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European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
1
Complex Effects of Hot and Cold Procedures on Skin
Elasticity in Spa & Wellness
Nevenka Panovska
Antoaneta Dimitrova, PhD
Department of Physiotherapy and Rehabilitation, National Sports Academy
“Vassil Levski”, Sofia, Bulgaria
Doi: 10.19044/esj.2018.v14n6p1 URL:http://dx.doi.org/10.19044/esj.2018.v14n6p1
Abstract
The purpose of this study is to evaluate the complex effects of the hot
and cold procedures, practiced in modern Spa & Wellness, on skin elasticity,
as that indicator is an integral factor defining the aesthetic vision of the skin.
Material and Methods: The present study tracked 60 women aged 35 to 65
years. The methods included an aesthetic skin rejuvenation program that
contained a complex of 12 Spa and Wellness rituals conducted in a period of
one month, three times per week. Each treatment was а temperature contrast
procedure through a Parafango body thermo-application and a face cryo-gel
application. The facial skin condition was assessed by an A-ONE apparatus -
an automatic skin diagnostic analyzer. Results: A significant improvement in
the skin elasticity in the three studied age groups was observed after the
procedures. This indicator increased 3.75 units (9.93%) in the 35-44 age
group, 3.5 units (11.36%) in the 45-54 age-group and 1.80 units (8.22 %) in
the observed individuals from 55-65 age-group. At the end of a treatment, the
increase in all three age groups was statistically significant (p<0.05). Skin
elasticity assessment was significantly lower for all three age-groups before
the procedures, compared to the established standards. After the applied
procedures, the skin elasticity was approaching the established standard (the
first age group exceeded the standard, the second approached the standard and
the third was slightly below the standard). Conclusion: The study reveals that
the complex effects of hot and cold procedures result in improved skin
elasticity.
Keywords: Spa, Wellness, cryotherapy, thermotherapy, skin elasticity
Introduction
Since ancient times the beneficial influence of the natural methods and
resources on health and beauty, including the complex effects of the thermal
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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and cold procedures, has been known. The authors in their studies confirm that
the contrasting procedures’ impact on the skin aesthetic vision is undeniable.
These procedures are a part of the modern Spa & Wellness concept, which
strives for a healthy lifestyle and achieving “Well-Being” - good health and
good spirit (Baumann, 2007; Cholewka et al., 2011; Clijsen еt al., 2008;
Dawes, 2013).
The temperature contrast results in a significant improvement in the
condition of the entire organism, including the skin as an organ. These effects
are due to the blood circulation improvement, activation of the cellular
metabolism, balancing of the endocrine functions of the glands, stimulation of
the immune system and controlling stress and fatigue. Moreover, these
beneficial effects are related to the improvement of the skin aesthetic vision.
The application of temperature-contrast procedures causes a skin-vascular
reaction, and this in turn leads to neovascularization, improving the skin
microcirculation, and stimulating the dermal fibroblasts function. It also
activates the elastin, collagen and glucosaminoglucan-hyaluronic acid
synthesis which are responsible for the skin condition, and more specifically
its elasticity (Baumann, 2007; Cholewka et al., 2011; Escoffier et al., 1989;
Shin et al., 2005). Improved skin elasticity results in a natural skin aesthetic
vision. The objective assessment of the aesthetic skin appearance is based on
examination of various indicators, one of which is the skin elasticity.
Purpose
Тhe present study aims to evaluate the complex effects of the thermal
and cold procedures used in the modern Spa & Wellness concept applied on
skin elasticity, which is an integral part of the factors influencing on aesthetic
skin vision.
Material and Methods
The subjects of this study were 60 women aged 35 to 65 years, divided
into 20 individuals in three age groups (35-44; 45-54 and 55-65 years). They
were selected on a voluntary principle, as an excluding criterion was a
presence of diseases that are contraindicated for application of heat and cold
procedures. The present study was conducted during the period of 2010-2013
in Dzhambazovski Center, Hotel Ambassador, Republic of Macedonia.
Skin diagnostic methodology
The skin condition of the individuals was evaluated by applying an A-
ONE skin diagnostic apparatus, which measures the following parameters:
elasticity, humidity, wrinkles, pigmentation, pores, etc. The assessment was
conducted before and after the 12 procedures applied, included in the
Aesthetic Spa & Wellness Ritual.
