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

on immediately. Then, I have the ice on top of the Alastin. One thing I used to do before that I don't do now, is I used to apply a steroid on immediately afterwards to calm down the inflammation. I've swapped out the steroid for the Regenerating Skin Nectar. I'm hospital-based, we have to use the McKesson ice bags. We just put sterile gauze around it.”

Dr. Karimi: “Right afterwards, we do very aggressive cooling measures with sterile water in ice and then use sterile gauze compresses for nearly an hour afterwards with a Zimmer® chiller. Then, we will apply refrigerated Alastin Regenerating Skin Nectar for them to use with the Soothe and Protect Recovery Balm.” “Initially we were presenting it as an upcharge to use the Alastin Procedure Enhancement Kit with some of the lasers, but some of the price-sensitive patients don't want it. I was a medical director for a very short period of time for a laser clinic that would literally give every patient Crisco® after an ablative laser resurfacing procedure to use for skin healing and recovery. Since then, we've basically just built Alastin Procedure Enhancement Kit into the cost of the laser and say that's an essential part of healing.”

Dr. Tanzi: “I use a lot of ice and forced chilled air to help make the patient comfortable and reduce the heat immediately after the procedure. At home, they can apply the Regenerating Skin Nectar and Aquaphor followed by a dilute white vinegar soak and ice packs.”

Dr. Kilmer: “I'm having patients pretreat with the Alastin Regenerating Skin Nectar 2 weeks ahead of the procedure. I do that for almost everything. I also suggest hydroquinone for at least 2 weeks, and up to a month beforehand, depending on skin type. I use retinoids all the way up to right before the procedure. There's definitely the patient that comes in to do something that day and you don't have enough time to pre-condition the skin, and of course I go ahead and do the procedure. For postprocedure, as Dr. Geronemus stated, as soon as one side of the face is done, we apply Regenerating Skin Nectar and then do the other side. I don't ice, but I'm probably going to change that listening to this group. With darker skin types and fractional ablative, I will put on hydroquinone right after just to get it to go down the channels. With fully ablative, I'm more worried about anything that causes irritation, itching, or infection, so I haven't done it as much with fully ablative.”

“After, we put on the Regenerating Skin Nectar, we let them cool down, and then I usually put another second dose of Regenerating Skin Nectar, which, from now on, will be refrigerated, because I really like that idea. Then, we put the Soothe and Protect Recovery Balm right on top. We've only had one person in all of our time react to the balm. We used to do Aquaphor® versus Vaseline®. If anybody's reacting to something, we immediately change to Crisco®, but Soothe and Protect Recovery Balm has been a lot better. We used to do dilute vinegar soaks every 2 hours for the first day with one teaspoon of vinegar to two cups of water and we made them get up and do that at night also. Then, about a year or two ago, we quit that when we started using Alastin Regenerating Skin Nectar. Now, we let them sleep through the night, but we do every 3-hour soaks during the day for the first day or so. We still do vinegar soaks just because of the whole potential for infection.”

“The other thing that we do, which I think a lot of you guys do, is Lasercyn®. Now that we're using Alastin Regenerating Skin Nectar and fewer soaks, we have patients do Lasercyn spray every 2 hours and just do two sprays, one to each side of their face. Also definitely use it for neck and chest. I don't think we've had one infection on the neck or chest, and the chest was really the issue. If you guys aren't doing that, really think about it.”

“I also recommend 5 to 7 days of oral antibiotics, and at least 10 to 14 days of antivirals, depending on their history. I've had people break out in herpes simplex virus on days 7, 8, 9, when we're taking them off and they still had enough injured skin. So now, routinely, it's 10–14 days, depending on how invasive and their history. At 1 month, they are gradually back to their normal regimen so we transition from the Regenerating Skin Nectar to the Restorative Skin Complex.”

Dr. Burns: “Afterwards, I give antibiotics, usually a cephalosporin, for about 3 days post-operatively. It might be overkill, but it's served me well for years without issue. I have found recently that Regenerating Skin Nectar and Stratamed® in combination is fantastic. I put on the Regenerating Skin Nectar twice a day, starting in the operating room immediately postprocedure. The Stratamed® is applied over the nectar twice a day and then as needed for comfort and to hold moisture in. That post-procedure approach has worked very well for me so far and has made life so much easier for both me and my patients. The other really important post-laser focus is to keep the crust off. Any crusting must be removed, and the wound kept moist as a priority. When I do my deep ablatives, the crust is the worst on day 5. So, it is important to stress that for deep resurfacing a physical and meticulous debridement is utilized as needed. The actual technique can be simple rolling off the crust with the Q-tip® or may require manual removal with forceps, but the wound must be kept clean and moist throughout the healing process. Any residual crust enhances the chance of infection, increases the time to healing, and inhibits penetration of the Regenerating Skin Nectar. After the wound is healed, I allow them to use the Regenerating Skin Nectar if they like it but once the Nectar is completed, I usually switch them over to Alastin Restorative Skin Complex. Most patients seem to love the Alastin Gentle Cleanser.”