INDIVIDUAL ARTICLE: Algorithm for Nonenergy and Injectable Treatment Pre-/Post-Procedure Measures

November 2021 | Volume 20 | Issue 11 | Supplement Individual Articles | ss3s | Copyright © November 2021

Published online November 1, 2021

Michael Gold MD FAADa, Anneke Andriessen PhDb, David J. Goldberg MD JD FAADc, Komel V. Grover MBAd, Shasa Hu MD FAADe, Z. Paul Lorenc MD FACSf, Stephen H. Mandy MD FAADg

aGold Skin Care Center, Nashville, TN; Vanderbilt University School of Medicine and Nursing, Nashville, TN
bRadboud UMC Nijmegen, Andriessen Consultants, Malden, NL
cSkin Laser & Surgery Specialists of NY and NJ, Hackensack, NJ; Icahn School of Medicine at Mt. Sinai, New York, NY
dSwiss American CDMO, Dallas, TX
eUniversity of Miami Miller School of Medicine, Miami, FL
fLorenc Aesthetic Plastic Surgery Center, New York, NY; Lenox Hill Hospital, New York, NY
gDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL

Background: Nonenergy and injectable treatments are frequently used for facial rejuvenation. Many publications have addressed methods to reduce adverse events related to the procedure; however, no algorithm exists on temporol before, during, and after measures for nonenergy and injectable treatments.
Methods: A panel of dermatologists and plastic surgeons convened a virtual meeting to develop an algorithm for measures before, during, and after nonenergy and injectable treatments based on the best available evidence and the panelists' experience and opinion. For the project, a Delphi method was applied, which was adapted from face-to-face meetings to a virtual meeting to discuss the outcome of literature searches to reach a consensus on the algorithm.
Results: The four sections of the algorithm address measures for optimizing outcome before, during, and after the procedure. Prevention includes avoiding excessive sun exposure and the use of a broad-spectrum sunscreen with an SPF 30 or higher. Before nonenergy-based and injectable treatments, the avoidance of alcohol, retinol peels, and agents such as acetylsalicylic acid and non-steroidal anti-inflammatory drugs, amongst other agents, is advised. Isopropyl alcohol, chlorhexidine, or hypochlorous acid (HOCl) prepare the skin before nonenergy and injectable treatments. The advisors recognize HOCL as particularly useful as it is active against bacterial, viral, fungal microorganisms and biofilm. The literature is inconsistent about the use of topical agents and skincare before and after the procedure.
Conclusions: The algorithm aims to support an optimal treatment outcome for their patients, providing physicians with guidance on measures before, during, and after nonenergy and injectable treatments.

J Drugs Dermatol. 2021;20:11(Suppl):s3-10.


Altered facial skin appearance due to photo- and chronological aging may be considered aesthetically displeasing to some patients and negatively impact the quality of life.1-3

Depending on individual patient characteristics, expectations, and physician expertise, various treatment modalities are used for the aesthetic improvement of the aging face.

Nonenergy devices for aesthetic and cosmetic treatments include microdermabrasion, microneedling, threads, and chemical peels.4-8 Patients frequently choose these treatments due to the minimally invasive nature, reduced risks, and associated shortened downtime compared to ablative laser treatments and surgical modalities.7,8

Nonenergy device-based treatments may improve skin condition inducing cutaneous changes that remodel the skin matrix.9 Potential adverse events (AEs) may occur, prolonging the duration and severity of the wound healing process also affected by the patient's existing systemic health condition, the type of treatment, and the settings of the device (eg, intensities, depth of passes).4-8 Signs and symptoms may resolve in a few days or up to several weeks.7

Nonsurgical procedures in the United States (US) were among the top five minimally invasive rejuvenation treatments and chemical peels performed in 2020, with a combined total of over 13.3 million yearly treatments.10 In addition, the American Society for Dermatologic Surgery reports that the number of