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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The A-ONE system applied in this study is a modern method for
automatic skin diagnosis and it is characterized as a new generation of
software solutions. To measure the elasticity parameter, the device software
sets standard values - 40 units is a standard for the 35-44 age group, 35 units
for the 45-54 age group, and 30 units for the 55-65 age group.
The diagnosis was performed on a clean body skin and face skin
without cream and makeup. The results obtained were automatically compared
to the established software standard, corresponding to the age and skin type.
This allowed objective assessment of the skin elasticity parameter, applied
during the Aesthetic Spa & Wellness ritual.
Methodology of the applied Aesthetic Spa & Wellness ritual
The tracked individuals were welcomed into a relaxing atmosphere;
the methodology of the thermo-application on the body skin and cryo-
application on the face skin was carefully described in details. This
conversation created a sense of well-being and trust in the specialist's
professional approach. Aesthetic Spa & Wellness ritual is always started with
thermal application on the body skin, while simultaneously applying the cryo-
application of the facial skin. This sequence was repeated in all 12 procedures
over a period of one month, three times per week.
Methodology of a Parafango thermal-application on the body skin
For the thermal procedures we used parafango-applications. Parafango
is a mixture of paraffin and volcanic mud. Those applications were heated to
50° C and the resulting emulsion was poured onto a special pad. Parafango
can be repeated multiple times. After each procedure, the packs were sterilized
at 130 °C. Parafango thermo-applications were placed on a bed covered with
two 2m x 2 m cotton sheets, and there was a nylon sheet between them. The
client was undressed and lying down on her back during the thermo-
application, which in turn enveloped her whole body. The clients’ backs were
covered with a natural wool blanket, and the client was left in a favorable
position for a period of 30 minutes. Then the she was unwrapped and her body
was dried with a towel, in order to absorb the sweat. The client dressed
immediately to keep the body warm.
Methodology of a cryo-application on the facial skin
A cryo-application on the face was simultaneously applied with the
parafango thermo-application on the body. The individual’s face was covered
with cotton fabric, which followed the shape of the ice-gel applicator. Cryo-
applications with ice gel (Rehamed Deutschland) were placed in plastic bags
that follow the shape of the face with openings for the eyes and mouth. Cryo-
application’s temperature was -20 °C, which was maintained in a special cryo-
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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camera. The cryo-applicator was applied on clean, facial skin, free of cream
and make-up, three times within 30 minutes. Duration of cryotherapy
treatment was applied at intervals - three minutes of cryotherapy then pause
for seven minutes. After the treatment was complete, the cryo-applicator was
removed and the skin was dried with a cloth.
Statistical methods: The hypothesis check was completed by the Student t-
criterion and Fisher's F-criterion.
Results
The results of the study in terms of skin elasticity are presented in
Table 1 and graphically illustrated in Fig. 1.
Table 1. Changes in the skin elasticity (mean value and standard deviation) in the three
groups before and after procedures
Groups
X1±SD
X2±SD
Difference
(X1-X2)
d%
Cohen's
d
t
P(t)
F
P(F)
35-44 yrs.
(n=20)
37,75 ±
1,92
41,40±2,35
3,75
9,93
4,41
19,71
100
45-54
yrs.(n=20)
30,80±2,44
34,30±2,47
3,50
11,36
6,82
30,51
100
1417,9
100
55-65 yrs.
(n=20)
21,60±3,44
23,40±3,6
1,80
8,33
4,39
19,62
100
n – number of subjects; yrs. – years; X1±SD - mean value and standard deviation before
procedures; X2±SD - mean value and standard deviation after procedures; P-significant
difference compared with values before treatment for each group (Student t-test)
Before beginning the procedures, in the first age group surveyed (35-
44 years) the initial mean average of the elasticity index was 37.75 ± 1.92 units
and increased to 41.40 ± 2.35 units at the end of the study. The achieved
improvement of 3.75 units (9.93%) is statistically significant (t = 19.71, P (t)
100.0) and clinically significant (Cohens'd = 4.41). The initial mean average
of the elasticity index in the second age group (45-54) had a value of 30.82.44
units. After the completion of 12 procedures, the skin elasticity index
increased with 3.5 units (11.36%) and reached a mean value of 34.30 ± 2.47
units. The increase in elasticity index is statistically significant (t = 30.51, P
(t) 100.0) and practically significant (Cohens'd = 6.82). In the third age group
(over 54 years), the elasticity index increased from 21,603,44 units to
23,403,60 units, i.e. with 1.80 units (8.33%) and also is statistically
significant (t = 19.62, P (t) 100.0) and practically significant (Cohens'd =
4.39).
