"Healing crisis", "Uglies", "Buried
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free skin care · Sun Apr 25, 2010 9:08 pm

"Healing crisis", "Uglies", "Buried damage"

I have read this words in several threads here.

I do understand the concept of "uglies" in relationship to Retin-A, why they occur, what they mean,etc. But it seems that this is very different from the way "uglies" are used in other situations. In Retin-A, you will get "uglies" depending on your own sensitivity to tretinoin, your age, etc. It does not depend on how much photodamage you have.

I have read phrases like... "you are having uglies because product XYZ is bringing buried damage up", "the reaction you are having is strong because you must have a lot of buried damage"

So to start, can someone help me understand...

a. What constitutes "damage"
b. Where is this buried damage located

TIA!

free skin care · Sun Apr 25, 2010 9:16 pm

For CPs, they often refer to the "damage" as a result of sun exposure, ongoing usage of eye shadow, etc. But I don't know if they are referring to epidermal or dermal damage. Here is an interesting link from their site that shows the "buried damage" that eventually surfaces.
http://reverseskinaging.com/buried-skin-damage.html

As far as the Wonderbar Healing Crisis, they say that it is removing years of toxins that are buried deep within the skin, but have no information to back that up. So epidermal or dermal...who knows?

Other products like acids to help remove hyperpigmentation will have spots get darker as they come closer to the surface of the skin, which would be epidermal storage.

free skin care · Sun Apr 25, 2010 9:25 pm

bethany wrote:

For CPs, they often refer to the "damage" as a result of sun exposure, ongoing usage of eye shadow, etc. But I don't know if they are referring to epidermal or dermal damage. Here is an interesting link from their site that shows the "buried damage" that eventually surfaces.
http://reverseskinaging.com/buried-skin-damage.html

Other products like acids to help remove hyperpigmentation will have spots get darker as they come closer to the surface of the skin, which would be epidermal storage.

Yes I understand the hyperpigmentation issue. The UV camera emits UV light and so since melanin absorbs UV rays specifically it makes all hyperpigmentation issues more apparent, even hyperpigmentation not visible with regular sunlight.

As the skin renews, the hyperpigmentation goes up. This can happen with Retin-A, AHA and anything that efoliates kind of thing. I think the clearest example of this is IPL where the laser targets melanin specifically and those those cells die and are brought to the surace... it's quite remarkable!

So I guess a product thought to "bring hyperpigmentation up" would either have to be:

a. An exfoliating agent (e.g. AHAs, Retin A)
b. An agent that kills/affects melanocytes (Retin A, hydroquinone, IPL, etc.)
c. And agent that promotes keratinocyte proliferation (Retin A)

So is that all people are talking about? Damage = hyperpigmentation or is there anything else?
And where would the toxins for the healing crisis be? And what would these toxins be?

free skin care · Sun Apr 25, 2010 9:35 pm

Josee wrote:

So is that all people are talking about? Damage = hyperpigmentation or is there anything else?

On the CP front, I think it also includes scar tissue, "damage" from using colored cosmetics on eyelids which supposedly can cause crepiness, etc. Hopefully one of the CP experts will weigh in.

Regarding the Wonderbar, they would also factor in clogged pores, and abnormalities like psoriasis, etc.

Quote:

And where would the toxins for the healing crisis be? And what would these toxins be?

Beats me! I'll email Tiffany and ask her to comment on that.

Editing to add: I just sent the email, and will post when I get a reply.

free skin care · Sun Apr 25, 2010 10:02 pm

This is a very interesting topic. Would love to get input from the "CP specialists". But they may be reluctant to weigh in, given the heated exchanges that have been taking place recently in the other threads.

free skin care · Mon Apr 26, 2010 6:19 am

There are other products claiming to bring damage up (the latest the wonderbar).

I just REALLY wonder what that "damage" is because I think there's only limited things that can "come up".

For e.g.

