Aftercare
Aftercare is started immediately after the procedure for up to 7 days. The treatment of pain and anesthesia for nonenergy and injectable procedures should be at the treating physician's discretion and is dependent on the patient and the type of treatment administered.4,5
Immediately, post-procedural sunscreen and gentle skin care that may include skin-lightening agents or formulations designed to prevent infection and promote optimum healing are advised.
It is recommended that patients use a gentle facial noncomedonal cleanser typically free of comedonal oils with neutral skin surface physiological pH (4 - 6); formulas with glycolic or lactic acid for skin rejuvenation are recommended.4,5,15 Patients should continue applying a broad spectrum SPF >50 or more sunscreen as before the procedure and a moisturizer, and consider additional products with antioxidants, HA, or both.4,5,15 Topical retinol is recommended for those who received drug-based procedures, and other skincare products that were used before the procedure may be continued as needed.
Follow-up care
Follow-up care is provided 1 to 4 weeks after the procedure and comprises skin care as described for aftercare.4,5,15 The panel agrees that prescribing a skincare routine to patients receiving neuromodulator and dermal filler procedures improves skin quality and overall aesthetic outcomes. The synergy between skin care and injectable procedures improves patient satisfaction and promotes long-term prevention and maintenance. The panel agreed that recommending postprocedure skincare routines long term, beyond 1 to 4 weeks postprocedure, improves outcomes.
Adverse Events
The panel agreed that general neuromodulator and dermal filler procedures do not pose a significant risk of hyper- and hypopigmentation with dyschromia even in more richly pig-mented individuals, unlike peels, microdermabrasion, or laser procedures. Delayed adverse effects after various types of filler injections may include pigment change, nodule formation, and infection.4,5,14-18 Different patterns of pigment change provide clues for etiology and treatment.15-18 The most common type of pigment change, hyper- and hypopigmentation with dyschromia results from skin trauma.15-18 Hyper- and hypopigmentation with dyschromia may spontaneously resolve over months, but the diligent use of sunscreen, skin-lightening agents, and possibly superficial chemical peels may hasten resolution.15 Reticulated brown-red discoloration can occur a few months later at the site of HA fillers, representing a hypersensitivity reaction to the HA filler.23,24 These pigment changes are unresponsive to hydroqui-none and may require laser treatment with Nd:YAG 1064 nm. This brown-red hyper- and hypopigmentation with dyschromia may also respond to hyaluronidase treatment, which dissolves the hyaluronic acid.23,24 This type of hypersensitivity reaction has not been seen with fillers composed of hydroxyapatite or poly-L-lactic acid.24
DISCUSSION
Integrating Skin Care for Facial Nonenergy and Injectable Treatments
Patients frequently choose facial nonenergy or injectable treatments due to the minimally invasive nature, reduced risks, and shortened downtime compared to ablative laser and surgical modalities.6-11 Cost, age, and access all play a role in the type of treatment considered.
Copious recommendations and publications exist for integrated skin care for energy-based device treatments.25 The panel agreed that data and recommendations for best practices for periprocedural skin care or skin care combined with aesthetic nonenergy and injectable procedures are relatively limited. For the algorithm on integrated skin care for nonenergy and injectable procedures, we reviewed periprocedural skin care and specific ingredients as an adjunct or combined with nonenergy and injectable facial treatments.
Antioxidants
Topical antioxidants can be effective in protecting against and reversing photodamage of the facial skin.26 Studies have shown that topical vitamins C and E and the mineral selenium may protect against sunburn and discoloration.26 Certain forms of these antioxidants are stable and active after application to the skin, such as non-esterified, acidic vitamin C, non-esterified vitamin E, and the isomer D-alpha tocopherol.26
Topical Retinoid, Topical Hyaluronic Acid
Adjunctive or combined specialized aesthetic skin care may enhance aesthetic procedure outcomes.26-31 Creams, serums, and gels containing various ingredients such as HA may improve skin hydration and elasticity.26-31 The use of skin care by individuals receiving neuromodulator injections has reduced the mean volume and depth of facial lines and hyperpigmentation and improved skin smoothness, tone, and color compared with neuromodulator injections alone.26,27
A study of 20 volunteers treated with a neuromodulator and HA injections in the cheeks, nasolabial folds, and lips randomized participants to a skincare regimen for 12 weeks in conjunction with injections.26 Ten volunteers (group 1) received skin care with a cleanser, antioxidant, exfoliator, retinol, and sunscreen. Group 2 (n = 5) received the same skincare regimen plus a series of 6 alpha-hydroxy acid pigment-balancing peels every 2 weeks, and group 3 (n = 5) received skin care with a cleanser, moisturizer, and SPF 50 sunscreen. Group 2 showed the most marked improvement (blinded evaluator Global Aesthetic Improvement Scale [GAIS]).26 Groups 1 and 2 exhibited markedly improved self-esteem scores.26
