Physiotherapy in cosmetology

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

Thanks to the closest connection with the physical sciences and technology, modern physiotherapy has a huge number of methods of application that are very diverse in their 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 significantly expanded the range of services provided in medical centers, clinics and beauty parlors. The term "hardware cosmetology", understood as the rendering of small physiotherapy services, using physical factors of influence, physicians by cosmetologists-dermatovenerologists and (or) physiotherapists, was well established and often used. According to the existing normative base, physiotherapy procedures (here we mean "hardware cosmetology"), can doctor-dermatovenereologist, but perform such an appointment can only be an expert who has a certificate of physiotherapy and balneology (doctor or medical practitioner tra). Unfortunately, today there is no cosmetology as an independent profession, and the fact that most doctors working in this field are specialists in dermatovenerology who do not have special knowledge about the methods of physical influence on the human body, leads not only to the lack of results after separate procedures and course effects, but also to serious mistakes and complications.

The desire to attract new patients, expand the range of services provided requires from cosmetologists the use of the latest technical developments and the latest technologies presented in modern equipment. Undoubtedly, the use of complex and expensive equipment increases the effectiveness of the impact, but increases the responsibility for high-tech procedures. Therefore, the basic safety requirements when using cosmetology equipment should be clearly and impeccably fulfilled.

This applies to the following aspects:

1. correct use of equipment;
2. the observance of safety precautions necessary when working on physiotherapy equipment;
3. compliance with protocols of procedures;
4. competent appointment of physiotherapy, taking into account existing indications and contraindications.

It is gratifying that specialists constantly receive information from producers, which are quite reliable and impressive, about the protocols of work, the equipment use technique, the clinical trials carried out, the effectiveness of the hardware effects. Cosmeticians and patients are satisfied with the results after the conducted procedures and course exposure using modern technologies and equipment. The effect of "rapid lifting" is highly evaluated as a 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 qualitative and quantitative of all the underlying structures in the affected area.

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

• What state of health at the time of the appointment of physiotherapeutic treatment is the patient;
• What physical factors can be used in the treatment of this patient;
• how to apply them;
• what contraindications exist for this type of impact: »how are physical factors combined (if two or more physical factors are used);
• how do they combine with other procedures (cosmetic, exercise, etc.);
• what unpleasant sensations happen during the procedure and the course effect;
• What are the possible complications and how to avoid them;
• what is the first aid algorithm for complications.

Exposure with the help of electric current, ultrasound therapy, vacuum and vibration, the action of high and low temperatures, light in all its diversity are all well-known and long-studied physical factors of influence on the human body. Undoubtedly, technological progress makes its own adjustments in technologies and their application and outlines: there are new technical solutions to the use of different effects - in a more efficient mode, with the least unpleasant or painful sensations and, of course, ensuring maximum safety of use.

Generalized classification of the methods most often used in hardware cosmetology, the factor of physical impact

Factors of physical impact	Methods used in hardware cosmetology
Electricity
Constant;	Electrophoresis Disinfestation Electrolysis Microcurrent therapy
Variable, pulse	Lymphatic drainage Myostimulation Lipolysis Darsonvalization Bioresonance therapy
A magnetic field	Magnetotherapy
Mechanical factors	UZT Presotherapy Vibrotherapy Brossage Micro-grinding
The effect of an artificially altered environment	Vacuum exposure

Complex use of therapeutic physical factors

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

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

The combined use of physiotherapy methods, when 2 or 3 physical factors act simultaneously and are applied to the same body site in the form of a single procedure. These include the simultaneous use of two types of electrical energy (for example, in the apparatus Futura Pro, Ultraton, UK), mechanical vibration and vacuum (Key Modul, LPG Systems, France), ultrasonic action and electric current and other combinations.

The combination in one procedure of the action on the body of 2-3 physical factors is based on the principles of rational selection. To date, this is one of the most promising and researched directions in the development of methods of hardware cosmetology. Most often, when combining physiotherapy, unidirectional synergistic action factors are used, the similar effect of which is added up or potentiated by each other. An example of such a combination is the lymph drainage effect and the stimulation effect of collagen production, obtained with simultaneous use of mechanical warm-ups: and vibration, in various ratios.

The result of the combined effect of several physical factors in the entrance of one procedure is an increase in the therapeutic effect with the administration of smaller doses. So, in galvanic mud treatment or a combination of 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 smaller galvanic current in the second.

