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

also mentions of Regenerating Skin Nectar and Restorative Skin Complex.

Minimally Invasive Treatment Modalities and the Use of Pre- Treatment Topical Protocols

Dr. Kilmer: “With micro-needling, you do have some ablation occur as well as with minimally-ablative fractional treatments. The one thing we should talk about whenever we're penetrating the skin is the fact that you can't put anything on topically that you can't put into the skin. Granulomas can form and other reactions can be seen from micro-needling specifically, with some of the reactive ingredients that have been applied topically to the skin.”

Dr. Geronemus: “A lot depends on what type of fractional laser we are using. Most of our work is done with a 1927 thulium, whether it be the Fraxel® Dual, LaseMD™, or the Clear + Brilliant, which is a 1927 diode. We use a 1550 as well with the Fraxel. The 1550 nanometer laser doesn’t require as much post-treatment care. We do pretreat whenever possible with the Regenerating Skin Nectar.” Dr. Tanzi: “I have patients start Regenerating Skin Nectar about one to two weeks before the treatment. I am a huge fan of the 1927 nanometer wavelength and have several different devices within the practice. Depending on the device and the density delivered, I’ll have the patients use the Nectar for a week or two afterward as well. I'll also recommend an over-the-counter ceramide-containing cleanser and moisturizer to use. After 2-3 days, patients may gently use the cleanser in a washcloth to stimulate the removal of the MENDs. I find that helpful to reduce the risk of an acneiform reaction. No intense rubbing or scrubbing with the washcloth, just gently to go over the skin while cleansing.”

Dr. Saedi: “Before a non-ablative laser procedure, I prep with Regenerating Skin Nectar, a retinoid, and a sunscreen. I try to have patients use the Regenerating Skin Nectar 1-2 weeks before the treatment.”

Dr. Karimi: “Ever since I've learned of the Regenerating Skin Nectar, we try to prepare everybody with that product, even for the non-ablative because the only non-ablative fractional laser we have is the 1540, the Palomar, and so we try to have everybody prepare for that, but sometimes they come in and do the treatment the same day, so we don't have the opportunity to pre-treat. But, very often, we do have the opportunity for them to pre-treat, so I would say just the Regenerating Skin Nectar, and then all the other regular stuff, sunscreen, and everything that has already been mentioned.”

Dr. Burns: “If they have sun damage; I will start them on the Regenerating Skin Nectar. If I can do it beforehand, that’s great. If they walk in and want the treatment right then, I do the procedures. There's a business we've got to run and a convenience for the patient. If that is the case, do the treatment, and give them Regenerating Skin Nectar post-procedure. I like for everybody that's never had a round of Regenerating Skin Nectar to get it, and then get on the Restorative Skin Complex. Then, the moisturizer we use is CeraVe®. I would use Regenerating Skin Nectar for minimally invasives. I would use it for microneedling. It just makes sense for me to use it in an ideal world. Now, if the cost is too much for the patient, then I would probably just go with something simple like CeraVe. But those are two different approaches.”

Summary: Pre-treatment for minimally invasive procedures include retinoids, moisturizers, ceramides, and sunscreens, but varied widely by practice. The most consistently used pretreatment is Regenerating Skin Nectar.

Minimally Invasive Treatment Modalities and the Use of Post- Treatment Topical Protocols

Dr.Tanzi: “I use the Regenerating Skin Nectar post-treatment for faster skin healing as well. Patients love the feel and it enhances patient satisfaction. This is new for me as I have never been impressed with post-laser products before.”

Dr. Saedi: “Immediately after, either I or my staff apply the Regenerating Skin Nectar. Then, after the treatment, I suggest they use the Regenerating Skin Complex at home along with sunscreen and hydroquinone if they're prone to hyperpigmentation.”

Dr. Geronemus: “Post-treatment, we use the Regenerating Skin Nectar as well. If I'm using the 1927, particularly patients with a lot of photo damage, then the need for more appropriate skin care is a little bit greater because the skin becomes dry and it feels like sandpaper. They have the MENDs, which is the microscopic epidermal necrotic debris. In that situation, particularly with darker-skin patients, or people with more photo damage, I like to make sure that post-treatment, they get the Restorative Skin Complex as well as the Regenerating Skin Nectar in the healing phase. I think these are important additions. Of course, all of our patients, whenever possible, are using the Alastin Renewal Retinol and usually starting at the 0.25 and going up to 0.5, if indicated. The sunscreen is a critical component, particularly when you're dealing with photodamage. In New York, which is more seasonal, we put a much higher emphasis on that during the spring and summer. Less of an issue during the winter. Prior to the use of the Alastin Procedure Enhancement System regimen that we're on now, we sometimes would use some light exfoliating products that I found led to more trouble than it was worth. One of the purposes of having a skin care