nonenergy and injectable treatments is highly variable.4,5 Nonenergy device-based treatments may improve skin conditions by inducing cutaneous changes that remodel the skin matrix.6-11 Adverse events may occur, prolonging the duration and severity of the healing process.4-7
The current algorithm aims to provide clinicians with skin care recommendations when treating patients with nonenergy-based and injectable treatments for facial antiaging to stimulate healing, reduce downtime, and improve comfort and treatment outcomes.
The current algorithm aims to provide clinicians with skin care recommendations when treating patients with nonenergy-based and injectable treatments for facial antiaging to stimulate healing, reduce downtime, and improve comfort and treatment outcomes.
MATERIALS AND METHODS
A panel of 7 global physicians (panel) who perform medical aesthetic procedures convened a face-to-face meeting and online follow-up to develop and customize the algorithm. The panel found this resource can provide the following: Insight into the fascinating similar philosophies across continents, which may reduce practice variability, a review of the peri/post procedure space, education for patients with richly pigmented skin, and highlighted differences within the injectable space. The panel employed a modified Delphi method and reached a consensus on the algorithm for periprocedural skin care for nonenergy and injectable antiaging treatments based on the best available evidence and the panel members' clinical experiences and opinions.12,13
Literature Searches
Structured literature searches on PubMed and Google Scholar (secondary source) by a physician (TE) and a physician/scientist (AA) were conducted from December 20 to 22, 2022, for publications in the English language from 2010 to January 2023. The following terms were used for the literature searches.
Group 1: Aesthetic dermatology AND nonenergy facial treatment; OR fillers OR injectables OR chemical peels AND hyperpigmentation OR post-inflammatory hypopigmentation.
Group 2: Aesthetic dermatology; pre-/post-procedure measures AND skincare; OR skincare for nonenergy aesthetic facial treatments; OR skincare for injectable treatment OR skincare for chemical peels
Group 2: Aesthetic dermatology; pre-/post-procedure measures AND skincare; OR skincare for nonenergy aesthetic facial treatments; OR skincare for injectable treatment OR skincare for chemical peels
The searchers reviewed the titles and abstracts and then the full articles. Excluded were duplicates and poor-quality studies. In case of a review or update, we used the latest version. The reviewers selected 54 nonenergy and injectable treatment articles; after excluding 24 articles, 30 remained. Article types included were clinical studies, algorithms, consensus papers, guidelines, meta-analyses, systematic reviews, and review papers (Figure 1).
Each selected clinical publication that included periprocedural skin care or skin care combined with nonenergy and injectable treatment was graded based on reviewer consensus.12 The reviewers assigned a level of evidence for each treatment (levels A, B, C, and 1 to 4) using the pre-established criteria.12 No grading was done due to a lack of clinical studies on periprocedural skin care.
Development of the Algorithm
Based on the literature results and in-field practice, the global panel worked in small groups on implementing and revising the initial algorithm skeleton proposed by TL and AA. The global panel reconvened into a plenary group to reach a consensus through blinded reiterations. Reviewing, editing, customizing the final algorithm, obtaining consensus, and discussing and reviewing this manuscript took place online.
The Algorithm
The purpose of a clinical algorithm is to guide medical decision-making by standardizing treatment regimens to encourage compliance with evidence-based recommendations.4,5 The algorithm on supportive skin care for nonenergy and injectable treatments has a pretreatment (starts 2 - 4 weeks before the procedure) and treatment (day of treatment) section, followed by care after the procedure ( 0 - 7 days) and follow-up care (1 - 4 weeks after the procedure or ongoing) (Figure 2). Nonenergy facial and injectable treatments included microdermabrasion, micro-needling, threads, chemical peels, fillers, and neuromodulator injections. Although microdermabrasion and micro-needling may use an energy-based device, the treatment is minimally invasive and, therefore, fits in the category. Moreover, these procedures are frequently combined with skin care or topical treatments, which is relevant for the algorithm.
Medical and Dermatological History
Pre-procedural consultation includes clarifying individual patient goals and expectations of the treatment, followed by a treatment plan.
Outcomes of previous skin treatments should be discussed with the patient, especially responses to dermabrasion or chemical peels.4,5,14
Before recommending nonenergy-based and injectable treatments, the medical and dermatological history of the patient is to be obtained with specific attention to skin issues that the procedure may exacerbate, such as history, ethnicity, and/or Fitzpatrick or Roscea skin type, that may predict a higher risk for pigmentary or scarring complications.4,5,14
Before recommending nonenergy-based and injectable treatments, the medical and dermatological history of the patient is to be obtained with specific attention to skin issues that the procedure may exacerbate, such as history, ethnicity, and/or Fitzpatrick or Roscea skin type, that may predict a higher risk for pigmentary or scarring complications.4,5,14
Pretreatment Measures
Starting 2 to 4 weeks before the procedure, clinicians advise patients to avoid excessive sun exposure before, during, and after facial nonenergy-based and injectable treatments.4,5,14,15 To protect the face from sun exposure, applying a broad-spectrum sunscreen with an SPF 50 or higher,