When carrying out combined physiotherapy in one procedure, 2 physical factors are often used, one of which is the main one, or the leading one. It improves the response or increases the sensitivity of the tissue, system or whole organism to the action of another factor. The effectiveness and safety of the procedure depend on the correctly selected dosage, primarily the leading factor. It is noted that a slight increase in body temperature during procedures aimed at strengthening the muscles, relaxes the muscles, contributing to a more effective and painless study of deep structures. The leading physical factor in this combination is the thermal effect, so the use of "high" temperatures will lead to overheating of the whole organism, the impossibility of directly effecting the current to obtain a myostimulation effect and worsening 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 application of infrared radiation and electrodipolysis). In this case, heat is also the leading factor, as overheating of tissues in the area of exposure can lead to the emergence of not only a local negative reaction (tissue hypoxia reduces the rate of lipolytic processes), but also a high overall load on the cardiovascular system. Increase of local temperature in tissues during such procedures should not exceed 2-4 ° С, which allows to obtain an effective political influence without unpleasant sensations and overloading of the cardiovascular system.

When combined physiotherapy, it is possible to use the factors of the opposite - antagonistic - action, most often to attenuate or mitigate certain reactions (often unfavorable) that occur in the body under the influence of one of the factors. Simultaneous assignment of galvanic current and sinusoidally modulated currents greatly alleviates the irritating effect and pain sensations under the electrodes caused by the passage of a direct current, which allows to prevent electrical burns and not to reduce the therapeutic dose of current exposure.

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

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

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

In this regard, the therapeutic effectiveness of the combined methods, as a rule, is much higher than the effectiveness of monotherapy. This applies only to immediate results of treatment, but also concerns long-term results. Apparently, it is a question of 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 reducing the number of daily applied techniques, providing a great time saving for both the patient and the staff. In this case, the therapeutic effect is achieved in a shorter period and persists 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 absence of complications

[1]

Contraindications to the use of physical factors of influence

The appointment of any physical factor should take into account the patient's health status, age, sex, indications and contraindications, individual characteristics and addictions.

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

When conducting electrotherapeutic methods, the most contraindications, as compared to other physical factors, are allocated. Electrotherapy includes methods based on the effect on the body of electrical currents of high and low voltage, electrical, magnetic and electromagnetic fields. The physico-chemical essence of the above-mentioned factors is the active movement of electrically charged particles (ions, electrons, polar molecules) in the tissues and intercellular fluid, accumulation of charged particles in membranes, etc., which leads to the appearance of thermal and oscillatory (specific) effects not only in the impact zone, but also at the organism level.

Contraindications are divided into absolute and relative. Absolute contraindications are 100% prohibition on performing any kind of exposure 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 area of exposure (general or local: restriction when using the method for general exposure may not limit the use of local therapy);
• method of exposure (for example, the use of electric current has the largest number of contraindications and under certain conditions the presence of contraindications to electrotherapy is not a prohibition to the appointment of other physical factors);
• the condition of the superficial soft tissues in the affected area and nearby areas (for example, a soft tissue injury or an early postoperative period, are contraindications for performing current procedures in this area, and the appointment of vibro-vacuum therapy is shown from the first day);
• used contact and (or) cosmetics.

Contraindications to all physical factors of exposure

1. General, absolute:
   • malignant neoplasms;
   • diseases of the cardiovascular system in the stage of decompensation (acute inflammatory processes in the myocardium, endocardium, pericardium, heart defects, myocardial infarction in acute period, frequent attacks of stenocardia, acute cardiovascular failure);
   • Stage III hypertension;
   • Severe cerebral sclerosis:
   • systemic blood diseases;
   • bleeding or inclinations;
   • cachexia;
   • the general severe condition of the patient;
   • fever (body temperature above 38 C);
   • mental illness (epilepsy, hysteria, psychosis);
   • varicose veins of the III stage;
   • active symptoms of phlebitis;
   • severe vascular sclerosis with a tendency to thrombosis and hemorrhage;
   • impaired renal, hepatic and thyroid function;
   • condition after a course of X-ray therapy 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 affected;
   • skin diseases in the stage of exacerbation in the area of the procedure;
   • suppurative and fungal skin lesions;
   • stones in the kidneys, gall bladder and hepatic ducts (when working in appropriate projections).

Additional contraindications to the appointment of individual treatment methods:

Contraindications to vaporization:

1. Are common:
   • hypertonic disease;
   • IHD;
   • angina pectoris;
   • asthma, allergic rhinitis.
2. Local:
   • rosacea, couperose;
   • multiple telangiectasias.