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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Fig. 1 Dynamics of the facial skin elasticity results in the individual age groups before and
after procedures
The absolute increase of the results in the first two age groups is
markedly improved (3.75 units and 3.50 units respectively). The improved
elasticity index in the third age group is significantly less (1.80 units). Due to
the natural influence of age on the aesthetic appearance of the skin, the
comparison with the established standard in the diagnostic method applied in
this study is more important.
The results between initial and final measurements are presented in
Table 2 and in Fig. 2.
The established standard for the 35-44 age group is 40 units. The
representatives of this age group were closest to a standard index values.
Before staring the procedure, the average value of 37.7519.2 units was with
2.25 units lower than the standard, (t) = 5.25, P (t) = 100). After the procedure,
the result was 41,402,35 units, 1,40 units higher than the standard. This
difference is statistically significant (t) = 2,85, P (t = 99,00).
The established standard for the 45-54 age group is 35 units. Before
starting the procedure, the measured value of the skin elasticity in this group
was 30.80 units, the difference of -4.2 is statistically significant (t) = 7.69, P
(t = 100). According to the final research results, the elasticity average value
in the second measurement of 34.30 was with a difference of -0.70 units below
the standard, and the difference is statistically unreliable (t) = 1,27, P (t = 77,9),
which means that the tracked individuals have reached the standard of their
age level.
[] 23.4
30.8
34.3
37.75
41.4
15
20
25
30
35
40
45
before procedures after procedures
Facial skin elasticity
55-65 years 45-54 years 35-44 years
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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Table 2. Comparison of the mean values and standard deviation of each age groups before
and after procedures with the standard values for the skin elasticity according the age
Groups
35-44
yrs.
(n=20)
45-54 yrs.
(n=20)
55-65 yrs.
(n=20)
X1±SD
X2±SD
X1±SD
X2±SD
X1±SD
X2±SD
Mean
values
37,75
±1,92
41,40±2,35
30,80±2,44
34,30±2,47
21,60±3,44
23,40±3,6
Standard
value
40
40
35
35
30
30
Difference
-2,25
1,40
-4,20
-0,70
-8,40
-6,60
t
5,25
2,85
7,69
1,27
10,92
8,19
P (t)
100
99
100
77,9
100
100
n – number of subjects; yrs. – years; X1±SD - mean value and standard deviation before
procedures; X2±SD - mean value and standard deviation after procedures; Difference –
between standard value and mean values of the three groups before and after procedures; P-
significant difference compared with standard values before and after procedures for each
group (Student t-test)
Fig. 2 Comparison of group average value with the standard in each measurement
The skin elasticity of the tracked persons in the third age group was in
worse condition - over 54 years. The established standard for the age group is
30 units and before the procedure the mean average was 21.60 units. The
difference from the standard of -8.40 is statistically significant (t) = 10.92, P
(t) = 100. After the applied procedure, the elasticity skin index was 23.40 units,
the difference from the standard of -6.60 is again statistically significant (t) =
8.19, P (t) = 100).
As a result of the conducted procedures, the skin elasticity increase
was statistically significant, in all tracked persons (F = 1417,9, P (F) 100,00.
15
20
25
30
35
40
45
55-65 years 45-54 years 35-44 years
Skin elasticity
before procedures after procedures
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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Discussion
Our findings suggested that the results obtained in regard to the skin
elasticity showed significant improvement in all age groups, which also means
a positive change in the aesthetic appearance of the skin.
The causes of aging skin and the reduction of its elasticity are
numerous and depend on many factors. Aging skin is а part of the natural
"mosaic aging". Researchers have shown that the cellular metabolism of the
skin slows down, and the number of dermal fibroblasts decreases with age. As
a result of these structural changes, the secretory function of dermal fibroblasts
and the biosynthesis of elastin biosynthesis, collagen and hyaluronic acid
reduce, which causes the loss of skin elasticity and natural, youthful looking
skin (Baumann, 2007; Escoffier et al., 1989; Maznev et al., 2017; Shin et al.,
2005).
The root cause of the skin aging process is the reduction of skin
perfusion. In his research, Li L. tracked a group age of 20-74 years and proved
that as age progresses, the capillary net density decreases by 40-70% (Li et al.,
2006). This shows that skin rejuvenation processes are dependent on
improving the blood circulation in the skin.