- Scars : CANNOT "come up"
- Wrinkles: CANNOT "come up"
- Sun spots: CAN "come up"

One of the things that scared me was when the manufacturer of the wonderbar (when asked about a person that started using the wonderbar and started getting more pigmentation) said that "oh it's all part of the healing crisis". Mmmm... how can it be part of the healing crisis? The sun spots that you see visible are organized in a certain way. Sometimes when they start drying (e.g. after a peel or with certain keratolytic creams) they can look a little darker because they get dehydrated but that's it. But any new "sun spot" is not because it's coming up. The epidermis is (at the thickest, on the sole of the feet) 1.5 milimeters and at the eyelid 0.05 mm. Things that are in the face in the epidermis... you can see because the light penetrates that deep. So when you put a UV light (like with the UV camera) you see more pigment because melanin absorbs more UV light (and thus the contrast is increased) but not because the hyperpigmentation is somehow "buried deep" and the UV is like an X-ray that lets you see deep.
So if some sunspots suddenly started appearing I would be VERY worried that it might be postinflammatory hyperpigmentation!

------------------
To sum up, I wonder what other damage can "come up" and WHY, what is the effect of the products (i.e. what cells or what biological processes it targets) that in theory the more "damage" (whatever damage is) the stronger the reaction.

Because in reality it seems to me that those products are just irritants and the "uglies" is just irritation, dehydration or exfoliation while the skin gets used to the product. That could be one of the reasons people say "oh you went to fast", or "you left the wonderbar on your skin for too long" , etc.

And if it IS irritation, it'd be good to know WHICH component of the product is actually doing the irritation.

free skin care · Mon Apr 26, 2010 7:10 am

Possible explanations for pigmentation appearing darker after starting a new purportedly "whitening" product:

- exfoliation (the superficial layers of the skin have sloughed off therefore the skin is thinner over the pigmentation areas and thus the pigmentation appears darker

- the "whitening" effect also affects the non-pigmented skin around the pigmented area and the RELATIVE whitening effect is greater on those areas with less pigment (because there is less pigment to eliminate). Therefore the darker spots may appear relatively darker compared to the neighbouring skin for a while until the whitening effect on the darker areas "catches up". I have noticed this previously when I was using certain whitening products but with prolonged usage, the pigmentation evened out and got less.

It is very very important to use a sunscreen with good UVA protection when embarking on any whitening regime. Some of the whitening agents make skin more sensitive to the sun and this could be counter-productive for the whitening effect.

Josee....if you think CPs don't have enough scientific basis to back them up, I think there could be even less evidence-based science behind the Wonderbar?

free skin care · Mon Apr 26, 2010 8:32 am

Josee wrote:

So if some sunspots suddenly started appearing I would be VERY worried that it might be postinflammatory hyperpigmentation!

I think in some cases the 'new' spots are not new but in fact pre-existing spots that could not previously be seen without the benefit of a UV light and now closer (and more visible) to the surface after exfoliation?

free skin care · Mon Apr 26, 2010 9:16 am

free skin care · Mon Apr 26, 2010 9:45 am

Josee wrote:

So if some sunspots suddenly started appearing I would be VERY worried that it might be postinflammatory hyperpigmentation!

I definitely saw some NEW spots appear when using the WB. Shock

free skin care · Mon Apr 26, 2010 9:48 am

m1rox wrote:

Josee....if you think CPs don't have enough scientific basis to back them up, I think there could be even less evidence-based science behind the Wonderbar?

There is NO evidence-based science behind the Wonderbar at this point, though they are looking at doing clinicals in the future.

free skin care · Mon Apr 26, 2010 10:29 am

its_kristy wrote:

Josee wrote:

So if some sunspots suddenly started appearing I would be VERY worried that it might be postinflammatory hyperpigmentation!

I think in some cases the 'new' spots are not new but in fact pre-existing spots that could not previously be seen without the benefit of a UV light and now closer (and more visible) to the surface after exfoliation?

The thing is that they're not that "buried". So when the cell with the extra melanin goes "up" it goes "up" by a fraction of a milimeter so it's not enough "going up" to see a difference.

For e.g. in trials of tretinoin where they put UV light to document hyperpigmentation, the hyperpigmentation went away but people didn't see "hyperpigmentation" coming up. In fact, I think there are lots of Retin-A users here and I don't think anyone reported suddenly seeing hyperpigmentation appear (except for the few that did not use sunscreen, but that would be new hyperpigmentation).

