeling and dermabrasion, gold and platinum reinforcement;
   • chronic dermatoses in the acute stage;
   • when working on the body: intrauterine device, stones in the kidneys, gall bladder and hepatic ducts (when working in the corresponding projections), acute thrombophlebitis in the area of impact

Contraindications to vacuum therapy:

1. General:
   • absolute: late pregnancy;
   • relative: infancy and old age, condition after heavy physical exertion.
2. Local:
   • the period after deep peelings, gold and platinum reinforcement, simultaneous use with courses of meso- and ozone therapy, pronounced flabbiness of the skin flap (especially in the neck area), pronounced vascular network (rosacea), multiple telangiectasias, condition after plastic surgery;
   • chronic dermatoses in the acute stage;
   • postoperative swelling.

Contraindications to vibration exposure:

1. General:
   • cholelithiasis and urolithiasis with frequent attacks of pain.
2. Local:
   • intra-articular fractures with hemarthrosis and in the early period (2 weeks);
   • non-symmobilized bone fragments;
   • pacemaker (when exposed at a distance of less than 50 cm from the artificial pacemaker);
   • pregnancy in the II-III trimester when performing the procedure in the lumbar and abdominal area;
   • simultaneous administration with courses of meso- and ozone therapy;
   • after the procedure of introducing fillers and Botox;
   • chronic dermatoses in the acute stage.

Contraindications to ultraviolet radiation:

1. General:
   • liver and kidney diseases with severe functional impairment;
   • hyperthyroidism;
   • increased sensitivity to UV radiation;
   • history of solar urticaria;
   • claustrophobia and other mental illnesses;
   • taking sensitizers to UV radiation;
   • history of hyperpigmentation;
   • history of frequent herpes outbreaks;
   • systemic lupus erythematosus;
   • benign neoplasms with a tendency to grow rapidly
2. Local:
   • condition after medium and deep peelings, for a period of up to six months after they are performed;
   • acute form of herpes infection;
   • extensive rosacea;
   • hypertrichosis;
   • dry, dehydrated skin;
   • pronounced signs of age-related aging

Contraindications to infrared radiation:

1. General:
   • IHD, angina pectoris.
   • pregnancy.
   • photophthalmia.
2. Local:
   • extensive rosacea;
   • acute purulent inflammatory processes

Contraindications to photothermal therapy:

1. Absolute:
   • history of keloid scars;
   • violation of the integrity of the skin;
   • fresh tan, including artificial (solarium), procedures are carried out after 3-4 weeks;
   • use of isotretinoin (Accutane) within the last 6 months;
   • taking medications that are photosensitizers for 2-4 weeks before the procedure;
   • epilepsy.
2. Relative:
   • age under 18 years (written consent of parents);
   • pregnancy;
   • increased photosensitivity;
   • eyebrow hair removal;
   • epilation of tattoo areas;
   • history of hyper- or hypopigmentation;

Contraindications to cryotherapy

Local cryotherapy:

1. General relative contraindications:
   • hypersensitivity to cold factors;
   • the patient's negative attitude towards this method of treatment.
2. Local relative contraindications:
   • extensive rosacea;
   • the presence of arterial vasculitis or thromboembolism of the main vessels in the area of impact (obliterating endarteritis, Raynaud's disease).

General cryotherapy:

1. General:
   1. absolute contraindications.
      • acute decompensated conditions of diseases of internal organs and systems;
      • arterial vasculitis or thromboembolism of the main vessels;
      • acute myocardial infarction and the rehabilitation period after infarction;
      • hypertension stage II (BP> 180/100);
      • hemorrhagic diathesis;
      • heart failure stage II;
      • blood diseases;
      • individual intolerance to cold;
      • the patient’s psycho-emotional unpreparedness and his negative attitude towards this method of treatment;
      • claustrophobia;
   2. relative contraindications:
      • chronic frequently recurring foci of localized infection (tonsillitis, pharyngitis, adnexitis, endometritis, pneumonia, etc.);
      • extensive rosacea;
      • chronic dermatoses in the acute stage

