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

regimen is that you really have total control with what the patient is using. That really makes me feel better and the patient has a better outcome.”

Dr. Burns: “In an ideal world, I would pretreat everybody with Regenerating Skin Nectar for 2 weeks. And then, after we did the treatment, I would apply Regenerating Skin Nectar. If this is their second time, I would just put a moisturizer, like CeraVe, that day, and have them continue on the Restorative Skin Complex. I do the same thing for microneedling. I'm a little bit more cautious with RF microneedling. I will give them an antibiotic right before the treatment, and maybe one dose afterwards, because we are creating a wound. It's a semi-sterile procedure, so I'll give them antibiotics, cephalexin or doxycycline, for maybe 1 to 3 days. I would apply Regenerating Skin Nectar immediately afterward.”

Summary: Post-treatment for minimally invasive procedures included moisturizers, hydroquinone for hyperpigmentationprone patients, sunscreens, Renewal Retinol, and oral antibiotics, but varied widely by practice. The most consistently used pretreatments are Regenerating Skin Nectar or Restorative Skin Complex, which would then be continued post-treatment.

Ablative Treatment Modalities and the Use of Pre-Treatment Topical Protocols

Dr. Geronemus: “I don't know what you're seeing around the country, but we've had a rather significant resurgence of both fractional and fully ablative resurfacing.”

Dr. Tanzi: “I absolutely agree that there is a resurgence of interest, not only by the patients, but also from physicians, for fully ablative resurfacing. In my office, adding focal fully-ablative resurfacing, particularly for the stubborn perioral rhytides, has been very successful. Then a non-ablative or fractional ablative is applied to the rest of the face. Skin care is extremely important for these patients to minimize side effects and reduce the downtime. I recommend a pre-treatment protocol with Alastin Regenerating Skin Nectar a week or two prior to treatment. I also have patients start mupirocin in their nose 3 days beforehand and Valtrex® starting the day before for fully ablative procedures.”

Dr. Saedi: “Pre-treatment, I start everyone on Alastin Regenerating Skin Nectar. I try to start 2 weeks before if possible. I do mupirocin in the nose the day before, I start Valtrex the day before, and I start Keflex® the day before.”

Dr. Karimi: “I've also been using the Alastin products now for ablative laser resurfacing. All my low-risk hyperpigmentation patients get 1 week of compounded cream. The high-risk get 2 weeks, which is an 8% hydroquinone...it's always sunny in California. They get hydroquinone, they get hydrocortisone, kojic acid, and tretinoin. They all get that at least 1 week before. If they're really high-risk, type-4+, type-5, then they get it for 2 weeks. Then, I have them give themselves a break from the compounded cream for a few days, prior to the procedure.”

Dr. Burns: “Everybody gets an antiviral. They get it for 10 days. I use Valtrex® because it has served me well for years and have had little issues with it. You could use Famvir®, as I suspect it works equally as well. However, I use Valtrex 500 mg per day. If they have a history of herpes, then I'll go ahead and treat them with 1 mg twice daily. If they have herpes outbreaks on a regular basis, then I will treat them with 1 mg three times a day, which would be the full treatment dose. I give them antibiotics, starting with typically one dose before the surgery. I pre-treat them with the Regenerating Skin Nectar for 2 weeks. And, I'm pretty adamant on that. I think that if they came in and they needed to be done next week, I'd probably do it, but I would start them on Regenerating Skin Nectar as soon as possible.”

Summary: Pretreatment for ablative procedures include mupirocin in the nose several days prior to the procedure, oral antibiotics and antivirals, hydroquinone for 1 to 2 weeks, depending on skin type, or hydrocortisone, kojic acid, and tretinoin. Once again, specific treatments varied by practice, but most mention using Regenerating Skin Nectar 2 weeks before the procedure.

Ablative Treatment Modalities and the Use of Post-Treatment Topical Protocols

Dr. Geronemus: “Getting patients through the process. Many of them are a bit traumatized by how their skin looks and they want to heal as quickly as possible and as safely as possible. Historically, what I have found is that you have to be particularly cautious about what people apply to wounded skin to avoid the acneiform eruptions, and to avoid a prolonged healing process, as some products can actually delay the process. I think it's a very important topic, where Alastin fits in quite well. I like the healing impact of the Regenerating Skin Nectar. If I finish one side of the cheek, I'll have the nurse apply the Nectar immediately, just to help bring down some of the inflammation. I found that very valuable. I do not use vinegar soaks anymore and don't see infections. I'm simply using some soaking with sterile water. That seems to work quite well with the Alastin Procedure Enhancement System, the pre-treatment or the post-treatment, as I mentioned before. In general, in my practice, we cover patients with oral antibiotics for about 5 days. I know some physicians don't use any antibiotics and the antiviral-approach, which I believe is more important, is really through the whole rehabilitation process.”

Dr. Saedi: “Afterwards, I place Alastin Regenerating Skin Nectar