The hyperpigmentation can become stronger when the cell dies while "going up" and the cell basically "dehydrates" but then since the skin surrounding it is also dying and dehydrating, then the difference is not quite visible.

The only exception is IPL or any other laser that specifically targets melanocytes. Then only the melanocytes are targeted and die so they become darker and then you can see them... but I don't know of other cases...

free skin care · Mon Apr 26, 2010 10:43 am

Mmmm I also realize that there are some things that don't make sense from a biological point of view.

For example some people believe that "scars" or "wrinkles" come up with the use of products and that is responsible for the "uglies" but I can't see how that would be biologically possible.

The same thing with applying a cream and even getting lumps on the skin and thinking it's "buried damage" coming up... that sounds scary!

I think even if we took a product that did not work much (imagine... a combination of AHA + collagen + some moisturizer) it could result in the same thing...
... first I get "uglies" because my skin gets dehydrated and irritated because of the AHA. But after a while, my skin gets used to the AHA so my skin will look more even (just due to the AHA) and more plump and less wrinkled due to the collagen and the moisturizer (even though it's not absorbed it sort of retains water and so makes the skin look plump). So I could conclude that I have less photoaging when in reality I have more or less the same but it's less apparent.

free skin care · Mon Apr 26, 2010 11:19 am

Here is an explanation of how "buried damage" comes up from one of the CP threads.

Star Model wrote:

Regarding buried damage & CP usage:

CPs are remodeling agents that repair skin damage by restoring the skin barrier & strengthening the collagen & elastins in the skin. They do not cause NEW damage to skin, but will trigger the remodeling process by slowly bringing up layers of "buried damage". Even young skin can have buried damage, but is not noticeable on the outside because young skin is thicker skin. Damage of "all sorts" is covered over by an outer layer of relatively good looking skin.

As we age & the skin naturally thins - buried damage becomes more noticeable. The damage (as with acne scars) actually looks worse when you get older, since it was covered over & disguised by "plumper more youthful skin".

So, while some freak out (and understandably so) when their skin begins to change when 1st starting CPs, it is all about what kind & how much damage has actually accumulated under the skin over the decades. Also damage does not necessarily mean acne scars. Use of moisturizers, makeup, sunscreens, etc. over time slowly damage the elastins in the skin & some will have more looseness than others when starting CPs. Those who experience looseness right away would do best by backing off using the mildest P&R products. Then slowly add CP Serum if needed. Many can get superior results by using only P&R not ever needing to push beyond.

Those who will have the hardest time of all are the *past acne suffers* because they have the most buried damage which is in the form of buried scar tissue. This takes a contentious effort to slowly break down the damage so CPs can rebuild. They will need (if they choose to eradicate the scars) stronger Hydroxys & CPs to attack scar tissue along with demarolling and/or needling techniques to help break up & loosen the scar tissue.

So all in all, CPs are safe, anti-inflammatory, non-irritating skin remodelers and you can safely use the products without necessarily going through all of the remodeling phases by keeping it MILD. This will give you all the benefits of CPs without bringing up too much of the hidden damage. Many people are not willing to go through the change, so MILD is the way to go for them.

It is difficult for people to comprehend *buried damage* in the skin because we can't see it. Many derms can't even understand it. They misdiagnose buried acne scars (which become more noticeable as we age) as certain disorders of the skin. The only way to have truly unblemished, bump-free beautiful skin is to slowly bring the existing damage up so that it can be degraded using various exfoliating methods. By doing this & going through the various stages, you can renew & remodel your skin to a youthful state using CPs.