Contraindications to russe:

1. Are common:
   • violation of the integrity of the skin;
   • bleeding disorder
2. Local:
   • sensitive skin;
   • couperose, rosacea;
   • fragility of blood vessels;
   • Atonic, weakened, "tired" skin;
   • chronic dermatoses in the acute stage

Contraindications to disinfestation:

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

Contraindications to ultrasound peeling:

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

Contraindications to vacuum cleaning (peeling):

1. Are common:
   • bleeding disorder.
2. Local:
   • violation of the integrity of the skin;
   • sensitive skin;
   • couperose, rosacea,
   • fragility of blood vessels;
   • Atonic, weakened, "tired" skin:
   • fine-wrinkled type of aging;
   • photoaging.

Contraindications to microcurrent therapy, microcurrent disinfection and bioresonance therapy:

1. General, Relative:
   • pacemaker;
   • pregnancy;
   • intolerance to electric current.
2. Local, relative:
   • sensitivity of the teeth (with procedures in the face area);
   • chronic dermatoses in the stage of exacerbation.

Contraindications to galvanization (electrophoresis), pulsed and alternating currents (myostimulation, electrolysis, electrolyphodrenage, ridolysis):

1. Are common:
   • presence of a pacemaker;
   • individual intolerance to the current;
   • individual intolerance of the drug substance;
   • pregnancy;
   • high blood pressure;
   • generalized eczema;
   • active thrombophlebitis.
2. Local:
   • sensitivity of teeth (for procedures in the face;
   • dental cysts (when performing procedures in the face area);
   • diseases of the thyroid gland (with procedures in the face, neck, decollete);
   • sinusitis, frontalitis in the stage of exacerbation (when carrying out the process in the face area);
   • gold and platinum reinforcement (for procedures in the face area);
   • severe skin irritation after the procedure;
   • the presence of metal structures in the area of the procedure (large pins, plates, dentures, etc.);
   • acute intraarticular lesions;
   • acute form of herpetic infection;
   • chronic dermatoses in the stage of exacerbation (neurodermatitis, psoriasis, etc.);
   • urine and cholelithiasis (when exposed to the abdomen and lower back);
   • violation of the integrity of the skin;
   • acute purulent inflammatory processes.

Contraindications to magnetotherapy:

1. Are common:
   • individual hypersensitivity to the factor;
   • cardiac ischemia;
   • stenocardia of stress III FC;
   • severe hypotension;
   • thrombophlebitis in the active phase;
   • threat of miscarriage;
   • presence of a pacemaker
2. Local:
   • metal structures in the area of influence (large pins, plates, dentures, etc.);
   • chronic dermatoses in the stage of exacerbation.

Contraindications to ultrasound therapy:

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

Contraindications to vacuum therapy:

1. Are common:
   • Absolute: late pregnancy;
   • relative: thoracic and senile age, condition after severe physical exertion.
2. Local:
   • period after deep peelings, gold and platinum reinforcement, simultaneous carrying out with courses of meso- and ozonotherapy, severe flabbiness of the skin flap (especially in the neck), pronounced vascular network (couperose), multiple telangiectasias, condition after plastic surgery;
   • chronic dermatoses in the stage of exacerbation;
   • postoperative edema.

Contraindications to vibratory action:

1. Are common:
   • cholelithiasis and urolithiasis with frequent pain attacks.
2. Local:
   • intra-articular fractures with hemarthrosis and in the early period (2 weeks);
   • nonsymbolized bone fragments;
   • a pacemaker (when exposed to a distance of less than 50 cm from an artificial pacemaker);
   • Pregnancy II-III trimester during the procedure in the region of the waist and abdomen;
   • simultaneous conducting with courses of meso- and ozonotherapy;
   • after carrying out the introduction procedure for fillers and Botox;
   • chronic dermatoses in the stage of exacerbation.

Contraindications to ultraviolet radiation:

1. Are common:
   • diseases of the liver and kidneys with pronounced impaired functions;
   • hyperthyroidism;
   • increased sensitivity to UFO;
   • solar urticaria in the anamnesis;
   • claustrophobia and other mental illness;
   • reception of sensitizers for UFOs;
   • hyperpigmentation in the anamnesis;
   • frequent exacerbations of herpes in the anamnesis;
   • systemic lupus erythematosus;
   • benign formations with a tendency to rapid growth
2. Local:
   • a condition after medial and deep peelings, in a period up to a half year after their carrying out;
   • acute form of herpetic infection;
   • extensive couperose;
   • hypertrichosis;
   • dry, dehydrated skin;
   • marked signs of aging

Contraindications to infrared radiation:

1. Are common:
   • IHD, stress angina.
   • pregnancy.
   • photophthalmia.
2. Local:
   • extensive couperose;
   • acute purulent inflammatory processes

Contraindications to light-thermal therapy:

