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

Summary: Post-treatment for ablative procedures include ice packs, more active post-procedure cooling, vinegar soaks, hydroquinone, oral antibiotics, and antivirals, Lasercyn, Stratamed, Restorative Skin Complex, and Alastin Gentle Cleanser. Specific treatments varied by practice, but Regenerating Skin Nectar and Soothe and Protect Recovery Balm received several mentions. Applying refrigerated Alastin Regenerating Skin Nectar immediately after the procedure is a novel use of the product.

What has Changed in Your Practice in the Last 5 Years?

Dr. Tanzi: “Preparing the skin beforehand. That was definitely not something that I was doing years ago, and I was very skeptical of these extended pre- and post-treatment regimens. But the researchers at Alastin have generated good science demonstrating the removal of collagen debris in preparation for a treatment that stimulates neocollagenesis. I find the patients are very interested to hear about the science and want to do everything they can to make the most out of their investment. Also, the Alastin products help reduce downtime, which is a big deal, because patients want to get back to their active lives as quickly as possible.”

Dr. Saedi: “One thing that I do differently now is using the term ‘pre-treating the skin’ before the procedure, especially with the Regenerating Skin Nectar. In the past, I have always used retinoids, basically leading up to a non-ablative procedure to prep the skin and help with the efficacy of the laser treatment. But one thing that I do use now, that I didn't use before, is I do pre-treat with hydroquinone and I know especially for people who are prone to post-inflammatory hyperpigmentation, and I know that the data isn't that consistent for its efficacy, but I have found that when I pretreat with hydroquinone, patients do have less hyperpigmentation, and especially with the Regenerating Skin Nectar, I do find much less hyperpigmentation after laser procedures.”

Dr. Kilmer: “Completely agree with Naz Saedi.”

Dr. Geronemus: “Most definitely, I have found the pretreatment to be particularly helpful for all procedures, so that's a big departure for me. One of the issues I have is that we often treat the same day a patient comes in for a consultation, so we sometimes don't have the opportunity to pre-treat, but when we do, or patients are coming back for a second treatment, the fact that they are on, in particular, the Regenerating Skin Nectar, I think, is particularly helpful for them in the recovery process. The feedback from the patients has been extremely positive and the impact on the practice is as good as many patients appreciate the concern we have for them rather than just focusing on the procedure itself.”

Dr. Karimi: “I think the only thing new that's in my vocabulary, and I'm newer than all of my skincare colleagues on this call, in terms of skincare, but the new term that I've made household term for all my patients is ‘serum.’ So, serum, when they hear the word serum, they're thinking of some sort of active ingredient that's going to be helping boost and maintain their skin.”

Dr. Burns: “I'd say the biggest difference is that I've gotten away from all the heavy petroleum products. Utilizing something like CeraVe has been much preferred by my patients. Some patients have especially dry skin and Aquaphor is still utilized but this is an uncommon occurrence now. Also, I've switched everything over to the Alastin product line in the last year. I really wasn't pre-treating until Regenerating Skin Nectar came along, which makes sense scientifically. Honestly, I had to make the switch as my previous dressing, Flexan, was discontinued. I tried many other occlusive barriers and products, but nothing was really satisfactory. I discovered the science behind Alastin and was intrigued but really didn’t think it would work on deep resurfacing patients. I thought it wouldn’t work with the oozing and sensitivity of these wounds, but I was wrong. I switched all over to the Regenerating Skin Nectar by default, and it's the best thing that I've done in a long time. It's so much easier for the patients to use and it is very well tolerated. For ablative procedures, the thing I do differently is have patients pre-treat now for 2 weeks with the Regenerating Skin Nectar. I don't use an occlusive dressing anymore. I believe patients now have less redness and inflammation, but still enough inflammation to impact an effective outcome. I now have patients that I did 15 years ago coming back for repeat treatments. They all prefer the non-occlusive Alastin regimen. The Flexan served my patients well for years, but the topical regimen is just easier on the patient and produces an easier recovery.

Summary: Most participants agree that the concept of pre- and post-treatment skincare is a recent advance in their practice. Pre-treatments included hydroquinone for patients prone to post-inflammatory hyperpigmentation, abandoning petrolatum- containing products, and universal use of Regenerating Skin Nectar.

Drug-Assisted Delivery

Dr. Geronemus:
“I have a general question for the entire group. One of the more interesting aspects of this field of energy-based devices, in combination with topicals, has been this issue or this concept of laser-assisted drug delivery. How does your skin care mix with that? Let's say, for example, you want to put on a topical poly-L-lactic acid after an ablative resurfacing procedure. How do you time the application of that product with the post-treatment skin care? Or does that not matter?”