Understanding the process is KEY.

http://www.essentialdayspa.com/forum/viewthread.php?tid=37752&start=325 (page 14)

free skin care · Mon Apr 26, 2010 1:45 pm

interesting topic - i'm also wondering about whether I'll see the uglies, or my HQ 2% + retin A combo aren't just working. Sometimes I thought the spots are getting lighter, but some other times, I thought they're getting darker. What is going on? Will the HQ 2% + retin A make my spots darker before they become lighter?

free skin care · Mon Apr 26, 2010 5:07 pm

This really feels like a stupid question but here goes. From how many years ago can something be digging damage "up" to the surface? For example I am 56 and stopped sunning at 20 so in 36 years has my skin not turned over more than once, I mean completely by now? I never had acne so I can't go there but I did bake in the sun when younger. The surface cells are dead we slough them of constantly and new cells move up to replace them die rinse and repeat. Where is the damage hiding?

free skin care · Mon Apr 26, 2010 5:29 pm

Natalyn wrote:

interesting topic - i'm also wondering about whether I'll see the uglies, or my HQ 2% + retin A combo aren't just working. Sometimes I thought the spots are getting lighter, but some other times, I thought they're getting darker. What is going on? Will the HQ 2% + retin A make my spots darker before they become lighter?

RetinA + HQ should not make the spots appear darker. Depending on the color of skin that you have and the irritation that you develop, they might seem a little darker for a bit.

free skin care · Mon Apr 26, 2010 5:30 pm

DarkMoon wrote:

This really feels like a stupid question but here goes. From how many years ago can something be digging damage "up" to the surface? For example I am 56 and stopped sunning at 20 so in 36 years has my skin not turned over more than once, I mean completely by now? I never had acne so I can't go there but I did bake in the sun when younger. The surface cells are dead we slough them of constantly and new cells move up to replace them die rinse and repeat. Where is the damage hiding?

Next to the toxins Smile

free skin care · Mon Apr 26, 2010 5:38 pm

Josee wrote:

DarkMoon wrote:

This really feels like a stupid question but here goes. From how many years ago can something be digging damage "up" to the surface? For example I am 56 and stopped sunning at 20 so in 36 years has my skin not turned over more than once, I mean completely by now? I never had acne so I can't go there but I did bake in the sun when younger. The surface cells are dead we slough them of constantly and new cells move up to replace them die rinse and repeat. Where is the damage hiding?

Next to the toxins Smile

LMAO

free skin care · Mon Apr 26, 2010 5:39 pm

Natalyn,I used HQ and retin a,and after about 3 months the brown spots on my face did fade completely.They did get a bit darker at first but I kept at it and did get results.My neck and chest were a different story.HTH

DM, my thoughts also,I stopped sunning in my early 20's some I would think that damage would have come and gone by now,at least for us older gals. I think we can do things to improve our skin and try new things that come out in hopes that we get results.

free skin care · Mon Apr 26, 2010 5:57 pm

Leggy 61 wrote:

Natalyn,I used HQ and retin a,and after about 3 months the brown spots on my face did fade completely.They did get a bit darker at first but I kept at it and did get results.My neck and chest were a different story.HTH

DM, my thoughts also,I stopped sunning in my early 20's some I would think that damage would have come and gone by now,at least for us older gals. I think we can do things to improve our skin and try new things that come out in hopes that we get results.

I get what you are saying but an example at 30 I burned the underside of my right forearm, I hit it on the red hot heating element of my oven and really burned the heck out of the skin. I had an awful scar that did last for years but now you could never even tell it was there? Our skin naturally turns over in time. I no longer can find that lovely polio vaccine we older folks got as kids that was around forever, it just disappeared?
I am not by any means saying we just let ourselves go and use nothing to pamper our skin just I don't really see how a topical can bring up damage, it seems only time and our natural skin turnover does that? Smile

free skin care · Mon Apr 26, 2010 6:07 pm

DarkMoon wrote:

I get what you are saying but an example at 30 I burned the underside of my right forearm, I hit it on the red hot heating element of my oven and really burned the heck out of the skin. I had an awful scar that did last for years but now you could never even tell it was there? Our skin naturally turns over in time. I no longer can find that lovely polio vaccine we older folks got as kids that was around forever, it just disappeared?
I am not by any means saying we just let ourselves go and use nothing to pamper our skin just I don't really see how a topical can bring up damage, it seems only time and our natural skin turnover does that? Smile

In the case of CPs, the acids bring up the damage...not the CPs. So that takes me back to a question I asked some time ago...is it really the acids that cause the improvements? They are clinically proven to generate collagen...

