Pre- and Post-Procedural Care Best Practices to Enhance Energy-Based Treatment Outcomes

August 2019 | Volume 18 | Issue 8 | Supplement Individual Articles | 187 | Copyright © August 2019

Suzanne L. Kilmer MD,a Roy G. Geronemus MD,b Nazanin Saedi MD,c Elizabeth Tanzi MD,d Kian Karimi MD,e A. Jay Burns MDf

aLaser & Skin Surgery Center of Northern California, Sacramento, CA bLaser & Skin Surgery Center of New York, New York, NY cJefferson Laser Surgery and Cosmetic Dermatology Center, Philadelphia, PA dCapital Laser & Skin Care, Chevy Chase, MD eRejuva Medical Aesthetics, Los Angeles, CA fDr. A Jay Burns Cosmetic Surgery, Dallas, TX

how I base most of my consultations. I ask them what kind of time can you give me? That's usually number one. Then, their skin type — Fitzpatrick skin type, and the patient goals. I think the Alastin products are great for all skin types. I think my fourth concern would be skin conditions. More or less, people who are acne-prone or have sensitivities to certain products.”

Dr. Saedi: “I treat a lot of African-American darker skin types, so skin type is a high priority for my consideration of what to do, and then recovery time, and then probably what they can afford.”

Dr. Tanzi: “Okay, for me, my highest two priorities are trying to deliver the best results possible with a reasonable amount of recovery time for the particular skin concern of the patient. That is how I approach laser selection to start, but then other factors such as the patient’s lifestyle, cost, and maintenance requirements are considered.”

Dr. Geronemus: “So, these people want to get in, they want to get out, they want to recover as quickly as they can, they want to look 30 years younger, and they don't want any downtime. So, there is a lot of concern on behalf of our patients and there is a lot of pressure on physicians to do the best we can to make sure that the patient recovers as well as they can, as quickly as they can. So, my main goal is recovery time. People just want to get back in action as quickly as possible and that's where the Alastin products really are extremely helpful in terms of the preconditioning, where we start ahead of time, and the posttreatment recovery where we have a very specific regimen that we ask them to follow. So, that would be my primary goal, and this does relate a lot to skin concerns as well for these patients. Some of them have exquisite sensitivities, a tendency towards acne breakouts when they're using products they buy at just any counter. These are the types of things that can be problematic in the healing phase. So, the concern for sensitivities, as well as what might be there as alternatives, would be my second concern. I don't see much difference in skin types. I think the Alastin products are great for all skin types including sensitive skin. My third concern would be conditions. More-or-less, people are acne-prone or have sensitivities to certain products or ingredients within commonly used topical agents. I think they might do very, very well with the Alastin products where we just don't seem to see the same level of sensitivity that we saw, or reactions, with other products.”

Dr. Burns: I would assume that patient goals – you could also say patient expectations – are to receive quality results. Producing those results safely is also a big deal. In other words, when they talk about optimizing recovery, I think they must talk about not only the time required for recovery, but also the intensity of the recovery. When we can decrease the intensity of the recovery, that has great value as well. If we can minimize redness during the recovery, they can then more easily cover it with makeup. So, there's an emphasis on the quality of the recovery and safety of the recovery and not just shortening the total recovery time.”

Summary: The two most important factors that determine treatment selection are those relating to skin type, such as likelihood of experiencing pigmentary changes or acne, and the duration of the recovery period. Both appear to be somewhat practicespecific. Other factors include patient expectations, safety, and cost.

Non-Ablative Treatment Modalities and the Use of Topical Preor Post-treatment Protocols

Dr. Burns: “For BBL and other non-ablatives, I think they all should be on some kind of skin care as well. I think providing the valuable active peptides found in the Restorative Skin Complex helps, so I recommend this regimen to my patients. If I have a patient who appears to have light type-3 skin but has brown eyes and a tendency to lay down some pigment during pregnancy, then I usually add a lightening agent as soon as the inflammation calms down a bit, usually around 10 days postprocedure. I would give them something like a hydroquinone if they are high risk for PIH and can tolerate it. If hydroquinone is too harsh and irritating early in the recovery process, we use Lytera®, which is often tolerated much better.”

Dr. Geronemus: “So, even though people are coming in for something where you may not need immediate post-treatment skincare, I do try to look at it from a long-term perspective. Have those patients on a long-term treatment plan that would include usually, of course, sunscreen, you have retinol products, and many patients are just loving the Regenerating Skin Nectar, and once they start that they simply won't stop.”

Dr. Karimi: “Agree with Roy.”

Dr. Kilmer: “I also agree with Roy.”

Dr. Tanzi: “I talk to patients at length about at-home skin care routines and how they can support and maintain the results from office procedures. There are a few main ingredients that I look for in a good skin care routine, which include an anti-oxidant, glycolic acid, and a retinol. When I make recommendations, I like to give options to pick up in the office, or at the CVS, or department store. Patients appreciate the variety. For those patients too sensitive for a retinol, the peptide in the Alastin products makes a great alternative.”

Summary: Post-treatment for non-invasive procedures includes antioxidants, a glycolic, retinoid, peptides, growth factor, and hydroquinone, but again, varied widely by practice. There were