1. Absolute:
   • keloid scars in the anamnesis;
   • violation of the integrity of the skin;
   • fresh tanning, including artificial (solarium), procedures are conducted after 3-4 weeks;
   • the intake of isotretinoin (Accutane) during the last 6 months;
   • taking medications that are photosensitizers for 2-4 weeks before the procedure;
   • epilepsy.
2. Relative:
   • age is less than 18 years (written consent of parents);
   • pregnancy;
   • increased photosensitivity;
   • hair removal in the eyebrows;
   • epilation in the field of tattoos;
   • hyperpigmentation or hypopigmentation in anamnesis;

Contraindications to cryotherapy

Local cryotherapy:

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

General cryotherapy:

1. Are common:
   1. absolute contraindications.
      • acute decompensated conditions of diseases of internal organs and systems;
      • vasculitis arterial or thromboembolism of major vessels;
      • acute myocardial infarction and the period of rehabilitation after a heart attack;
      • hypertensive disease of II st. (Blood pressure> 180/100);
      • hemorrhagic diathesis;
      • heart failure II st .;
      • blood diseases;
      • individual cold intolerance;
      • psychoemotional unpreparedness of the patient and his negative attitude to this method of treatment;
      • claustrophobia;
   2. relative contraindications:
      • chronic, often recurring foci of localized infection (tonsillitis, pharyngitis, adnexitis, endometritis, pneumonia, etc.);
      • extensive couperose;
      • chronic dermatoses in the acute stage

Contraindications to oxygen therapy:

1. Are common:
   • circulatory insufficiency II st .;
   • hypertensive disease I and II;
   • acute and chronic inflammatory diseases of the respiratory system (bronchitis, pleurisy).
2. Local:
   • open wounds in the field of procedure;
   • purulent-inflammatory processes on the skin;
   • intolerance of the ingredients used in the cosmetic formulation used

Contraindications to ozonotherapy:

1. Are common:
   • hemophilia and all disorders of blood coagulability (at low therapeutic concentrations, ozone has moderately expressed hypocoagulation effects);
   • thrombocytopenia;
   • hyperthyroidism.
2. Local:
   • individual intolerance (rarely seen).

Contraindications to cosmechanics:

• violation of the integrity of the skin;
• sensitive skin;
• extensive couperose;
• chronic dermatoses in the stage of exacerbation.

Contraindications to endermology:

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

[2], [3], [4], [5], [6]

General rules for prescribing physiotherapy procedures

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

1. When carrying out a complex of procedures, it is necessary to distinguish the basic procedure from additional ones, which are used to enhance the overall effect. Additional procedures should be non-load-bearing. The total time of procedures should not exceed 2 hours.
2. One day, two general procedures are not prescribed. You can not combine in one day procedures that cause a pronounced generalized reaction of the body, affecting the overall reactivity, which can cause fatigue, a marked change in hemodynamics. Particular attention should be paid to the appointment of general lymph drainage procedures: it is impossible to prescribe 2 general drainage effects in a single day, and even more so 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 expedient in complex physiotherapy is the addition of local procedures aimed at solving a local problem, general effects with strengthening effects (common UFO, baths, hyperthermic and normothermic wraps, etc.), stimulating (souls, contrast baths, ), sedative (hypothermic wraps, general lymphatic drainage, etc.) of the character.
4. Incompatible in one day procedure for the same reflex zone (collar zone, nasal mucosa, Zakharyin-Ged zone, sinocarotid zone, etc.) and the area of the projection of the endocrine glands through which an active effect on the overall reactivity of the organism is carried out.
5. As a rule, in one day, factors that are close in their physical characteristics are not used, they are similar in the mechanism of action, since the total dose of the stimulus can exceed the optimal one and cause an inadequate response, and factors of multidirectional effects (except for special effects).
6. Physiotherapeutic procedures incompatible in one day, if there are indications, may be prescribed on different days.
7. Ultraviolet irradiation during the period of erythema is not combined with thermal procedures, current procedures, massage and laser therapy. They are compatible with hydropathic procedures, not current lymphatic drainage effects.
8. With mud therapy (piloidoterapiya) do not combine hypothermic baths, showers and wraps, general darsonvalization, and in one day - common baths, heat treatment, general UFO.
9. When combining hydrotherapy and phototherapy take into account the scope of impacts: the total irradiation precedes the water procedures, the local - spend after them
10. When combining current procedures with other effects, they are always performed first, if various types of electrotherapy are administered, the total duration of treatment should not exceed 1 hour 30 minutes. When prescribing current procedures with a violation of the integrity of the skin (needle electrolysis, ridolysis, electroepilation), the effect is performed without combining with other appointments on one day or final.
11. Do not appoint in one day two procedures that cause severe skin irritation.
12. In the early days of menstruation should refrain from general physiotherapy procedures.

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