And in the case of the Wonderbar, I suspect the dehydration from the clay drives the cell turnover. But that's just a guesstimate?

free skin care · Mon Apr 26, 2010 6:12 pm

That makes sense Bethany, I don't use acids very often and didn't try the WB, but that seems to me that it's just because they are expediting our normal cell turnover, which we want but at what cost? Smile

free skin care · Mon Apr 26, 2010 6:28 pm

bethany wrote:

Here is an explanation of how "buried damage"

Quote:

Regarding buried damage :

As we age & the skin naturally thins - buried damage becomes more noticeable. The damage (as with acne scars) actually looks worse when you get older, since it was covered over & disguised by "plumper more youthful skin".

So, while some freak out (and understandably so) when their skin begins to change when 1st starting CPs, it is all about what kind & how much damage has actually accumulated under the skin over the decades. Also damage does not necessarily mean acne scars. Use of moisturizers, makeup, sunscreens, etc. over time slowly damage the elastins in the skin & some will have more looseness than others when starting CPs. Those who experience looseness right away would do best by backing off using the mildest P&R products. Then slowly add CP Serum if needed. Many can get superior results by using only P&R not ever needing to push beyond.

Those who will have the hardest time of all are the *past acne suffers* because they have the most buried damage which is in the form of buried scar tissue. This takes a contentious effort to slowly break down the damage so CPs can rebuild. They will need (if they choose to eradicate the scars) stronger Hydroxys & CPs to attack scar tissue along with demarolling and/or needling techniques to help break up & loosen the scar tissue.

It is difficult for people to comprehend *buried damage* in the skin because we can't see it. Many derms can't even understand it. They misdiagnose buried acne scars (which become more noticeable as we age) as certain disorders of the skin. The only way to have truly unblemished, bump-free beautiful skin is to slowly bring the existing damage up so that it can be degraded using various exfoliating methods. By doing this & going through the various stages, you can renew & remodel your skin to a youthful state using CPs.

Understanding the process is KEY.

Mmm... I don't know where this theory came from but it does not seem to be based on skin biology.

You cannot bring "scars up", you cannot bring bad collagen or bad elastin from the dermis "up", you cannot dermal "damage" up!!!

The epidermis is one thing... the dermis is another thing. If anything, when you "break the damage" (i.e. with microneedling you break collagen that's not well organized) then that collagen would be REABSORBED within the dermis, the same way that a bruise is reabsorbed. Bruises don't come up, hence "scar tissue" does not come up either!

I know I'll probably be disliked for saying this but if "bringing damage up" is similar to what bethany quoted, I do think it's irresponsible to propagate the "this is bringing damage up" theory coupled with "the more damage, the more uglies". I know that people mean well but still.

There is no such thing as "bringing damage up" really so if someone is experiencing a reaction... there is a reason for that. It can be an allergic reaction, a side effect, it can be a lot of things. So by giving an incorrect reason we might mislead the person, that person might not seek medical attention and the person can actually have some long-lasting effects.

When we use Retin-A, some people have pretty strong reactions. So because we know those "uglies" are due to the irritation of tretinoin and increased turnover and keratolytic effect, we say... "ok be careful. This can be pretty irritant, back off, you don't want to irritate your skin, it can cause more damage than good, etc.". I think most people will back off.

Now, in my view, this is totally different from saying..."oh no... Retin A is completely harmless, if you're getting a reaction is because you have a lot of buried damage, you might want to back off if the "uglies" bother you". Well... that person might actually think... "no I'm going to put up with this uglies because it means all this damage is coming up so I'll continue" and then that person can actually ruin her skin Sad

free skin care · Mon Apr 26, 2010 6:35 pm

bethany,I feel you are right in that acids help generate collagen and so do CP so thats why I use the retin a first and than the CP and so far so good.I'm going to give it 6 months and see if I have any more results.When I used the Nuderm system my skin was greatly improved and I do feel it was because of the acid.I'm now looking to improve on that if I can.

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