The effect of hot and cold applications on the skin in the tracked
individuals can be explained by a number of physiological changes caused by
the influence of these physical factors. One explanation is the occurring
improvement of skin perfusion and its aesthetic vision. In a recent study, the
authors demonstrated that parafango thermal applications increased blood
perfusion rate in the skin from 23.2 to 197p.u. and this parameter remained
elevated during the parafango thermal application and decreased slowly to
baseline after the applied therapy (Clijsen et al., 2008).
Another effect of the thermal procedures is the activation of dermal
fibroblasts and increase of structural proteins secretion responsible for the skin
condition. Société de Recherche GREDECO, in collaboration with researchers
at Pitié-Salpetriere Hôpital in Paris, conducted a clinical study on skin biopsies
aiming at skin rejuvenation by heating. The results obtained showed the
production of new collagen from the dermis (more than 40%) in the dermal
skin biopsies of the skin treated with thermal procedures as compared to the
non-thermal skin biopsy control samples (Lazar, 2008). This confirms that the
heat activates the dermal fibroblasts and stimulates their secretory function.
The conducted studies have confirmed that the application of
cryotherapy also reduces signs of skin aging. The cryotherapy stimulates
blood circulation in the skin and activates all skin layers and structures,
resulting in a natural and younger appearance (Cholewka et al., 2011).
In his study, Guan, X. examined the effects of two different
temperature influences (37 °C and -20 °C) on human fibroblast cell cultures.
The results were better at a temperature of -20 °C as compared to the effect
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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obtained at 37 °C. The shock cooling maintains the vitality of the fibroblast
cell, activates cellular proliferation and differentiation, and stimulates its
function (Guan et al., 2007). The data obtained confirms that cryotherapy is a
powerful method for revitalizing and stimulating of the dermal structures.
The mentioned studies show that both thermotherapy and cryotherapy
have a beneficial effect on the skin rejuvenation process. In addition, the
authors have found that the complex effects of cryo- and thermotherapy create
an intensive improvement in blood circulation, which in turn delivers blood to
all skin structures. New capillaries are being created that supply blood to
deficient areas, and therefore connective tissue cells are stimulated, in
particular dermal fibroblasts (Baumann, 2007; Escoffier et al., 1989; Shin et
al., 2005). The physiological changes, occurring under influence of
temperature contrast on the skin, can be explained by a skin-vascular reaction
in which the skin perfusion increases (Koleva, 2010; Kostadinov & Kraev,
1987; Tasheva, 2007). This, in turn, stimulates the dermal fibroblasts. It leads
to elastin biosynthesis, and collagen and glycosaminoglycan-hyaluronic acid
increase, which are responsible for the general skin condition and elasticity
(Samuel et al., 1987).
The aforementioned changes in skin microcirculation, the activation of
dermal fibroblasts, and possibly other effects result in increasing of skin
elasticity, which is an essential element of the aesthetic appearance of the skin
(Maznev et al., 2017).
The data obtained in our research shows that during the application of
Aesthetic Spa & Wellness ritual there is a significant increase in skin elasticity
in all age groups. When comparing to the established standard, before starting
the procedures, in all groups the results were lower than the standard. As a
result of the beneficial effect of the applied therapy, the representatives of the
first age group have had skin elasticity higher than the standard. The second
age group managed to reach the established age- standard. However, the third
age group did not reach the standard, despite the observed positive effect of
the procedures.
A better effect achieved in younger individuals as compared to older
individuals can be explained by the fact that the physiological potential for
activating skin rejuvenation mechanisms is greater. In younger individuals, the
cellular metabolism of the skin is faster and the dermal fibroblasts are greater
in number. The skin vascularization is also better, which is associated with
better skin perfusion, more intensive dermal fibroblasts function, and
synthesis of structural proteins responsible for the skin condition, specifically
elasticity. The positive effect of the applied procedures is visible in the other
two age groups as well, however it is less pronounced than in the first age
group.
European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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Conclusion
At the conclusion of the study, we established that the complex effects
of the thermal and cold procedures, applied in the aesthetic Spa and Wellness
ritual, are associated with a number of beneficial physiological changes that
have a positive influence on the skin elasticity in all observed participants. The
intensity of the skin elasticity is the most pronounced in the first tracked age
group and decreases with age.
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