Contraindications to oxygen therapy:

1. General:
   • circulatory failure stage II;
   • hypertension stage I and II;
   • acute and chronic inflammatory diseases of the respiratory system (bronchitis, pleurisy).
2. Local:
   • open wounds in the area of the procedure;
   • purulent-inflammatory processes on the skin;
   • intolerance to the ingredients included in the cosmetic formulation used

Contraindications to ozone therapy:

1. General:
   • hemophilia and all blood clotting disorders (at low therapeutic concentrations, ozone has a moderate hypocoagulant effect);
   • thrombocytopenia;
   • hyperthyroidism.
2. Local:
   • individual intolerance (extremely rare).

Contraindications to cosmechanics:

• violation of the integrity of the skin;
• sensitive skin;
• extensive rosacea;
• chronic dermatoses in the acute stage.

Contraindications to endermology:

• violation of the integrity of the skin;
• inflammatory diseases of the subcutaneous fat tissue;
• thrombophlebitis in the acute stage.

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General rules for prescribing physiotherapy procedures

When planning a course of treatment, it is necessary to remember the well-known rules in physiotherapy, formulated on the basis of special studies and clinical experience, which must be taken into account.

1. When performing a set of procedures, it is necessary to distinguish the main procedure from additional ones, which are used to enhance the overall effect. Additional procedures should not be stressful. The total time of procedures should not exceed 2 hours.
2. Two general procedures are not prescribed on the same day. It is forbidden to combine procedures on the same day that cause a pronounced generalized reaction of the body, affect general reactivity, can cause fatigue, pronounced changes in hemodynamics. Particular attention should be paid to the prescription of general lymphatic drainage procedures: it is forbidden to prescribe 2 general drainage effects on the same day, and especially in a row, it is necessary to observe the drinking regime, the total time of the procedure should not exceed 40-60 minutes.
3. The most effective and appropriate in complex physiotherapy is the addition of local procedures aimed at solving a local problem, with general effects that have a strengthening (general UV radiation, baths, hyperthermic and normothermic wraps, etc.), stimulating (showers, contrast baths, etc.), sedative (hypothermic wraps, general lymphatic drainage, etc.) effect.
4. It is incompatible to perform procedures on the same reflex zone (collar zone, nasal mucosa, Zakharyin-Ged zone, carotid sinus zone, etc.) and the projection area of the endocrine glands, through which an active effect on the general reactivity of the body is carried out, on the same day.
5. As a rule, factors that are close in their physical characteristics, similar in their mechanism of action, are not used on the same day, since the total dose of the irritant may exceed the optimal dose and cause an inadequate reaction, and factors with multidirectional effects (except for special effects).
6. Physiotherapeutic procedures that are incompatible on the same day may, if indicated, be prescribed on different days.
7. Ultraviolet irradiation during the erythema period is not combined with thermal procedures, current procedures, massage and laser therapy. They are compatible with hydrotherapy procedures, non-current lymphatic drainage effects.
8. Mud therapy (piloid therapy) is not combined with hypothermic baths, showers and wraps, general darsonvalization, and general baths, heat therapy, and general ultraviolet irradiation are not combined on the same day.
9. When combining hydrotherapy and light therapy, the volume of exposure is taken into account: general irradiation precedes water procedures, local ones are carried out after them.
10. When combining current procedures with other effects, they are always performed first; if various types of electrotherapy are prescribed, the total duration of treatment should not exceed 1 hour 30 minutes. When prescribing current procedures with damage to the integrity of the skin (needle electrolipolysis, ridolysis, electroepilation), the effect is performed without combining with other prescriptions on the same day or as the final one.
11. Do not prescribe two procedures on the same day, as they cause severe skin irritation.
12. In the first days of menstruation, you should refrain from general physiotherapy procedures.

Of course, the listed rules are not absolute and do not claim to be exhaustive. The development of scientific research and further accumulation of clinical experience will supplement these recommendations, and may even lead to a revision of some of them.